Putting prostate cancer out of business

Professor Jim Denham freely admits that he is trying to put himself out of business.

A leader in the field of radiation oncology, Denham is coordinating two of the world’s largest trials involving innovative ways to treat one of the biggest killers of Australian men – prostate cancer.

Denham is a researcher at the University of Newcastle and Calvary Mater Newcastle, and recipient of the 2006 Hunter Medical Research Institute Research Excellence Award.

It is quite clear that a significant number of men developing prostate cancer across Australia and New Zealand are getting diagnosed at a late stage, when they are really threatened by inoperable cancer," Denham says.

"What I would really like to do is put these trials out of business. We would save many more men by catching these cancers early."

Denham's clinical trials are investigating the use of hormone therapy in addition to radiotherapy in the treatment of localised but inoperable prostate cancer.

"In the early 90s, the treatment of choice for men with inoperable cancers was radiotherapy only. During the five years following this treatment, 30 to 40 per cent of them developed some form of relapse, and 10 per cent of these died from their cancer.

"Our trials group – the Trans-Tasman Radiation Oncology Group – agreed that this was a horrendous situation. So we started to research the role of hormone treatment in shrinking the cancer, making the job of radiotherapy easier."

Coordinated by Denham, a trial was launched in 1996 involving over 800 men at 19 cancer treatment centres across Australia and New Zealand. The trial has shown that hormone therapy given to men with localised but inoperable prostate cancer a few months before radiotherapy can help stop the cancer returning after treatment and reduce cancer deaths.

"The use of hormone therapy and radiotherapy has now become the standard of care not only in Australia and New Zealand, but in treatment centres in America and Europe."

Building on this breakthrough, Denham is coordinating a second trial to examine the benefits of using hormone therapy both before and after radiotherapy. The second trial is also investigating whether a new drug that strengthens bones can reduce the chances of cancer returning to the bones.

Regrettably Denham has more than enough men to participate in his trials.

"In the Hunter, men are being diagnosed at a much later stage than they are in Sydney. The death rate due to prostate cancer is actually 40 per cent higher here than in metropolitan Sydney."

For this reason, Denham has thrown his support behind calls for testing for the early detection of prostate cancer. An advocate for prostate-specific antigen (PSA) testing, Denham hopes the use of the test will become as common and as accepted as mammography is for detecting breast cancer.

"PSA tests for any abnormal condition of the prostate. This includes not only prostate cancer, but benign conditions like prostate enlargement, which is very common in men. Unfortunately PSA shows up a lot of false positives – it suggests cancer is present, when in fact, it is not.

"What is being ignored is that the 'false positive' rate in mammography is exactly the same as the 'false positive' rate for PSA."

Denham acknowledges that until research shows PSA testing can actually save lives, there will be doubts about its usefulness. He says in the meantime, he will continue his campaign to raise awareness of the deadly disease, and ultimately reduce the demand for his trials.