The incidence and mortality statistics for prostate cancer - 179,300 new cases this year and 37,000 deaths - does little to convey the very real pain, fear, and uncertainty experienced by every man who is diagnosed with prostate cancer. Despite advances over the past decade, our treatments for prostate cancer are inadequate, the side effects of treatment are unacceptable, and troubling questions remain about the relative benefit of early detection for the disease. Every day, too many men in the United States hear the life-changing words "You have prostate cancer." Every day, too many men are faced with the agonizing decision of how to treat their prostate cancer. And every day, too many men are dying too young of this disease.
In this report, the focus is on the prostate cancer research activities of the National Cancer Institute (NCI), and also highlights the research programs of other Institutes and Centers. This plan describes a number of initiatives, projects, and mechanisms with the potential to directly improve the quality of life of prostate cancer patients and survivors, as well as those at risk for the disease. Fully 70 percent of the cost of potential research opportunities presented here is targeted at clinical or translational research - research that will have a direct impact on patients, survivors, and at-risk men.
An important goal is to ensure that every man with prostate cancer has access to participation in a clinical trial. The Multicenter Clinical Trials Program and the new QuickTrials initiative would enable us to make progress toward achieving this. Our goal is to use our new understanding of prostate cancer at the molecular level to develop "intelligent" drugs that will kill the tumor but spare surrounding tissue. The Molecular Target-Based Drug Discovery Initiatives would give us the tools we need. Our goal is to move new drugs as speedily and efficiently as possible from the laboratory to the men who desperately need them. The new Rapid Access to Intervention Development (RAID) program would be designed for this purpose. These initiatives would be certain to move us closer to the day when prostate cancer is no longer a burden.
Each of these initiatives is described in further detail in this report. The plan describes our intention in clinical trials to find agents that would allow us to prevent prostate cancer altogether, and our efforts to understand prostate cancer at its most basic levels, as it is only by understanding the disease that we will ultimately defeat it. Following this plan would ensure the development of new treatments, new preventives, and new interventions with the potential to improve, extend, or even save the lives of all men touched by prostate cancer. If our efforts are successful, as we believe they must be, our sons and grandsons will grow old in a world in which they no longer fear prostate cancer.
Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. Despite significant advances in diagnosis and treatment, many patients still suffer from the sequelae of unresectable disease, including debilitation, pain, and premature death. The continuing challenge to the scientific and medical communities and to the NCI, in particular, is to develop successful preventive strategies to reduce the overall incidence of prostate cancer. We need to develop effective early detection strategies for all men and appropriate treatment strategies for men with prostate cancer, especially those with advanced lesions.
Recent trends in prostate cancer incidence and mortality are encouraging. Prostate cancer incidence began to accelerate dramatically in the mid-1980s to a peak of 190.9 per 100,000 in 1992, and then began decreasing; the corresponding rate in 1994 was 147.8 and was down to 137.2 in 1995. Mortality from prostate cancer had also been increasing for some time, reaching its peak in 1991 of 26.7 per 100,000 and subsequently decreasing to 25.9 in 1994 and to 24.9 in 1995. Additional information regarding trends in prostate cancer incidence and mortality including comparisons of racial and ethnic patterns can be found in the NCI monograph SEER Prostate Cancer Trends, 1973-1995. The document offers one of the most comprehensive population-based evaluations ever published on demographic and clinical features of prostate cancer cases. It provides insights into the likely directions for prostate cancer research over the next decade related to etiology, prevention, early detection and therapy. The monograph is web-accessible at http://www-seer.ims.nci.nih.gov/Publications/ProstMono/.
Prostate Cancer Funding and Professional Judgment
This professional judgment plan builds from our investment in 1998, increases significantly in 1999, and extends to 2003. The NIH Plan is currently in its first year of operation. A major acceleration in prostate cancer research funding has already begun in 1999 and is integrated and balanced with the opportunities and needs of the entire research effort. In fact, the original 1999 estimates of $170 million for prostate cancer research have been increased by $10 million as additional funding opportunities have been identified primarily by the NCI, and also in the National Institute of Mental Health and the National Institute of Deafness and Other Communication Disorders. With this research program we see the potential to establish a vibrant, geographically dispersed but well coordinated national program for research, education, training, and treatment of prostate cancer.
The first year, 1999, sets a target for NIH investment of $180 million, almost a 60 percent increase over 1998 funding of $114 million. This spending is generally guided by the report of the Prostate Review Group completed in August 1998. The full plan identifies $420 million worth of potential research opportunities that could be supported in 2003. It should be noted that this estimate is based on our assessment of scientific opportunities over the next five years without regard to economic constraints or other competing priorities of the Federal government.
The NCI budget for prostate cancer has risen considerably in recent years. In the 1980s the funding level increased gradually from a 1981estimate of $6.4 million (the first year in which this data was gathered) to about $13 million at the end of the decade. Recently this area has increased with even greater speed reaching $87 million in 1998 and projected to be $141 million in 1999.
Over the past three years NIH has implemented a number of initiatives that capitalize on certain extraordinary opportunities presented by contemporary science and technology. We are also moving to strengthen crucial elements of the nation's cancer research infrastructure - its cancer centers, clinical trials groups, training programs, and resources for research reagents and information. The NIH intends to increase its support for studies relating to prostate cancer. We wish to speed the generation of new insights into the biology and behavior of this common tumor and increase the rate at which new insights are translated into more effective interventions for prevention, detection, diagnosis, and treatment.
While research activities related to prostate cancer are centered at the NCI and the National Institute of Diabetes and Digestive and Kidney Diseases, other institutes also have research activities aimed at reducing the burden of prostate cancer for all Americans. These institutes are committed to this goal. Staff of the involved institutes are in frequent contact with one another. Related programs exist in the National Human Genome Research Institute, the National Center for Research Resources, the National Institute of Environmental Health Sciences, the National Institute on Aging, the National Institute of Nursing Research, the National Institute of Mental Health, and the National Institute of Deafness and Other Communication Disorders. These collaborations maximize the return on NIH's efforts in prostate cancer. Each of the institutes with prostate cancer research programs, and the NIH as a whole, recognize that our ultimate success will be measured by tangible progress against cancer.