A renowned prostate cancer surgeon is working to make Central Florida the global epicenter of the battle against the disease — the No. 2 cancer killer of men — by launching a charitable foundation to promote education and research on genetic testing and more sophisticated treatment options.
Dr. Vipul Patel, the 42-year-old medical director of the Florida Hospital Global Robotics Institute in Celebration, has operated on more than 5,000 men from around the world, including NBA Hall of Fame basketball player Oscar Robertson — who is now on Patel's board of directors and joining his public-awareness campaign
"There's still a stigma about prostate cancer," Patel said. "Until five or 10 years ago, when someone got diagnosed with prostate cancer, it was a life-altering thing. Many died, and others had treatment that either left them impotent or incontinent."
Through his International Prostate Cancer Foundation, Patel hopes to raise an initial $5 million to start early-screening programs and online education. He also has recruited board members from the University of Central Florida College of Medicine, the Sanford-Burnham Medical Research Institute and an A-list of Central Florida business leaders, including defense attorney Mark NeJame.
The legwork on the foundation already was underway last October when a government task force advised against routine prostate screening, saying the current tests do not save men's lives and often lead to unnecessary and potentially harmful treatment. The position outraged many urologists, including Patel.
"Screening saves lives - that's the message we want out," said Patel, who wrote a position paper against the task force's advisory.
In 2012, nearly 250,000 American men will be diagnosed with prostate cancer, said Ranjan Perera, scientific director of genomics and bioinformatics at Sanford-Burnham, and a founding member of Patel's charity. And more than 28,000 will die from the disease.
"Prostate cancer is a major problem," said Perera. "So what is extremely important at this moment is prostate-cancer awareness."
Patel, Perera and Dr. Kristiina Vuori, president of Sanford-Burnham, already are writing grant proposals for prostate-cancer research. Their hope is to use such advanced technologies as next-generation DNA sequencing to pinpoint which tumors are likely to be aggressive and to decide the best and most targeted way to treat them.
"Ever since PSA screening was implemented a decade ago, the death rate from prostate cancer has gone down. Every year it has gone down," Patel said. "But even with that, prostate cancer is the No. 1 [non-skin] cancer diagnosed in men, and it's the second-leading cause of death. So if we get rid of screening, it will become the No. 1 cause of death - by far."
PSA, or prostate-specific antigen, is a protein often found in elevated amounts in the blood of patients with prostate cancer. In 1994, U.S. health officials approved the PSA as a screening method; since then, there has been both a dramatic increase in the diagnosis of prostate cancer and a significant drop in the death rate. Typically, doctors use both the PSA blood test and a digital exam of the rectum to screen for the disease.
The problem is that neither elevated PSA levels nor an enlarged prostate detected during the digital exam definitively indicate cancer. And even if there is cancer, the task force said, many times it grows so slowly that men will die of other causes long before their prostate disease becomes a problem.
Still, Patel, his foundation and many fellow urologists say the tests can provide essential information, at least as a point of comparison for monitoring men over time. And they insist that advances in surgery, radiation and chemotherapy have both improved chances for survival and lowered the risk for devastating side effects.
"Men should have this checked out so they can find out what's in their body," said Robertson, who is convinced that routine screening - and the subsequent surgery by Patel - saved his life. "If they don't, I think they're being foolish."
Robertson, 73, knows many men are reluctant, both because of the invasive nature of the digital exam and because of what may happen if cancer is detected. But he hopes to be a catalyst to change that mentality.
For one thing, African-American men are more than twice as likely to die of prostate cancer than white man. Partly, Patel said, that's because they're less likely to be screened, but also because they're genetically predisposed to more aggressive tumors.
NeJame applauds Robertson's decision to discuss his experience publicly.
"This is the male equivalent of breast cancer," NeJame said. "You know, it took countless brave women to come out and talk about breast cancer, and now men need to come out and talk about and help educate the public about prostate cancer."
The American Urology Association, which "strongly opposes" the task-force opinion, continues to recommend that men over 40 have the option of PSA screening but that they be informed of both the benefits and the potential risk of "over-detection and overtreatment." Patel agrees.
"Our perspective is: The decision to treat or not to treat should be made after diagnosis. And it should be made by the patient in consultation with his physician." Patel said. "But just denying men screening and denying them the right to know doesn't really make sense."