If prostate cancer treatment still remains a contested area, it could be because not enough men come forward to participate in clinical trials on new drugs.
One major clinical trial in the US, called Spirit, for Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial, would have compared surgical removal with brachytherapy, which involves implanting radioactive seeds. Just 56 of the 1,980 needed patients enrolled, and the trial was called off in 2004.
"Men don't go into the clinical trials," said Dr. Daniel P. Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center. "That's the whole problem. Patients ask me all the time, 'What is the best treatment?' And I can't give them an evidence-based approach for that, because we don't have the data."
Prostate doctors and patient advocates often compare their cause with that of the other leading sex-specific cancer: one of the largest prostate cancer support groups is called Us Too, a play on the Y-ME National Breast Cancer Organization. The dismal state of prostate cancer research and advocacy pales in comparison to the campaign against breast cancer.
"We're at least a decade behind where breast cancer awareness is," Thomas Kirk, president of Us Too, said. "We need to catch up. The lessons learned by breast cancer are the ones we're trying to apply to prostate cancer."
Prostate cancer groups have tried to replicate the success of the pink ribbon campaign with their own blue ribbon, but it has yet to gain widespread acceptance. A group advocating the development of imaging technology for prostate screening created a mascot, Prosty the Spokesgland, complete with a theme song, to the tune of "Frosty the Snowman." Not surprisingly, it has not caught on, either.
Government spending for prostate cancer lags, too. In 2007, the National Cancer Institute spent an estimated $551.1 million on breast cancer research and $305.6 million on prostate cancer. For 2008, the Defense Department, which has a history of supporting health research, has allocated $138 million for breast cancer and $80 million for prostate cancer, notes Tara Parker-Pope, writing in the New York Times.
Prostate cancer researchers say the real problem is not so much financing as enlisting doctors and patients on board for clinical trials.
But by 2010, men should have some answers from Pivot, the Prostate Cancer Intervention Versus Observation Trial, which is comparing surgical removal with watchful waiting. Results of studies looking at P.S.A. screening as well as the preventive benefits of the supplements vitamin E and selenium are also expected in a few years.
"This is the state of prostate cancer," Mr. Kirk of Us Too said. "There aren't any clear answers."