News Story in the Rancho Santa Fe Review, February 12, 2004
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Profile: Dan Mercola, M.D., Ph.D.
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RSF resident spearheads published research study that may spare prostate
cancer patients from unnecessary surgery
By Arthur Lightbourn
If you run into Dr. Dan Mercola in the village, you may want
to shake his hand.
The soft-spoken, 63-year-old pathologist and 17-year resident of theRanch
has spent the past four years quietly leading a group of researchers
in La Jolla to a discovery that may eventually save many men diagnosed
with prostate cancer from unnecessary and risky surgery.
Current procedures for diagnosing prostate cancer are not as precise
as scientists would like, sometimes resulting in surgeries conducted
just to be on the safe side. But surgery, although often curative,
carries the risk of impotence, incontinence, infection and other side
effects. Mercola's research group has identified critical biomarkers
that distinguish between aggressive tumor cell genes and benign cell
genes in prostate tumors.
The ground-breaking discovery means that scientists may soon be able
to formulate a reliable test that will distinguish the more aggressive
forms of the disease requiring immediate surgery from themore common,
benign forms tht can be managed by "watchful waiting."
All of which is encouraging news for more than a million older men in
the U.S. who, during the next six years, will be told by their doctors
that they have prostate cancer.
Mercola was the principal investigator on the $4.7 million research project
funded with a grant from the National Institutes of Health (NIH) and
conducted in collaboration with UCSD, the Veterans Affairs San Diego
Healthcare System and the Ludwig Institute for Cancer Research.
The project's findings were published last month by the prestigious Proceedings
of the National Academy of Sciences in a paper titled "In Silico Dissection
of Cell-Type Associated Patterns of Gene Expression in Prostate Cancer."
The paper describes how the genes thatare active in three amjor cell
types of the prostate gland, including the tumor cells, can now be
identified by combining a determination of the messenger RNA (ribonucleic
acid) molecules present in the prostate with a determination of percent
cell composition of the gland.
The method provides a "gene expression profile" that may be used to more
accurately advist patients on their treatment options.
We interviewed Mercola in his laboratory office at the Sidney Kimmel
Cancer Center (SKCC) in La Jolla.
The mustached, 140-pound pathologist, who initially trained as a researcher
and at 40 became a physician, is a man who loves to talk about his
work.
Emphasizing the necessity of collaboration in combating disease today,
Mercola said, "It's not one guy working with one microscope that can
make headway with these very intricate modern problems... cooperative
teams are very important."
In all, Mercola explained, some 15 researchers from various disciplines
worked on the study, using the latest in sophisticated genetic analyses
to examine the biopsy specimens of 500 prostate cancer patients and
with the consent of the patients, to access their medical histories.
The prostate is a small gland, located just beneath the bladder, that
secretes much of the liquid portion of semen that transports sperm
through the penis during ejaculation. Prostate cancer affects one in
five older males and can be life threatening.
"At the time of discovery [of prostate cancer in a patient], a crucial
question becomes...is that cancer agressive and in need of immediate
treatment, like surgery, which for many cases is curative, or is the
disease indolent, slow growing, minor, that will never bother the patient
and...that we can somehow watch by annual measurements.
"That's not a trivial question because the bulk of prostate sees is,
we think, the indolent sort that does not need these radical surgeries.
So a research question becomes, 'Can you tell them apart?'"
The NIH funded the project in the belief that the recent explosion in
human gene sequence information could be directed toward coming up
with an answer to that simple but complex question.
And the answer, Mercola and his team believe, is: Yes, it appears we
can tell them apart, the aggressive versus the indolent. Now the challenge
is to develop a reliable test that will answer that question on a patient-by-patient
basis.
Today when prostate cancers are detected, they are graded as to severity
by a system known as the Gleason Scores, Mercola said. Pathologists
examine tissue samples and grade the samples from 1 to 10, with 1 being
the least aggressive and 10 being the most.
Tumors graded between 8 and 10 are considered most dangerous requiring
immediate attention, surgery often and/or radiation. Tumors between2
and 4 are considered low grade and "watchable." But, Mercola pointed
out, most tumors are in the middle range, making it difficult for doctors
to determine whather the disease is aggressive or indolent.
"So urologists live with this problem, but on a massive sacle, because
the disease is so common."
For Mercola, making a contribution in the fight against disease, is what
being a researcher ad physician is all about.
