Monthly Meeting

Where: Our meeting will be in the Bennett & Suzy Katz Cancer Resource Center on the 1st Floor of the two-story redwood Education Building behind Santa Cruz Dominican Hospital.

When: Tuesday, February 23rd, 2010 7:00 PM. For more information: Please call-The Bennett and Suzy Katz Cancer Resource Center at Dominican Hospital (831) 462-7770

March 23rd Meeting – Special Featured Speaker Daniel Lewis, Ph.D., was diagnosed with prostate cancer in November 2007. In January 2008, he and his prostate were separated due to irreconcilable differences. Janice, the prostate, wanted to metastasize. Daniel wanted to live. Daniel, a Research Scientist and resident of Monterey will present parts of his as yet unpublished manuscript “The Gland at the Center of the Universe,” a humorous and melodrama-free account of his encounter with prostate cancer from symptom to diagnosis to treatment and recovery. Daniel’s motto: If you don’t laugh, you’ll cry……. More details in next month’s newsletter!

Prostate Cancer in the News

Boost For Prostate Cancer Screening

Report Shows Mortality Reduction As High As 31% Dec 9, 2009

The effectiveness of PSA (prostate-specific antigen) screening on reducing prostate cancer mortality has been given a boost with new data from the European Randomized Study of Screening for Prostate Cancer (ERSPC). This shows the true impact to be far higher than previously reported up to 31%.

Preliminary ERSPC findings showed that screening reduced prostate cancer deaths by 20%. This latest ERSPC analysis corrects for non-attendance and contamination to assess the effectiveness of PSA testing in those men actually screened From 1992, the ERSPC study randomized 162,000 men, aged 55 to 69, in seven European countries to either a screening arm or a control group. Those screened were given a blood test to detect PSA levels: if it was 3.0ng/ml or more, they were offered a biopsy. Screening took place on average every four years. Mean follow-up was nine years.

In any randomized trial, some in the screening arm do not attend and some in the control group inadvertently receive a PSA test (contamination). Contamination makes it difficult to detect differences. This is believed to be one reason why the Prostate Lung, Colon and Ovarian (PLCO) study failed to detect any significant reduction in mortality.

Using retrospective data from the Dutch arm, the ERSPC has shown that using a screening algorithm - an individual risk assessment - alongside PSA testing can reduce the number of unnecessary biopsies. PSA testing is sensitive but not specific, so elevated levels do not necessarily imply cancer. Approximately 30% of detected cancers are non-aggressive - 'indolent' or slow growing.

Their findings, published in January 2010's European Urology suggest that a PSA cut off level of 3ng/ml combined with an individual risk assessment would reduce biopsies by 33%. The majority of cancers potentially missed would be indolent, so there would be no benefit from active treatment. Increasing the PSA cut-off level from 3 to 4 ng/ml may save a similar number of biopsies, but will miss more clinically significant cancers. Source: European Randomized Study of Screening for Prostate Cancer http://www.medicalnewstoday.com/articles/173341.php

 

The Monoclonal Antibody F77 and Media “Over-hype”

December 28, 2009 - “Found, the super molecule to kill prostate cancer cells,” trumpeted the MailOnline. And worse still, “A miracle molecule has been discovered that offers the hope of saving men with currently incurable prostate cancer,” screamed the Press Association. Of course the truth is vastly less dramatic, and so far we haven’t been able to identify the media release that stimulated these reactions.

These eye-catching headlines were created on the basis of a report by Zhang et al., available on line in the Proceedings of the National Academy of Science since earlier this month. What Dr. Zhang and his colleagues have actually shown is that in mice a monoclonal antibody or MAb called F77 binds selectively to cell surface antigens specifically associated with androgen-dependent and androgen-independent prostate cancer cells.

Is this scientifically interesting? Absolutely, it certainly is. Additional data provided by Zhang et al. suggest the possibility that F77 may be able to identify, bind to, and define a unique prostate cancer marker and that F77 may therefore have significant potential in the diagnosis and treatment of prostate cancer, especially for androgen-independent metastatic prostate cancer.

However, this is a long way from saying that F77 is “A miracle molecule” that can save men with “incurable prostate cancer.” There’s probably another 5 years of research needed before we could even think about the possibility of a clinical trial of F77 to see if it might work in men with prostate cancer.

Media hype based on early science of this type is near to criminally negligent. It’s not as though there is even a tiny, Phase I clinical trial of F77 that anyone with late stage prostate cancer could go and enroll in. In fact, we have no idea whether it is possible to administer F77 to a human at all! On the other hand, the media didn’t all stumble over this paper by accident. Someone, somewhere “set up” this story, and the media “bit,” without doing anything like enough homework.

One of the few things that the media did get right in the coverage of this story is that, to date, we have been monumentally unsuccessful in the development of “targeted” drugs to treat prostate cancer based on MAb technology. However, that isn’t for lack of trying! It seems to be particularly hard to identify MAbs that really are appropriately selective for cell surface or other antigens specifically associated with certain types of cancer. Why is that? We don’t know (yet).

Lots of people (at drug companies and in universities around the world) have been working on this, so maybe F77 is the beginning of a breakthrough. However, readers need to understand that for every 5,000 candidate drugs that make it into animal studies, about 1 will make it all the way through the clinical trials system and get approved to treat a specific disorder in humans.

There is no doubt in my mind that, in time, we will develop MAb-based technologies that can be used to treat men with progressive forms of prostate cancer — and other serious forms of cancer. However, as we struggle toward this difficult goal, it would be helpful if the media could (at least sometimes) resist their desire to “sell newspapers” and tell something approaching the truth — especially when it comes to the impact on people with life-threatening diseases!

If this is “all the news that’s fit to print,” I’ll stick to reading the prostate cancer literature directly! Source: http://prostatecancerinfolink.net/2009/12/28/the-monoclonal-antibody-f77-and-media-over-hype/

Exercise may prevent incontinence from prostate surgery

January 08, 2010 - A healthy weight and regular exercise may help protect men from one of the most common side effects of prostate cancer surgery, a new study suggests.

Researchers found that among 165 men who had their prostate glands removed due to cancer, those who were not obese and were getting regular exercise before surgery had the lowest prevalence of long-term urinary incontinence. What's more, even among obese men, those who had been physically active before surgery were less likely to be incontinent one year after surgery.

All of the men in the study had undergone radical prostatectomy, where a surgeon removes the prostate gland and some of the surrounding tissue. Urinary incontinence and sexual dysfunction are common side effects, though both often improve over time.

So far, most efforts to prevent lasting side effects have focused on improving surgical techniques -- limiting damage to the nerves, muscles and blood vessels around the prostate gland. But these latest findings suggest that there are also lifestyle measures men can take to cut their risk of lingering urinary incontinence, said lead researcher Dr. Kathleen Y. Wolin, an assistant professor of surgery at Washington University School of Medicine in St. Louis. "This is another reason for men to get up and get active," she told Reuters Health in an interview.

In general, men with prostate cancer, like all other men, are encouraged to follow a healthy lifestyle, which includes regular exercise. A study published last month found that among men with prostate cancer, those who got as little as 15 minutes of exercise per day had lower death rates than inactive men during the two-decade study period. "We strongly recommend that men with prostate cancer talk with their physicians about how to fit physical activity into their lives if they are currently sedentary," Wolin said.

For their study, published in the Journal of Urology, Wolin and her colleagues looked at urinary incontinence rates among 165 men roughly one year after radical prostatectomy. Before surgery, all of the men had reported on their exercise habits; those who said they exercised for at least one hour per week were considered active.

Overall, the researchers found that obese, sedentary men had the highest rate of long-term incontinence, at 41 percent. Active, non-obese men had the lowest rate, at 16 percent. Among obese men who were physically active, one-quarter were incontinent, which was identical to the rate among non-obese, inactive men -- suggesting, the researchers say, that exercise can offset the negative effects of obesity.

Exactly why exercise might prevent incontinence is unclear. One possibility, Wolin said, is that exercisers have better overall muscle tone, which may help with bladder control.

Another potential reason is that long-time exercisers are more likely to follow their doctors' advice on performing post-surgery Kegel exercises, which strengthen the pelvic-floor muscles and may improve incontinence and sexual function. According to Wolin, more studies are needed to see whether certain types and intensities of exercise are more effective than others -- and how exercise habits after prostate surgery may affect long-term incontinence risk. Exercise may prevent incontinence from prostate surgery Source:: Journal of Urology, February 2010. http://www.reuters.com/article/idUSTRE6063FX20100107?feedType=RSS&feedName=healthNews

Intermittent Hormone Therapy At Least as Effective As Continuous Therapy

'Potential Benefits of Intermittent Androgen Suppression Therapy in the Treatment of Prostate Cancer: A Systematic Review of the Literature' is the title of an article by P-A. Abrahamsson in the January 2010 issue of European Urology, the official journal of the European Association of Urology. The author evaluates available evidence regarding the efficacy and tolerability of intermittent androgen deprivation (IAD) and assess its value in the treatment of prostate cancer.

Prostate cancer (PCa) is the second most common male cancer worldwide and the most frequently occurring in Europe (20.3% of the total in 2006). Androgen-deprivation therapy (ADT) has progressed since 1941 when surgical castration was shown to improve PCa outcomes. The well-known side effect profile of ADT has significant quality-of-life implications such as sexual dysfunction , hot flushes, fatigue etc. Furthermore, it appears that androgen suppression causes a change in stem cells from an androgen-dependent to an androgen-independent phenotype. Because this progression to androgen independence is thought to begin early after treatment initiation, stopping androgen deprivation prior to this change occurring should restore apoptotic potential and help tumour cells remain sensitive to re-initiating treatment.

The strategy behind IAD, therefore, is to alternate androgen blockade with treatment cessation, allowing hormonal recovery between treatment periods, thus potentially improving tolerability and quality of life.

The author wishes to evaluate available evidence regarding the efficacy and tolerability of IAD and assess its value in the treatment of PCa. Key phase 2/3 clinical trials of IAD in PCa published within the last 10 years were identified on Medline using different search terms.

The conclusions were that IAD seems to be as effective as continuous androgen deprivation while showing tolerability and quality of life advantages, especially recovery of sexual potency. IAD has been a treatment option for >20 years and the EAU considers that its status should no longer be regarded as investigational.

However, QoL data are surprisingly limited given that this, rather than survival, is the key driver for IAD and considering the length of time this approach has been under evaluation.

Based on available evidence and general clinical opinion, IAD is a valid treatment option in nonmetastatic PCa cases, i.e. patients with locally advanced disease with or without lymph node involvement and those experiencing relapse following curative treatment. These patients have a higher chance of survival than those with more advanced disease, making QoL a key consideration. Full results from phase 3 trials, which include both locally advanced and metastatic patients, will further clarify target populations.

IAD has come of age, and many clinicians believe it has earned its place in the management of PCa; however, there are still insufficient data to determine whether IAD has the potential to prevent or reverse the long-term complications associated with ADT.

More information: European Urology 57 (2010) 49-59 Provided by European Association of Urology http://www.physorg.com/news181910829.html

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The Santa Cruz County Prostate Cancer Support Group does not endorse any provider, organization, product or individual.  All medical decisions should be made with the advice and consultation of medical professionals.

Many THANKS to the American Cancer Society for assisting with the printing and mailing of this newsletter and the Katz Cancer Resource Center for allowing us to use their facility.