Community Involvement

Past Newsletters

July 2009

Howard Waage  ---- Editor

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, July 28th, 2009 7:00 PM.  For more information: Please call-The Bennett
and Suzy Katz Cancer Resource Center at Dominican Hospital (831) 462-7770

Please feel free to contact any of the following steering committee members if you would like to volunteer or if you have any suggestions or questions. 

*Joe Ferrara, 426-7724 *Frank and Janet Schmetz, 438 4781 *Bill McDermott, 423-8350 *Howard Waage, 688-0423 *Michael & Julie Batz, 724-2701 *Tim Ryan, 476-6550  *Ron Locey, 214-4338 
                         Our website: http://www.scprostate.org          Webmaster: Paul Johnson

….PROSTATE CANCER IN THE NEWS..…

Study Details Quality of Life for Prostate Cancer Patients 4 Years Out From Treatment

Newswise — A long-term study by researchers at UCLA’s Jonsson Comprehensive Cancer Center found that the three most common treatments for localized prostate cancer had significant impacts on patients’ quality of life, a finding that could help guide doctors and patients in making treatment decisions.

The four-year study, which followed 475 men treated for early stage prostate cancer, also resulted in the development of “probability plots,” gauges which can be used to predict when treatment side effects such as urinary incontinence, sexual dysfunction or bowel problems might return to normal, or whether the patient will ever fully recover. Such predictions could be used to determine whether further treatments or surgeries are needed to deal with adverse side effects, said Dr. John Gore, an urologist and the study’s first author. The study appears June 9 in the early online edition of the Journal of the National Cancer Institute.

“These probability plots are more helpful than the normal functional trajectory curves that are used,” Gore said. “They allow people to point toward where the function level is currently and predict what it might be in the future. Is a patient’s incontinence, for example, likely to get better? If not, the doctor and patients may agree to proceed with treatment options such as drugs or surgery.”

The study is unique because it is not a cross-sectional review. Rather, researchers knew what a patient’s baseline function was prior to treatment. That way, Gore said, they had a target to shoot for in judging recovery from side effects. The goal was to get the patient back to the function level experienced before treatment, if possible.

The researchers studied the quality of life in men who either underwent radical prostatectomy, implantation of radioactive seeds in their prostate gland or had external beam radiation therapy. The three treatment options rank about equally in survival outcomes for most men, so specific impacts on quality of life become paramount in making treatment decisions, said Dr. Mark Litwin, the study’s senior author, a professor or urology and a researcher at UCLA’s Jonsson Cancer Center. “The good news is that the patients’ overall mental and physical well-being were not profoundly affected by any of the three treatment choices,” Litwin said. “That’s good news for men with a diagnosis of prostate cancer hanging over their heads. In general, they’ll be OK, no matter which of the three options they choose.”

The study found that urinary incontinence was more common among patients who underwent prostatectomy than those who had seed implants, called brachytherapy, or external beam radiation. Sexual dysfunction was found in patients in all three treatment groups. Surgery patients were less likely to regain baseline sexual function than were patients who underwent external beam radiation. Bowel dysfunction and irritable bladder were more common after either form of radiation therapy than after prostatectomy.

Study patients were given comprehensive questionnaires to fill out before treatment to assess generic and prostate cancer-specific, health-related quality of life. Questionnaires were filled out again at one, two, four, eight, 12, 18, 24, 30, 36, 42 and 48 months after treatment to “capture maximal fluctuations in functional convalescence,” the study states. The most rapid change in the slope of patient recovery came very early after treatment, Gore said, either for better or worse. However, once more than two years had passed, the patient’s recovery or decline had stabilized. The study patients were diagnosed with the most common type of prostate cancer, low-risk, clinically localized disease. Many of the patients were older men and already were experiencing age-related functional issues such as erectile dysfunction, so each had individual baseline goals to achieve.

The study will allow oncologists to look at the patient, look at the characteristics of their cancer and determine what treatment will mostly likely help them to achieve their baseline health-related quality of life. For example, a patient with an existing irritable bladder condition should probably not receive external beam radiation because the treatment could exacerbate the underlying condition. A patient’s acceptance of potential side effects also should be considered. “Different men are bothered by different things, so it depends on what their baseline function is,” Litwin said. “If a man is already impotent, for example, loss of sexual function won’t be an issue in making a treatment decision.” Funding for the study came from the California Department of Health Services.

Source: http://www.newswise.com/p/articles/view/553166

Cheap Flaxseed Powder Seems To Improve Prostate & Overall Health By Mark Moyad M.D.

(Reference: Demark-Wahnefried W, et al. Cancer Epidemiol Biomarkers Prev 17:3577-3587, 2008)

Flaxseed (linseed) is a popular alternative remedy to reduce cholesterol and hot flashes and to improve overall health. It is also high in fiber and omega-3 fatty acids! However, its impact in prostate cancer has been controversial because over the past decade some laboratory studies and other studies that did not include flaxseed but some of the compounds in it suggested it could be harmful and encourage tumor growth. However, over the past 10 years when flaxseed powder was used in men with and without prostate cancer the studies have all been positive!

So, these researchers tried to determine the impact of flaxseed powder and/or a low-fat diet on prostate tissue and other parameters before and after radical prostatectomy in a very large and impressive study. In fact, it is one of the largest and well-done dietary studies in medical history conducted only with prostate cancer patients! A total of 161 prostate cancer patients at least 21 days before surgery were randomized to one of 4 groups: control (regular) diet, flaxseed (30 grams/day), low-fat diet (<20% of calories from fat), or flaxseed and lowfat. Post-surgical specimens were analyzed for Ki-67 a proliferative biomarker and apoptosis (cell death) before (biopsy) and after surgery. The average time on these treatments was 30 days. Proliferation rates were significantly (P<0.002) reduced among men in the flaxseed groups compared to lowfat alone or control (that is a good thing because more proliferation suggests more tumor growth and less proliferation suggests less tumor growth). Men on a low-fat diet experienced a significant (P=0.05) reduction in total cholesterol. No other differences were observed between groups. So, flaxseed was found to be safe and may provide molecular changes that may ultimately discourage prostate cancer growth.

What does this mean for you and me? Few randomized trials in prostate cancer have made me happier than this one! I got so tired of hearing from the radical lifestyle crowd that flaxseed was dangerous for the prostate because some animal or test tube study suggested harm. Flaxseed has a history of being completely heart healthy by reducing cholesterol and perhaps body weight and belly fat, and it is a wonderful source of fiber and lignans, which have been shown to reduce hot flashes. However, its best feature is that any individual can afford it because it is so dirt-cheap. Gee, I wonder why you do not see any flaxseed powder commercials on TV or pushed by the fly by night “experts"?! How can you possibly make money from cheap flaxseed! Heck, I don't know but if someone figures it out let me know please! How about flaxseed monogrammed towels (stupid idea—lets move on)! Also, keep in mind that this is one of the largest and well-conducted randomized trials before prostate cancer surgery, so it seems that surgeons have a new recommendation to add to their pre-operative instructions.

Regardless, these findings should continue to provide assurance to those concerned about flaxseed that flaxseed powder is safe and may fight tumors along with conventional treatment. Flaxseed pills and flaxseed oil have little to no research in prostate cancer so I would not spend my money on them. One more important finding from this clinical trial needs to be emphasized. When researchers looked at prostate and blood levels of omega-3 fatty acids (the heart healthy fats found in flaxseed) they could not find large amounts of the plant form, but they did find higher levels of the fish oil form of omega-3 fatty acids! What does this mean? The body seemed to convert the plant form of omega-3 fats in flaxseed to the healthy type found in fish oil! Perhaps this is another reason flaxseed powder is so darn healthy. What a wonderful study. These researchers should get some type of award for doing this study in the first place!!

Bottom Line: Three tablespoons of flaxseed powder per day should be recommended before a radical prostatectomy (and perhaps before and after other prostate cancer treatments).

Source: PAACT NEWSLETTER, June 2009

Re: Letter to the Editor Regarding a Wall Street Journal Article titled: Two Big Studies Tackle Debate on Prostate Test published on Thursday March 19, 2009

The Wall Street Journal recently published a letter to the editor under the heading, “Lifestyle Is Fine, but Cancer Needs Effective Treatment.” The physician writing the letter vilified the idea of using anything but surgery to treat his prostate cancer. Unfortunately, his uninformed convictions are prevalent throughout the medical community. Now definitive, well-performed studies unequivocally prove that over-treatment is the norm (New England Journal of Medicine 2009;360:1310-9 and 1320-8).

As has been the case for years, the a priori assumption that “all cancer needs treatment” has confused the expert commentators who are interpreting these crystal-clear study results as being part of an ongoing unresolved controversy about PSA testing. The reality is that huge amounts of precious research dollars are being spent to answer a foolish question. Whether or not to do PSA testing is not the issue. The issue is deciding what to do with the information the PSA provides.

Right now the nation is in the grip of 8-billion dollar industry hell-bent on administering treatment to every kind of prostate cancer whether it is life-threatening or not. The solution to the problem of over-treating prostate cancer is not less PSA testing. The solution is educating physicians to forgo recommending immediate surgery or radiation to every last man who gets a diagnosis of prostate cancer.

Newly-diagnosed patients need to research all their options before agreeing to irreversible radical treatment. PSA testing (in conjunction with other means) has a useful role in determining which men harbor the more aggressive types of prostate cancer. Only with a “go slow” approach, ongoing monitoring known as Active Surveillance, can we distinguish men with aggressive disease who need treatment from men with indolent disease who don’t need treatment.

Mark Scholz, M.D. Prostate Cancer Research Institute, Los Angeles, California

http://www.prostate-cancer.org/aboutus/press/news_debate_prostate_test.html

Mayo Clinic Reports Dramatic Outcomes In Prostate Cancer Study

Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced today. “We were all pretty shocked,” says Dr. Eugene Kwon, an immunologist and urologist at Mayo and leader of the clinical trial in which the experimental therapy was being used. “These results were far beyond anything we ever envisioned.”

The two patients had a particular subset of prostate cancer that is very aggressive and deadly. Unlike most prostate cancer, which grows slowly and usually remains confined to the prostate gland, aggressive forms tend to advance and spread quickly. By the time the cancer is diagnosed, treatment is usually ineffectual. These aggressive prostate cancers are the second-leading cause of cancer death (after lung cancer) in American men.

A treatment that tricks the immune system - The clinical trial that the men were enrolled in was a Phase II study — one designed to see if a particular treatment is effective in a modest-sized group of people (usually 100 to 300) and thus deserving of a much larger, randomized Phase III trial. The agent being tested was an immunotherapeutic drug called MDX-010, or ipilimumab. It was given to the two men in combination with standard hormone therapy.

The men first received the hormone therapy, called androgen ablation, which blocks the body’s production of testosterone, thus shrinking their tumors somewhat. “It ignites a little immune response,” says Kwon. The response isn’t strong enough to fight off all cancer cells, however. That’s where the ipilimumab comes in. “It’s like pouring gasoline on a pilot light,” says Kwon. The ipilimumab tricks the immune response into “burning” long enough to overpower the cancer cells, he says.

A surgical surprise - Within weeks of treatment, the two men’s tumors could not be seen on MRIs. But the real surprise came when the first patient underwent surgery. Removing the prostate gland in advanced cases has not been shown to have any therapeutic benefits. But because of the remarkable MRI results — and the tenacious insistence of the wife of one of the patients — Kwon and his Mayo colleague, urologist and surgeon Michael Blute, MD, decided to go “off study” and operate.

When Blute opened the patient on the operating table, he saw a lot of blanched scar tissue — usually a sign of advanced cancer. He sent tissue samples to the pathology lab (standard procedure) and, while waiting for the results, went out to prepare the patient’s family for what he was sure was going to be bad news. “But the pathologist came back saying he couldn’t find the cancer,” says Kwon. “They ended up removing the prostate. Not only could they not find cancer outside the prostate, they couldn’t find it inside either.”

Surgery on the second patient produced similar results. A year-and-a-half later, both patients are entirely off therapy and have no evidence of cancer, says Kwon.

Caveats - Much more research is needed, Kwon points out, to determine the precise mechanisms behind this treatment and what the most effective dosages and ways of administering it might be. Kwon also points out that so far, only three of the 54 patients in the therapy arm of the clinical trial have demonstrated such dramatic results. “In this trial, we may have been working with sub-optimal doses,” he says. This fall, Mayo intends to start a clinical trial using higher and repeated doses of ipilimumab in combination with hormone therapy. “If that moves in a promising direction, we’ll go on to Phase III trials,” says Kwon.

Source: http://www.minnpost.com/healthblog

New Drug for Advanced Prostate Cancer

The US Food and Drug Administration recently approved a new drug for advanced prostate cancer. Degarelix, an injectable drug manufactured by Ferring Pharmaceuticals, blocks the body’s production of testosterone, slowing prostate cancer growth. The approval is based on encouraging results from a year-long phase III randomized clinical trial. The study showed that degarelix is as effective at suppressing testosterone as Lupron, a commonly used, similar drug, and it appears to take effect much more quickly. At the end of the study, nearly all of the men involved showed testosterone levels comparable with surgical removal of the testes. However, 99% of the patients on degarelix reached these low testosterone levels after about 2 weeks of treatment, compared to only 18% of the patients receiving Lupron.

Further, degarelix didn’t appear to cause the temporary surge in testosterone levels at the start of treatment, an effect often seen with Lupron and other hormone therapies for prostate cancer. Prostate-specific antigen (PSA) levels were also monitored during the study. While PSA results are not always clear-cut, a high PSA level is usually a good indicator of the presence of prostate cancer. Patients on degarelix saw their PSA levels drop by an average of 64% 2 weeks after starting treatment, by 85% after 1 month, and by 95% after 3 months. PSA levels stayed low during the rest of the trial Commonly reported side effects included pain, redness, and swelling at the injection site; hot flashes; weight gain; fatigue; and increases in some liver enzyme levels.

Source: ACS Man to Man News-June 2009

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