Santa Cruz County Prostate Cancer Support Group
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Serving all of SANTA CRUZ COUNTY Santa Cruz PROSTATE CANCER SUPPORT GROUP June 2008 NEWSLETTER 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. Tuesday, June 24th, 2008 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 Our website: http://www.scprostate.org ....PROSTATE CANCER IN THE NEWS..... Radiation
Improves Survival for Advanced Prostate Cancer May 20, 2008 (HealthDay News) - Men with advanced prostate cancer that hasn't spread beyond the gland should receive radiation therapy as soon as the prostate has been removed, a new long-term study says. "What we are showing today is that there is a significant difference between men who were treated with radiation and those who weren't," study co-author Dr. Gregory P. Swanson, of Cancer Care Northwest Spokane, Wash., said during a Tuesday teleconference at the American Urological Association annual meeting, in Orlando, Fla. "We found that overall survival increased among men who had radiation therapy compared with those who did not," he said. For the study, 413 men with advanced localized prostate cancer were assigned to receive radiation soon after surgery to removed their prostate, or no radiation until their blood levels of prostate-specific antigen rose. Prostate-specific antigen (PSA) is a protein produced by the cells in the prostate; because PSA can be used to detect disease, it is sometimes called a biological marker or tumor marker, according to the National Cancer Institute. The men were checked every three months for one year, every six months for two years, then annually until death. The examinations included PSA measurements and bone scans if warranted, the researchers said. The researchers found that radiation therapy after prostatectomy (removal of the prostate) significantly reduced the recurrence of prostate cancer during the 11.5 year follow-up period. There was significant improvement in disease-free survival and overall survival, with survival rates increased by almost two years, the researchers said. However, the men who did undergo radiation therapy reported more side effects, such as incontinence and impotence, than men who didn't receive the therapy, which is to be expected, the researchers noted. "Here we had a study that shows that radiation improves survival," said study co-author Dr. Ian M. Thompson Jr., of the Division of Urology and the Department of Surgery at the University of Texas Health Science Center at San Antonio. "More importantly, you live longer, with less risk of having metastatic disease. To improve survival by almost two years is extraordinary." The men who got radiation therapy had more than 50 percent less need for hormone therapy, Thompson said. Given the results of this trial, patients should receive radiation therapy immediately after prostate surgery and not wait for their PSA levels to start rising, he said. "Perhaps the most commonly used treatment is to watch these patients until their PSA starts to go up," Thompson said. "At least from this randomized clinical trial, the evidence would suggest that the cure rate is less, survival is less with that approach." Dr. Bruce Roth, a professor of medicine and urologic surgery at Vanderbilt University, said radiation procedures have changed since the study began, so the findings may not be as applicable now. "Now, we routinely give significantly higher doses of radiotherapy," he said, adding that higher doses are probably more effective, but they also increase side effects. "Offering radiation therapy to all patients with advanced prostate cancer is not the right thing to do," Roth said. "There are patients who are more likely to have a local-only recurrence, and therefore benefit from radiation therapy. We have become a little more sophisticated in terms of whom to offer this therapy to." SOURCES: Bruce Roth, M.D., professor, medicine and urologic surgery, Vanderbilt University, Nashville, Tenn.; May 20, 2008, teleconference with Gregory P. Swanson, M.D., Cancer Care Northwest Spokane, Wash.; Ian M. Thompson Jr., M.D., Division of Urology, Department of Surgery, University of Texas Health Science Center at San Antonio; May 20, 2008, American Urological Association annual meeting, Orlando, Fla. http: //www.medicinenet.com/script/main/art.asp?articlekey=89653 Lowering
Cholesterol May Also Lower Prostate Cancer Risk May 21, 2008 (HealthDay News) — Men who keep their cholesterol down might also help lower their levels of prostate specific antigen, a protein that can warn of prostate cancer, a new study says. "Prostate cancer is controlled by the male hormone testosterone. The main molecule that forms testosterone is cholesterol," said Dr. Murugesan Manoharan, an associate professor of urology at the University of Miami Sylvester Comprehensive Cancer Center, who was not involved in the study. "So it is known that prostate cancer is related to testosterone, and testosterone is related to cholesterol." The study's inference is that by lowering cholesterol, you also lower PSA, which in turn may reduce the risk of prostate cancer, Manoharan said. "Obviously this is a very small study and does not confirm anything, but it is a very good start that could lead to something more at a later point," he said. The results of the study were expected to be presented Wednesday at the American Urological Association annual meeting, in Orlando, Fla. For the study, researchers collected data on 1,214 men taking cholesterol-lowering drugs called statins. The researchers found that PSA levels were lower after starting the statins, and the drop in PSA was proportional to the drop in cholesterol. The results of the study confirm those of a previous study that also found that lowering cholesterol lowered PSA, the researchers noted. If confirmed, the results of the new study would provide more evidence that cholesterol plays a role in the biology of the prostate, the researchers said. It's still not clear, however, whether lowering PSA with cholesterol-lowering drugs may actually hide developing prostate cancer, Manoharan said. "Bringing down the PSA levels artificially does not mean necessarily decreasing the chance of developing prostate cancer," he said. "It might just bring the blood test reading down without reducing the risk of prostate cancer. In fact, we could miss the prostate cancer, because the PSA readings are on the lower side." Manoharan said the new findings need to be studied further. "If statins do, in fact, reduce the incidence of prostate cancer that would be a very good thing," he said. Two other studies presented Wednesday confirmed that so-called "watchful waiting" of men with a low risk of prostate cancer is a viable option. Watchful waiting is a strategy in which no treatment is given, but the patient is monitored to check the progress of the cancer. But, the researchers of one of the studies noted that PSA exams and digital rectal exams aren't good predictors of the progress of prostate cancer. They suggest that better monitors of the disease need to be developed. In another study presented Wednesday, researchers from Johns Hopkins University found that men 75 to 80 years of age with low PSA levels — less than 3 nanograms per milliliter of blood — may be able to stop regular prostate cancer screenings. The researchers found that these older men who have PSA levels below 3 nanograms per milliliter have a low probability of dying from prostate cancer, while men with PSA levels of 3 nanograms or more have an increased risk of dying from the disease. SOURCES: Murugesan Manoharan, M.D., associate professor of urology, University of Miami Sylvester Comprehensive Cancer Center; May 21, 2008, presentation, American Urological Association annual meeting, Orlando, Fla. http://www.medicinenet.com/script/main/art.asp?articlekey=89693 Active Surveillance A Viable Option For Low-Risk Prostate Cancer Active surveillance remains a viable option for low-risk, localized prostate cancer, according to two studies presented during the Annual Scientific Meeting of the American Urological Association (AUA), yet researchers point out a strong need for regular monitoring and development of stronger clinical predictors of progression. Researchers present their findings to the media on May 18, 2008 at 11:00 a.m. Researchers from the University of Texas Health Science Center in San Antonio evaluated the efficacy of digital rectal exam (DRE), prostate-specific antigen (PSA) testing, repeat biopsy and endorectal magnetic resonance imaging (MRI) in accurately monitoring disease progression. Researchers conducted a retrospective review of 80 patients with low-risk prostate cancer (stage T1-T2, NX0, MO) who were managed with active surveillance from 2004 to 2007. Patients (mean age 65) underwent routine clinical checkups with DRE and PSA every four months and repeat biopsy at 18 months. Select patients (12) also underwent endorectal MRI. The study shows that PSA and DRE were unreliable in predicting disease progression. Of the 41 percent of patients with an initial positive DRE, 42 percent with a previously abnormal DRE had a subsequent normal DRE. PSA at the time of repeat biopsy was insufficient in predicting subsequent positive biopsy, and a majority with a positive repeat biopsy also had a decreased PSA level. Endorectal MRI, not currently part of the routine surveillance protocol, was the most reliable predictor, and showed location and disease stage as expected in 50 percent of the patients being followed by MRI. The second study, a multi-institutional retrospective review of data from four North American academic centers - Cleveland Clinic Foundation, Memorial Sloan-Kettering Cancer Center, University of British Columbia and University of Miami - indicated that active surveillance for appropriately selected patients with low-risk prostate cancer appears to be safe, durable and associated with low risk of systemic progression. Cancer detected on re-biopsy and the total number of involved cores are associated with a lower likelihood of remaining on active surveillance. This study evaluated actuarial rates, incidence of metastatic disease, pathological findings subsequently undergoing radical prostatectomy and predictors of remaining on active surveillance in patients with low-risk, localized prostate cancer . The study cohort consisted of 262 patients (aged 75 and younger) with localized prostate cancer and low-risk clinicopathologic features who had at least two biopsies prior to going on active surveillance. Median follow-up was 29.7 months. The presence of cancer in the second biopsy and the number of positive cores at first and second biopsy (combined) were strong indicators of progression requiring active treatment. Of the group, 43 patients subsequently underwent primary therapy (radical prostatectomy, radiation therapy or androgen deprivation). The one- two and five-year actuarial probabilities of remaining on active surveillance were 95 percent, 01 percent and 75 percent. Eggener SE, Mueller A, Berglund RK, Aboussaly R., Zappavigna C, Soloway CT et al: A Multi-Institutional Cohort Of Active Surveillance For Low-Risk Localized Prostate Cancer. J Urol, suppl., 2008; 179: 64, abstract 183. Miyamoto R, Thompson IM: the reliability of digital rectal exam, PSA, repeat prostate biopsy, and endorectal MRI for following patients with clinically localized prostate cancer on active surveillance. J Urol, suppl., 2008; 179: 154Source: Lacey Holt American Urological Association http://www.medicalnewstoday.com/articles/107743.php Data Re-analysis Shows Drug Finasteride May Reduce Risk For Most Prostate Cancers ScienceDaily (May 24, 2008) — A re-analysis of data from the landmark Prostate Cancer Prevention Trial (PCPT) finds that finasteride reduces the risk for prostate cancer without boosting the odds of aggressive tumors. PCPT, which involved more than 18,000 men 55 years of age or over, was stopped early in June 2003 because researchers noted that while it reduced prostate cancer in men taking finasteride (Proscar) by up to 25 percent, men taking finasteride also appeared to have more aggressive prostate tumors if and when they did develop the disease. That caused some experts to worry that finasteride was encouraging higher-grade cancers. But a new analysis led by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center should lay that worry to rest. "Finasteride has long been used by doctors to treat benign enlarged prostate -- it shrinks the prostate. So when we accounted for this shrinkage in prostate volume, the disparity in tumor aggressiveness between the finasteride and placebo groups vanished," says study lead author Dr. Steven A. Kaplan, professor of urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. He and his colleagues will present their findings May 20, at the annual meeting of the American Urological Association, in Orlando. Physicians grade the aggressiveness of prostate tumors on what's called the Gleason Score -- a grading of tumor characteristics, with scores ranging from 2 to 10 (10 indicating the most highly aggressive cancers). "After their initial analysis, the PCPT investigators discovered that men taking finasteride had fewer prostate cancers overall, but a higher incidence of grades 7, 8, 9 and 10 cancers," Dr. Kaplan explains. This was worrying, since it is higher-grade, potentially metastatic prostate cancers that are the real cause for clinical concern. "Lower-grade cancers are often what we call 'indolent,' meaning they grow so slowly they pose little real threat to the patient," Dr. Kaplan says. "So it was important to find out if this finding was real, or some kind of methodological artifact." His team had one theory: "We know that finasteride shrinks the prostate. So perhaps that simply meant that doctors were better able to spot a highly aggressive tumor in patients taking the drug, because there was less tissue in which it could hide," explains senior author Dr. E. Darracott Vaughan, the James J. Colt Professor of Urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. With that in mind, the researchers looked once more at PCPT data on biopsies taken from the 18,882 men in the study. They adjusted for treatment type, age, race, family history of prostate cancer, baseline prostate-specific antigen (PSA) levels, and the individual patient's prostate volume. "What we found was a significant reduction in the incidence of prostate cancers for men taking finasteride vs. placebo -- even for the higher-grade cancers," Dr. Kaplan says. "Most importantly, finasteride was associated with significant declines in tumors with Gleason scores 5, 6 and 7, which comprise 72 percent of all prostate cancers diagnosed in the United States. For tumors with Gleason scores of 8, 9 and 10, the incidence for men taking finastride was no higher than for men not taking the drug, after we had adjusted for prostate volume." This means that men who are prescribed finasteride should not be concerned that the drug will boost their odds for aggressive prostate cancer. In fact, while it's too early to say that the drug prevents the disease, it may sometimes help suppress it when it occurs, the researchers say. "I believe that the drug is chemo-suppressive," Dr. Kaplan says. "We know that it reduces PSA levels, which are indicative of prostatic disease. Finasteride appears to be particularly adept at suppressing the more indolent cancers. So in the future, it might be useful to use the drug to determine just how aggressive -- and needful of treatment -- a particular tumor is. If the patient takes finasteride and his PSA levels quickly drop, he probably has a less-threatening tumor that may just require 'watchful waiting.' But if PSA levels rise, that tumor may need more active treatment. All of this needs to be tested in a controlled, randomized trial." In the meantime, researchers need to keep prostate volume in mind whenever they conduct trials assessing the anticancer properties of prostate-shrinking medications. "Right now, drug maker GlaxoSmithKline is testing out a similar drug, Avodart, as a possible agent against prostate cancer. We hope that they will incorporate prostate volume in their analysis, to help avoid the confusion that dogged PCPT," Dr. Kaplan says. The PCPT trial was funded by the U.S. National Cancer Institute and Merck, the maker of finasteride. Co-authors on this study include Dr. Claus Roehrborn, of the University of Texas Southwestern Medical School, Dallas; Dr. Alan G. Meehan, Dr. Bruce S. Binkowitz and Norman L. Heyden, of Merck Research Laboratories, Rahway, N.J.; and Dr. Kenneth S. Liu and Dr. Alexandra D. Carides, of Merck Research Laboratories in Upper Gwynedd, Penn. Source: http://www.sciencedaily.com? /releases/2008/05/080520144001.htm +++++ 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. Our newsletter serves over 260 members. 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.
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