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, April 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
By Salynn Boyles - Reviewed by Louise Chang, MD
WebMD Health News March 19, 2009 -- The best treatment may be no treatment at all for some younger men with early stage, good-prognosis prostate cancer, new research suggests. Known as active surveillance or watchful waiting, the strategy of intensive monitoring instead of treatment is mostly reserved for elderly patients with other health problems who are likely to die of some other cause before their prostate cancer spreads.
The thinking has been that the approach may be too risky for younger men who may live with prostate cancer for decades instead of a few years. But a new study shows active surveillance to be a viable option for carefully selected prostate cancer patients, regardless of their age, as long as they are closely followed to make sure their disease does not progress. Of the 262 men in the study who were initially observed but not treated after being diagnosed, 43 ended up needing treatment over an average follow-up of about 30 months and one patient died after his cancer spread to his bones.
“There is definitely a risk to this strategy,” University of Chicago urologist and lead researcher Scott E. Eggener, MD, tells WebMD. “What we were able to do in this study was quantify this risk, and it appears to be very low.” Prostate Cancer Without Treatment Eggener made it clear that not all prostate cancer patients with early-stage disease and a good prognosis are good candidates for active surveillance.
In the United States, one man in six will receive a diagnosis of prostate cancer during his lifetime, but a much smaller percentage -- one in 35 -- will die from the disease, according to the American Cancer Society. Surgery and radiation therapy save lives, but they also carry the risk of serious long-term side effects, including incontinence, bowel problems, and sexual dysfunction.
“Some men may be rushing into treatment that won’t necessarily benefit them, prevent problems, or prolong life,” Eggener says. “Close observation in certain patients may maintain quality of life without increasing the chances of the cancer spreading.”
The newly reported study included 262 prostate cancer patients recruited from four treatment centers in the United States and Canada between 1991 and 2007. All the men were younger than 75 at recruitment, with the average age being 64. All had early-stage, localized disease and all had the most favorable biological disease markers, including a prostate-specific antigen (PSA) score of below 10 ng/mL and a Gleason score of 6 or below.
Instead of having one biopsy to determine eligibility for active surveillance, the patients had two. The second biopsy was done between 3.7-10.5 months after the first biopsy. As a result of the second biopsy, about 30% of the patients who were initially considered candidates for surveillance were excluded from the study because they ended up undergoing treatment. “We feel that the second biopsy was an important step in identifying patients who are not good candidates for active surveillance,” Eggener says.
With active surveillance, the patients had physical exams and PSA tests every six months, with biopsies recommended every one to two years. Over an average of two and a half years of follow-up, 43 of the study participants showed evidence of cancer progression and received treatment. In two patients, cancer spread beyond their prostate.
The findings support the idea that some men with prostate cancer may not need treatment, American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD. He says the addition of a second biopsy should help refine the search for men who are appropriate candidates for active surveillance, but he also agrees that the strategy of watchful waiting is not without its risks. “The real advance will be when we have tests that will tell us with a high degree of accuracy when treatment is needed and when it is not,” he says. A great deal of research is being done to identify genetic tests or tumor markers that can do this, but Lichtenfeld says it will be years before these tests are validated. The study is published in the April 2009 issue of the Journal of Urology. http://seattlepi.nwsource.com/health/401360_cancer25.html?source=rss
Mar 25, NEW YORK (Reuters Health) - A diet high in omega-3 fatty acids offers protection against advanced prostate cancer, even in men who carry a particular variant in the COX-2 gene that is known to raise the risk of the disease. "Previous research has shown protection (by omega-3 fatty acids) against prostate cancer, but this is one of the first studies to show protection against advanced prostate cancer and interaction with COX-2," Dr. John S. Witte of the University of California, San Francisco noted in a statement from the American Association for Cancer Research.
Witte and colleagues studied 466 men diagnosed with aggressive prostate cancer and 478 healthy matched controls. They assessed diet using a "food frequency" questionnaire and genotyped the men for nine COX-2 variants. The researchers report in the journal Clinical Cancer Research that increasing intake of long-chain omega-3 fatty acids -- the kind found in dark fish, like salmon, and shellfish -- was strongly associated with a decreased risk of aggressive prostate cancer. Men who consumed the most long-chain omega-3 fatty acids had a 63 percent reduced risk of aggressive prostate cancer compared to men who consumed the least.
"Importantly," Witte and colleagues say, this protective effect was even stronger in men who carried the COX-2 variant, rs4647310, which is a risk factor for prostate cancer. Specifically, men with low intake of long-chain omega-3 fatty acids and this particular variant had a more than fivefold increased risk of advanced prostate cancer. But men with high intake of omega-3 fatty acids had a substantially reduced risk, even if they carried the COX-2 rs4647310 variant.
In other words, the increased risk of prostate cancer associated with the COX-2 rs4647310 variant was "essentially reversed by increasing omega-3 fatty acid intake by a half a gram per day," Witte said. "If you want to think of the overall inverse association in terms of fish, where omega-3 fatty acids are commonly derived, the strongest effect was seen from eating dark fish such as salmon one or more times per week," he added. SOURCE: Clinical Cancer Research, online March 24, 2009. http://www.reuters.com
By Marilynn Marchione
February 24, 2009 – Associated Press - For the first time, leading medical groups are advising millions of healthy men who are regularly screened for prostate cancer to consider taking a drug to prevent the disease. The advice stops short of saying men should take the drug finasteride, sold in generic form and as Proscar. It is already widely used for urinary problems from enlarged prostates as men age. However, it has not been widely prescribed as a cancer preventive, and it may carry some risks. The new guidance tells men to talk to their doctors and decide for themselves if the good outweighs the bad.
This advice is bound to be confusing, doctors admit. For one thing, it doesn't apply to men who choose not to have screening with PSA blood tests, which no major medical groups recommend. In men who are regularly screened, finasteride can cut the odds of being diagnosed with prostate cancer by about 25 percent. "If a man is interested enough in being screened, then at least he ought to have the benefits of a discussion" about taking the drug, said Dr. Barnett Kramer, a National Institutes of Health scientist and one of the authors of the new guidelines.
They were published in two medical journals and discussed in a news briefing Tuesday in connection with a cancer conference in Florida. They were written by doctors with American Society of Clinical Oncology and the American Urological Association.
Cost could be a big issue for many men. Finasteride, which must be taken daily, costs $2 to $3 a pill and insurers may not cover it for cancer prevention. Also, to prevent a single additional case of cancer, 71 men would have to take the drug for seven years -- another reason this is an individual decision, doctors say. "There probably would be millions of different attitudes about taking a pill a day to prevent a condition that may or may not occur," said Dr. Howard Sandler, of Cedars-Sinai Medical Center in Los Angeles.
About 186,000 American men this year will be told they have cancer of the prostate. The disease often is diagnosed from a biopsy after a suspicious PSA blood test, which measures a protein. PSA can be high for many reasons, and there's no proof that screening saves lives -- the reason no major cancer groups recommend it. Most men over 55 get the test anyway, then face a dilemma if cancer is found. It usually grows so slowly it is not life-threatening, but it can prove fatal. Treatments often cause sexual or bladder control problems.
"We still don't know if screening and aggressive treatment is a good thing," but if men are getting PSA tests, taking finasteride is reasonable, said the American Cancer Society's chief medical officer, Dr. Otis Brawley. Finasteride shrinks the prostate and curbs testosterone, a hormone that helps cancer grow. It's already used for urinary problems, and at a lower dose, it's sold as the baldness drug Propecia.
A similar drug, dutasteride, sold as Avodart, is being tested to see if it, too, prevents prostate cancer. The guideline covers the whole class of drugs but for now, doctors are focused on finasteride. That's because it's the only one shown to prevent cancer so far. A landmark study in 2003 found fewer men who took it got prostate cancer than those on dummy pills.
The new advice to consider finasteride "is long overdue," said Dr. Eric Klein, prostate cancer chief at the Cleveland Clinic. When men are given a full picture of the drug's effects, "it's not a tough sell," he said. Finasteride has been linked to lower sexual desire and difficulty having an erection. However, in a study of older men, those were problems for most who weren't taking the drug as well. Finasteride also gave benefits: fewer urinary problems and less incontinence. "The overall quality of life was identical," and most side effects go away after a few weeks of use, Kramer said.
Feb 2009 - UroToday.com - Fatigue is the most common complaint among patients undergoing radiotherapy (XRT) for prostate cancer (CaP) and occurs in 60-80% of these men. It persists after treatment is completed and can decrease quality-of-life and functional capacity. In the December 2008 issue of the Journal of Clinical Oncology, Dr. Segal and colleagues report on the benefit of an exercise program during XRT with the hypothesis that it would improve patient related fatigue and quality-of-life. Modest benefits were observed.
A total of 325 eligible patients were approached and 121 agreed to randomization for this prospective study. Three arms comprised the study, usual care (n=41), resistance exercise training (n=40), and aerobic exercise training (=40).
Both exercise groups were under the supervision of an exercise specialist and had a warm up period followed by exercise regimens that increased over the 24-week period. Resistance training was 3 times per week performing 2 sets of difference resistance exercises. Aerobic training was 3 times per week and ultimately increased to 45 minutes per session. Patients rated outcomes pertaining to fatigue, CaP-specific and cancer specific QOL.
Objective measured outcomes such as strength, body weight, body fat percentage, and serum lipids were assessed. Participants completed a median of 88% of resistance and 83% of aerobic scheduled sessions. Only one significant morbidity occurred - a non-fatal myocardial infarction. Fifteen percent of participants also reported regular exercise outside of the study.
Regarding fatigue, no main effect was found for the group, but fatigue was improved with resistance and aerobic training compared with usual care from baseline to 12 weeks. From baseline to 24 weeks, only resistance exercise was superior to usual care. CaP-specific QOL declined over time, but no difference between groups was found. VO2peak was superior with both exercise programs compared to usual care, and resistance training attenuated increases in body fat percentage and triglycerides. Thus, a resistance exercise program has both short and long term benefits on fatigue associated with XRT for CaP. Source: J Clin Oncol. 2009 Jan 20;27(3):344-51 10.1200/JCO.2007.15.4963 Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
Current research suggests that lowering cholesterol may block the growth of prostate tumors. The related report by Solomon et al, "Ezetimibe Is an Inhibitor of Tumor Angiogenesis," appears in the March 2009 issue of The American Journal of Pathology.
High cholesterol not only leads to atherosclerosis and heart disease, but may also contribute to cancer growth and progression. Prostate cancer is the most common non-skin cancer in the United States, affecting approximately 1 in 6 men. Prostate tumors accumulate high levels of cholesterol, and tumor incidence correlates with eating a high fat/high cholesterol diet "Western" diet. In addition, prostate tumor progression has been linked to serum cholesterol levels.
To examine the role of high cholesterol in prostate cancer, Dr. Keith Solomon and colleagues fed mice a high fat/high cholesterol "Western" diet. They found that high cholesterol levels promoted tumor growth and that Ezetimibe (Zetia™), which blocks the absorption of cholesterol from the intestine, could prevent this increased tumor growth. Ezetimibe also blocked a cholesterol-mediated increase in angiogenesis, the growth of new blood vessels required for tumor progression. These data suggest that reducing cholesterol levels may inhibit prostate cancer growth specifically by inhibiting tumor angiogenesis.
The article from Solomon et al suggests "that cholesterol reduction, which is routinely accomplished pharmacologically in humans, may reduce angiogenesis, ultimately leading to less aggressive tumors." "Lowering cholesterol levels whether through diet, exercise, or the use of safe cholesterol-lowering drugs is known to provide a substantial benefit to patients—in the future it may be possible to add reduced risk of serious prostate cancer to that list of benefits" says Solomon. "We are in the process of working with clinicians to translate these findings into potential human studies. If we can demonstrate the effects noted in our pre-clinical studies in human patients we may be save lives and improve the quality of life," adds Dr. Michael Freeman, senior author of the study. Source: American Journal of Pathology http://www.physorg.com/news154618084.html
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