Prostate Cancer News - Radiation, Fitness, Phi

Don't wait for radiation after surgery for agressive Prostate Cancer

The Best Prostate Cancer Treatment? U.Va. Research Offers Long-Needed Answers | UVA Today

Sweeping prostate cancer review upends widely held belief on radiation after surgery Medical News Today
Important news for men receiving treatment for prostate cancer: Two new studies from the University of Virginia School of Medicine have upended the widely held view that it's best to delay radiation treatment as long as possible after the removal of the prostate in order to prevent unwanted side effects.
"The common teaching has been, without clear evidence, that urinary incontinence and erectile function are worse when radiation is delivered earlier rather than later, but we didn't see any protective effect of delayed radiation compared to earlier radiation," said radiation oncologist Timothy N. Showalter, MD, of the UVA Cancer Center. "It contradicts the clinical principle of delaying radiation as long as possible for the sake of the patient's side effects. It really speaks against that, and that ought not to be used for a reason to delay radiation."

What Matters Most to Prostate Cancer Patients - Cure or Quality of Life? 

European experts reveal new survey data that demonstrates a need for increased focus on 'the man behind the prostate cancer' Medical News Today

Day-to-day living
When asked what matters most since being diagnosed with prostate cancer, nearly 1 in 2 (47%, n=314) men highlight the importance of maintaining a good quality of life, living life to the full and being able to spend quality time with family and friends. These are more important than 'being cured' (19%, n=127).¹
40% (n=27/67) of men with advanced prostate cancer agreed that their quality of life had improved with treatment. However, of those men with advanced prostate cancer who had also experienced bone pain, nearly 2 in 5 (38%, n=16/43) are no longer able to complete day-to-day activities such as shopping and walking due to their pain, and nearly a quarter (24%, n=10/43) live with pain that they feel is not manageable.¹
Contributing to society
Beyond family, feeling well enough to be able to contribute to society is important for men with advanced prostate cancer. Amongst men aged between 35-54 years old who are currently taking medication, one third (33%, n=14/43) say they sometimes feel too unwell to go to work. However, nearly half (46%, n=307) of all survey respondents want to continue working as much as possible.¹

Is being fit at 50 better or worse for Prostate Cancer?

JAMA Network | JAMA Oncology | Midlife Cardiorespiratory Fitness, Incident Cancer, and Survival After Cancer in Men:  The Cooper Center Longitudinal Study

Results  Compared with men with low CRF, the adjusted hazard ratios (HRs) for incident lung, colorectal, and prostate cancers among men with high CRF were 0.45 (95% CI, 0.29-0.68), 0.56 (95% CI, 0.36-0.87), and 1.22 (95% CI, 1.02-1.46), respectively. Among those diagnosed as having cancer at Medicare age, high CRF in midlife was associated with an adjusted 32% (HR, 0.68; 95% CI, 0.47-0.98) risk reduction in all cancer-related deaths and a 68% reduction in cardiovascular disease mortality following a cancer diagnosis (HR, 0.32; 95% CI, 0.16-0.64) compared with men with low CRF in midlife.
Conclusions and Relevance  There is an inverse association between midlife CRF and incident lung and colorectal cancer but not prostate cancer. High midlife CRF is associated with lower risk of cause-specific mortality in those diagnosed as having cancer at Medicare age.

Does being fit at 50 really NOT lower risk for prostate cancer? | THE "NEW" PROSTATE CANCER INFOLINK
A new study just published in JAMA Oncology appears to suggest that a man’s fitness at age 50 lowers his risk for cardiovascular disease, for colon cancer, and for lung cancer, but actually increases his risk for prostate cancer. One might justifiably wonder whether this makes sense.
The study by Lakoski et al. (which has already received coverage in TIME magazine) is based on data from a prospective, observational cohort of 13,949 community-dwelling males at a preventive medicine clinic, all of whom were given a baseline fitness examination between 1971 and 2009. The fitness examination included an incremental treadmill exercise test to evaluate their cardiorespiratory fitness or CRF. The available data then allowed the research team to divide the patients into three CRF fitness groups: low ( the least fit 20 percent), moderate ( the middle 40 percent), and high (the upper 40 percent). 

In the Discussion section of their paper, the authors get into the issue of whether fitness at mid-life really has no impact on risk for prostate cancer. They write that:

The exact reasons for the observed positive association between CRF and incident prostate cancer risk are not known, but differences in related health behaviors, such as screening, may be an important contributing factor. Specifically, men with higher CRF may also be more likely to undergo more frequent preventive health care screening and/or detection visits and, thus, had greater opportunity to be diagnosed as having localized prostate cancer relative to men with lower CRF, possibly with less frequent preventive health care visits. Notably, these findings are also consistent with those of several studies on physical activity and prostate cancer risk, an important predictor of attained CRF.

It does seem difficult to accept the concept that a relatively high level of fitness would not lower risk for (at least) clinically significant prostate cancer. It is even harder to see why a higher fitness level might increase risk for a diagnosis of prostate cancer by 22 percent. However, there may be good reasons for this that we don’t yet understand.

Phi - A Better Test for Early Detection with fewer false indications?

ROC curve demonstrated that when p2PSA measurements
are combined with Access Hybritech PSA and free PSA
measurements, the resulting phi index demonstrates a significant
improvement in clinical specificity for prostate
cancer detection, relative to PSA detection rates

The Prostate Health Index for Detecting Prostate Cancer

Abstract

A major focus in urologic research is the identification of new biomarkers with improved specificity for clinically-significant prostate cancer. A promising new test based on prostate-specific antigen (PSA) is called the Prostate Health Index (PHI), which has recently been approved in the United States, Europe and Australia. PHI is a mathematical formula that combines total PSA, free PSA and [-2] proPSA. Numerous international studies have consistently shown that PHI outperforms its individual components for the prediction of overall and high-grade prostate cancer on biopsy. PHI also predicts the likelihood of progression during active surveillance, providing another noninvasive modality to potentially select and monitor this patient population. This article reviews the evidence on this new blood test with significant promise for both prostate cancer screening and treatment decision-making.

The Prostate Health Index (phi test) and the need for biopsy | THE "NEW" PROSTATE CANCER INFOLINK
The authors conclude that the Prostate Health Index (phi test) is significantly better than the PSA test

detects aggressive prostate cancer with a better specificity than total PSA and percent free PSA in a biopsy-naïve population, and could be a useful tool to decrease unnecessary prostate biopsies.

• At 95 percent sensitivity,
  • The specificity of the phi test was 36.0 percent.
  • The specificity of the total PSA level was 17.2 percent.
  • The specificity of the %free PSA level was 19.4 percent.
• At 95 percent sensitivity for the detection of aggressive prostate cancer
  • The optimal phi cut-point was 24.
  • A cut point of 24 predicted avoidance of 41 percent of unnecessary biopsies.