Prostate Cancer News 08-01-2015
General Case
Management
A Decade of Dramatic Change in the Treatment of Prostate Cancer - Cancer Therapy Advisor
In 2005, the relative 10-year survival rate for prostate cancer was
92% and the relative 15-year survival rate was 61%, according to the
American Cancer Society.
1
Today, the numbers are significantly higher: the relative 5-year
survival rate for all stages of prostate cancer is almost 100%, the
relative 10-year survival rate is 99%, and the 15-year relative survival
rate is 94%.
2
“The greatest advances in the management of prostate cancer in the
last decade have come directly from our understanding of the biology of
what causes prostate cancer cells to become resistant to treatments we
had a decade ago,” said Anthony D'Amico, MD, PhD, of Brigham and Women's
Hospital and Dana-Farber Cancer Institute, in Boston, MA.
Urological
cancer: Management of patients with prostate cancer: evolution towards a
risk-stratified approach : Nature Reviews Clinical Oncology : Nature Publishing
Group
Growing evidence exists that patients with localized prostate cancer have
substantial differences in their management needs, depending on their
individual risks of adverse outcomes. Now, results of an extensive analysis
have confirmed that this evidence is beginning to be adopted into clinical
practice: an analysis of the Cancer of the…
India relies on PSA and ADT for initial detection and treatment of Prostate
Cancer in elderly
Doc
suggests prostate cancer test for elderly - The Times of India
This disease takes place in old age, with 75% patients being above 60 years,
he said. Early detection can increase longevity of the patient. Because of
early detection, survival for five years after detection, which was 76%
earlier, has now gone up to 98%. Kolkata-based Dr G S Bhattacharya said if
detected early, there is no need for aggressive treatment for prostate cancer.
"The first line of treatment in this disease is hormonal manipulation,
because it is a hormone-dependent disease, and chemotherapy is reserved for
those cases which has become resistant to hormone therapy," Dr
Bhattacharya said and added many drugs are available these days which are very
effective in prostate cancer. There are many drugs in pipeline and in clinical
trial stage, which will revolutionize the management of prostate cancer,
provided there is early detection.
What you can do
You can make choices in your life to impact whether you get
it, or how well you respond to treatment.
"Eat plants, that's the healthiest thing to do. You don't have to go paleo, but eat plants," Dr. Klein said. Green
veggies are great at slowing down the spread of cancer-causing
substances. So, men who eat three or more half-cup servings of green
veggies a week drop their odds of getting prostate cancer by 41-percent.
The
lycopenes found in red fruits such as tomatoes can, according to one
study, lower the risk of prostate cancer by 35-percent and advanced
prostate cancer by half.
And feast on fish. Omega-3's found in tuna, trout and salmon also slow the growth of prostate cancer cells.
But avoid fat.
Foods
That Affect Prostate Cancer Risk | Naija247news
Getting enough vitamins and minerals with a healthy, balanced diet may be
one of the keys to warding off prostate cancer.
And using nutrition to your advantage may prove very useful when fighting
prostate cancer too.
Diet
can be a powerful tool, according to Roberta Anding, a registered dietitian,
instructor at the Baylor College of Medicine, and a spokeswoman for the
American Dietetic Association.
Screening -
Diagnosis
Early detection and diagnosis of Prostate Cancer is key to
survival. The PSA test has been criticized for too many false alarms, which new tests could reduce.
Initial
PCA3
Test Now Offered at Dr. Samadi's Prostate Cancer Center -- NEW YORK, July 28,
2015 /PRNewswire/ --
The
PCA3 test is a simple urine sample collected following a
digital rectal exam for the determination of the PCA3 score. Specific for
prostate cancer, and,
unlike the PSA, this test is not affected by prostate enlargement or other
non-cancerous prostate conditions. In combination with PSA and DRE results, the
PCA3 score provides useful information to help decide if a biopsy is needed, or
can be delayed. It's much more specific in giving additional information about
the aggressiveness of the cancer if the patient has a positive biopsy.
,
July 21, 2015
/PRNewswire/ -- Dr.
David Samadi's Prostate Cancer Center is now offering the
4K Score test for
prostate
cancer screening.
The
4K Score is a blood test measuring 4 different
prostate-related
proteins that provides a percent risk score of having an aggressive
prostate cancer. This new tumor marker is an
optimized screening and diagnostic test for prostate cancer that assesses the
risk of prostate cancer to further indicate the need for a biopsy.
"The purpose of this new tumor marker test is to
reduce unnecessary biopsies. Not every elevated PSA translates to the need for
a biopsy. The 4K Score test was specifically developed to address the
criticisms of the detection of too many low-grade, indolent prostate cancers.
If we can identify the high-risk cancers early on, we can focus on treatment
right away," said Dr.
David Samadi,
Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in
New York City.
The 4K Score aids in a smarter diagnosis for prostate cancer, which then
leads to the right treatment for each patient. The 4K Score tumor marker test
also has created a major shift in the field because it improves and helps
distinguish between high and low risk cancer through a simpler method versus a
biopsy.
Prostate
cancer: Men should not take GP's 'no' for an answer - Telegraph
Trained dogs can sniff out prostate cancer - Harvard Prostate Knowledge
One method which proves totally reliable - and is used in many hospitals
around the world - but is still not accepted in the UK, is that of 'sniffed'
detection by the
Medical Detection Dogs.
Research on early detection of prostate cancer is on-going at the charity's
unit in Milton Keynes, with the help of volunteers from the Warwick centre of
Graham Fulford's Trust. Men attending on the third Thursday of each month are
being asked to donate a urine sample to help train the dogs and become part of
MDD's second, vitally important
Prostate
Cancer Study.
Pathology
Instead of a Gleason Score based on cell shape and structure, genomic classification may be more effective.
Prostate cancer: Five types 'found' - BBC News
Five subtypes of prostate cancer identified, paving way for more personalized treatments - The Washington Post
Prostate cancer is five different diseases, experts say -- ScienceDaily
Scientists have, for the first time, identified that there are five
distinct types of prostate cancer and have found a way to distinguish
between them, according to a landmark study.
How many “different” types of prostate cancer are there? | THE "NEW" PROSTATE CANCER INFOLINK
a new article by Ross-Adams et al. in the online journal
EBioMedicine may be helpful in this regard (see also
this report on the ScienceDaily web site).
If you click here,
the entire article by Ross-Adams et al. is also freely available.
Basically, Ross-Adams et al. argue that prostate cancers can be
classified
into five genetically different categories and that this classification
system may be helpful to doctors (and presumably their patients too) in
deciding on the best course of treatment for each
individual
patient, based on the characteristics of each patient’s individual
tumor. More specifically, here is what they did and found.
- They used tissue specimens from 259 men diagnosed with primary prostate cancer in the UK.
- From those tissue specimens, they isolated 482 different samples of
cancerous tissue, benign tissue, and so-called “germline” tissue.
- By analyzing copy number alterations (CNAs) and methods, they
identified genomic loci affecting expression levels of messenger RNA
(mRNA) in a quantitative manner and then they were able to stratify the
patients into subgroups associated with future clinical effects and
behaviors of the cancers.
- They were able to describe five separate patient subgroups with distinct genomic alterations and expression profiles.
- Using these five subgroups, they were able, consistently, to predict
future biochemical relapse after first-line treatment with a high
degree of accuracy.
- They were able to validate their predictions using a different cohort of patients.
- They confirmed alterations in six genes previously associated with prostate cancer (MAP3K7, MELK, RCBTB2, ELAC2, TPD52, ZBTB4),
and identified 94 genes other not previously linked to prostate cancer
progression that would not have been detected using either transcript or
copy number data alone.
- They confirmed several known molecular changes associated with high-risk prostate cancer (including MYC amplification, and NKX3-1, RB1, and PTEN deletions, as well as over-expression of PCA3 and AMACR, and loss of MSMB in tumor tissue).
- They showed that use of the subset of 100 genes described above
significantly outperforms established clinical predictors of poor
prognosis (PSA, Gleason score) and previously published gene signatures (p = 0.0001).
High-Grade Prostate Cancer Linked to Low Testosterone - Renal and Urology News
Low testosterone levels predict an increased likelihood of high-grade
prostate cancer (PCa) being found as a result of a prostate biopsy, new findings suggest.
Biopsy
Addressing
the need for repeat prostate biopsy: new technology and approaches : Nature
Reviews Urology : Nature Publishing Group
No guidelines currently exist that address the need for rebiopsy in patients
with a negative diagnosis of prostate cancer on initial biopsy sample analysis.
Accurate diagnosis of prostate cancer in these patients is often complicated by
continued elevation of serum PSA levels that are suggestive of prostate cancer,
resulting in a distinct management challenge. Following negative initial
findings of biopsy sample analysis, total serum PSA levels and serum PSA
kinetics are ineffective indicators of a need for a repeat biopsy; therefore,
patients suspected of having prostate cancer might undergo several unnecessary
biopsy procedures. Several alternative strategies exist for identifying men who
might be at risk of prostate cancer despite negative findings of biopsy sample
analysis. Use of other serum PSA-related measurements enables more sensitive
and specific diagnosis and can be combined with knowledge of
clinicopathological features to improve outcomes. Other options include the
FDA-approved Progensa
® test and prostate imaging using MRI. Newer
tissue-based assays that measure methylation changes in normal prostate tissue
are currently being developed. A cost-effective strategy is proposed in order
to address this challenging clinical scenario, and potential directions of
future studies in this area are also described.
Genomics
Young-Age Prostate Cancer
Although prostate cancer is a disease of the elderly, its diagnosis is
not uncommonly made in men younger than 55 years. Both ethnic, familial
and genetic factors play a role in the early onset of prostate cancer,
but the biology, particularly of low-grade prostate cancers detected at
young age is not well understood. Autopsy studies have shown a high
prevalence of Gleason score 6 prostate cancers in men under 55 years,
but mortality of prostate cancer at this young age is almost negligible.
Recently, a number of susceptibility genes such as
BRCA2 and
HOXB13
were reported, each with their own specific biological and
histopathology features. In this review, we provide an update on the
most recent findings in young-age prostate cancer.
Prostate
cancer: Intrapatient heterogeneity in prostate cancer : Nature Reviews Urology
: Nature Publishing Group
A newly published study used whole-genome sequencing of multiple prostate
tumour foci from several patients with intermediate-risk prostate cancer to
track evolutionary patterns and delineate the marked intrapatient molecular
heterogeneity of this disease. Their findings have potential implications for
the development of clinical prognostic and predictive biomarkers.
Genetic
risk, aggressive prostate cancer, and ethnic/racial differences | THE
"NEW" PROSTATE CANCER INFOLINK
According to a newly published article in the
Journal
of Clinical Oncology, there are new and strong indications that a
specific “genomic fingerprint” is associated with elevated risk for diagnosis
of aggressive prostate cancer in African Americans compared to Caucasians.
The article just published by Yamoah et al., along with
a media release issued by Thomas Jefferson University
define a subtype of prostate cancer that the research team has defined as
“triple negative prostate cancer.” They define such triple negative disease as
prostate cancer exhibiting the absence or the expression of only low levels of
three genes called
ERG,
ETS, and
SPINK1.
"Cancer
driver gene" reduces metastasis in prostate cancer
A gene that is responsible for cancer growth plays a totally unexpected role
in prostate cancer. The gene Stat3 is controlled by the immune modulator
interleukin 6 and normally supports the growth of cancer cells. The
international research team led by Prof. Lukas Kenner from the Medical
University of Vienna, the Veterinary University of Vienna, and the Ludwig
Boltzmann Institiute for Cancer Research (LBI-CR) discovered a missing link for
an essential role of Stat3 and IL-6 signalling in prostate cancer
progression.
Imaging
18F-Fluciclovine
PET/CT for the Detection of Prostate Cancer Relapse: A Comparison to
11C-Choline PET/CT
F-fluciclovine provided a statistically significant better performance in
terms of lesion detection rate as compared with C-choline.
Treatment
Prostate
cancer: treatment options | CPD article | Pharmaceutical Journal
Treatment of early stage prostate cancer and locally advanced disease can
involve surveillance, radical treatment or androgen deprivation therapy;
however, as the disease progresses, these options change. Although
patients may require definitive therapy as their disease progresses, active
surveillance is an important treatment option.
Radical prostatectomy or radical radiotherapy are recommended for men with
intermediate- and high-risk localised prostate cancer, where there is a
prospect of long-term disease control. However, both options are associated
with complications, including impaired sexual function.
Androgen deprivation therapy has been the mainstay for advanced prostate
cancer management; however, recently there has been a move towards initiating
hormonal treatment in younger men with early disease or recurrent disease after
definitive treatment. Advanced disease, or metastatic castrate resistant
prostate cancer, usually occurs 12–18 months after diagnosis and androgen
ablation, with a median survival of two to three years. Treatment usually
involves chemotherapy with docetaxel, but a number of newer drugs, including
cabazitaxel, abiraterone and enzalutamide, are available.
Active Surveillance
Active surveillance in prostate cancer: a critical review.
Tools for better selection of candidates and monitoring of the disease
process have evolved since the conception of AS, including new
biomarkers like phi, mpMRI and alternate biopsy strategies. AS is a
sound strategy for reducing overtreatment of men with low-risk, and
potentially selected men with intermediate-risk prostate cancer and
shorter life expectancy, without compromising overall and cancer
specific survival.
Hormone (ADT)
Dose-dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events.
Exposure to ADT with GnRH agonists is associated with an increased risk
of cardiac events in elderly men with localized PCa and a decent life
expectancy. Clinicians should carefully weigh the risks and benefits of
ADT in patients with a prolonged life expectancy. Routine screening and
lifestyle interventions are warranted in at-risk subpopulations treated
with ADT.
Surgery
Prostate
cancer: Opting for robotic surgery, Health News & Top Stories - The
Straits Times
In recent years, many centers have reported positive outcomes after using
robotic surgery to treat aggressive prostate cancer, with cancer recurrence
rates that are similar to or lower than those who had open surgery.
In such high-risk patients, removing the pelvic lymph nodes helps to reduce
the likelihood of the recurrence of cancer.
For those who find that the cancer has spread outside the prostate capsule
or involves the attached seminal vesicles, a short course of radiation may be necessary
to completely eradicate the cancer cells in the pelvis.
First
Report: Robot-Assisted Total Pelvic Exenteration for Locally Advanced Prostate
Cancer.
Pelvic exenteration is used in the treatment of several pelvic cancers,
including those of the rectum, uterus, and bladder.
We report the first case of robotic pelvic exenteration for the treatment of
symptomatic prostate cancer involving the rectum and bladder.
A six-port transperitoneal robotic approach was used. Bilateral extended
lymphadenectomy up to the inferior mesenteric artery was performed.
The rectum and bladder were removed en bloc, and a double-barrel anastomosis
was then performed with both ureters being connected to the lower opening of
the colostomy. Operative time was 249 minutes, and estimated blood loss was
600 mL.
No intraoperative or postoperative complications were recorded. Biopsy of
the rectum and bladder showed prostatic adenocarcinoma with a Gleason score of
9 (5+4), and 1 of 17 nodes was positive for cancer. Postoperative
prostate-specific antigen level was 1.24 ng/mL.
The patient is already 19 months after surgery with optimal quality of life.
Thus pelvic exenteration is a feasible alternative for highly symptomatic
prostate cancer involving adjacent pelvic organs.
Radiation Therapy
Common side
effect of radiation treatment for prostate cancer - Medical News Today
In the study, a collaboration among five institutions, researchers analyzed
1,001 men who received various types of radiation therapy for prostate cancer.
While doctors are aware that medium and high doses of radiation to the rectum
increase the risk of late rectal bleeding, this the new study found that, the
dose being equal, men with shorter rectums were more likely to suffer from
rectal bleeding. The probability of bleeding can be predicted using a
mathematical formula during treatment planning to minimize the risk.
"By reducing the dose to the edge of the area being irradiated in men
with shorter rectums, possibly using better treatment image guidance, we can
significantly reduce the risk of late-stage rectal bleeding," said Joseph
Deasy, Ph.D., chair of the Department of Medical Physics at Memorial
Sloan-Kettering Cancer Center, New York. "This formula potentially could
be put into treatment planning systems that are routinely used."
Scientists
discover why some prostate tumours are resistant to radiotherapy
In the latest studies, published in
European Urology and the
British
Journal of Cancer, scientists in The YCR Cancer Research Unit in the
Department of Biology at York have shown a direct link between these tiny
molecules – known as micro-RNAs - and resistance to radiotherapy.
Clinical
Oncology News - Mixed Results for RT Dose Escalation in Prostate Cancer
“Dose escalation to 79.2 Gy for
intermediate-risk prostate cancer did not improve the overall or
disease-specific survival. However, dose escalation did improve local control,
distant metastases–free and biochemical disease–free survival [DFS] rates,” and
was associated with less use of salvage therapy, said Jeff M. Michalski, MD,
MBA, a radiation oncologist at Washington University’s Siteman Cancer Center,
in St. Louis.
Dose-escalated radiation therapy in prostate cancer patients is included in
the National Comprehensive Cancer Network’s guidelines and commonly is used in
the United States. Five clinical trials, with study populations ranging from
300 to 850 patients, have shown that dose escalation improves biochemical DFS
rates, but these studies have failed to identify a benefit in OS. The
researchers wondered whether a larger trial would identify a survival benefit,
and thus launched the randomized RTOG 0126 trial. The trial analyzed data from
roughly 1,500 patients who received three-dimensional conformal radiation
therapy (CRT) or intensity-modulated radiation therapy (IMRT). An equal number
of patients received a minimum target volume prescription of either 70.2 Gy in
39 fractions or 79.2 Gy in 44 fractions.
Advanced;
Recurrent
When initial treatment fails, and the cancer comes back and
spreads, there are still treatments.
Molecular
biology of castration-resistant prostate cancer.
Castration-resistant prostate cancer was subjected to a paradigm switch from
hormone resistance to androgen deprivation therapy resistance during the last
decade.
Indeed, new therapeutics targeting the androgen receptor showed clinical
efficacy in patients with progressive disease under castration.
Thus, it is a proof that the AR remains a dominant driver of oncogenesis in
earlier-called hormone resistant prostate cancer.
This review summarizes the molecular mechanisms involved in
castration-resistant prostate cancer.
New Therapies
Molecule
identified that facilitates spread of prostate cancer - Medical News Today
The study is published in the journal
Cancer Cell and
was completed by researchers from the Thomas Jefferson University in
Philadelphia, PA.
The results offer a target for the development of a drug that could prevent
metastasis in
prostate cancer -
and possibly other
cancers, too.
Karen Knudsen, PhD, director of the Sidney Kimmel Cancer Center at Thomas
Jefferson University, says:
"Finding a way to halt or prevent cancer
metastasis has proven elusive. We discovered that a molecule called DNA-PKcs
could give us a means of knocking out major pathways that control metastasis
before it begins."
We think cryotherapy and another recent development, HIFU,
have a real role to play.
Unlike radiotherapy, they can be used again if the treatment
isn't successful the first time because they don't cause irreversible changes
in the surrounding healthy cells. Cryotherapy is especially useful for patients
who, like Mr Tallant, aren't suitable for HIFU.
After taking a biopsy and MRI scan to work out where to
target the treatment, the patient comes in for day surgery.
With the patient under general anaesthetic, we insert fine
needles into the prostate, using the MRI images as guidance. We insert a
catheter into the urethra and pass through a warm saline solution to protect
the area and stop the cells there freezing.
We then pass compressed argon gases through the needles into
the prostate. These cool rapidly to minus 40c and develop into balls of ice on
the ends of the needles.
After ten minutes of freezing, we run helium through the
needle to warm up and thaw the ice ball. Typically, we run through two freezing
and thawing cycles.
Chemo Therapy
Prostate
cancer patients being denied low-cost, breakthrough treatment - News -
pharmaphorum
Men with advanced prostate cancer are being
denied access to a breakthrough treatment for the disease – despite it being
low cost, and based on UK research.
The chemotherapy drug docetaxel has been around for decades, but new research
shows if used earlier, it can help men with metastatic prostate cancer live
much longer – adding 22 months of life on average.
This is a massive increase in overall survival, a huge benefit rarely seen in
any clinical trials. But NHS England and other regional bodies across the
country are currently ignoring the new evidence – this means thousands of men
could be missing out on the breakthrough and many extra months of life.
Prostate
cancer breakthrough must wait for publication, says NHS England - News -
pharmaphorum
Groundbreaking, low-cost treatment which dramatically extends the lives of
prostate cancer patients won't be recommended until after trial results are
published in a peer reviewed journal, NHS England has said.
Prostate
cancer: Abiraterone in elderly patients with CRPC : Nature Reviews Urology :
Nature Publishing Group
Abiraterone acetate seems to be effective and well tolerated in elderly
patients with metastatic, castration-resistant prostate cancer, according to
interim findings from the randomized, controlled COU-AA-302 trial.
