Prostate Cancer News - 2015-06-30
Choices you can make to influence the odds. Detection, Diagnosis, and Treatment
I recently completed Radical Prostate Surgery and Adjuvent ADT plus IMRT
Radiation treatment at Moores. I can recommend it for quality of care
with minimal side effects.
Choices you Make
Are you an “Illustrated Man”? | THE "NEW" PROSTATE
CANCER INFOLINK
Heavily tattooed men with prostate cancer should be aware that there is a low risk — and probably only a very
low risk indeed — that tattoo ink can migrate to the pelvic lymph nodes
leading to misdiagnosis of node-positive prostate cancer when such
patients are given PET/CT scans.
Screening and Diagnosis
The original Gleason system was developed between 1966 and 1974. It was complex, with 25 potential scores. Now, the latest version divides prostate cancer into five groups, numbered simply from 1 to 5, in order of aggressiveness.
Vanderbilt-led
study finds significant drop in new prostate cancer diagnoses - Medical News
Today
A new study led by Vanderbilt University Medical Center investigators found new diagnoses of
prostate cancer
in the U.S. declined 28 percent in the year following the draft
recommendation from the United States Preventive Services Task Force
(USPSTF) against routine PSA screening for men. The new research, led by
first author Daniel Barocas, M.D., MPH, assistant professor of
urological surgery and medicine, was posted online in the June 15 issue
of
The Journal of Urology in advance of publication.
Dr. Guo and colleagues combined the Company's enhanced Barocycler
NEP2320 instrument and MicroPestle consumable ("PCT-HD") with AB Sciex's
SWATH-MS mass spectrometric system (together, "PCT-SWATH") to permit
what they characterize as the high throughput, reproducible,
quantitative profiling of proteins in biopsy tissues. The authors
concluded that PCT-SWATH (i) separated previously
histologically-indistinguishable tissue biopsy samples, and (ii)
identified new protein biomarker candidates for more precise
classification of prostate cancer. The authors indicated their results
await further validation in independent studies.
Prostate
cancer screening said to be “not cost effective”
A clinical research team based on New Zealand (
Lao et al.) came to this conclusion
after evaluating a wide range of published data on the costs associated with
screening for and treating prostate cancer, including the cost per cancer
detected, the estimated costs per life-year saved, and cost per
quality-adjusted life year (QALY) gained.
The most interesting information in this study actually appears to be the
extraordinary range of the estimated economic costs: from $3,000 to $729,000 in
the US alone for the estimated cost per life-year saved.
The authors argue that
- The most appropriate data for economic evaluation of prostate cancer
screening should be the cost per QALY gained.
They then go on to note that
- The estimated costs per QALY gained by prostate cancer screening were
significantly
higher than the cost-effectiveness threshold.
Of course the authors’ conclusion can only be reached — or justified — on a
societal level (as opposed to an individual level). The cost-effectiveness of
annual screening for prostate cancer risk among known groups of high-risk
individuals may be a great deal higher than the cost-effectiveness of annual
screening for every man in America aged between 45 and 75.
Lao
C1,
Brown
C,
Rouse
P,
Edlin
R,
Lawrenson
R.;
Economic evaluation of
prostate cancer screening: a systematic review.
Future Oncol. 2015;11(3):467-77. doi: 10.2217/fon.14.273.
Tests
Imaging
Award-winning
agent developed for prostate cancer diagnosis and treatment - Medical News
Today
Prostate-specific membrane antigen (PSMA) is a surface protein that
is normally present on healthy prostate cells, but is found at much
higher levels on
prostate cancer
cells. It is barely found in the rest of the body. "Therefore, PSMA is
an ideal target for diagnostic purposes as well as targeted therapies
against prostate cancer," says biotechnologist Dr. Matthias Eder of the
German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ).
Eder's group has developed a small molecule (PSMA-617) that is capable
of specifically attaching to PSMA and can be labeled with various
radioactive substances, called radionuclides.
Turning
up the volume on prostate cancer: RIT research on targeted molecular imaging
could improve detection and treatment - Medical News Today
"There is no reliable imaging screen for early prostate cancer," said
Schmitthenner, research professor in RIT's Department of Chemistry and
Chester F. Carlson Center for Imaging Science. "Initial diagnosis is
dependent on measurement of PSA (prostate-specific antigen) levels
followed by confirmation via biopsy. Prostate biopsies can be painful
and can have side effects.
Ultrasound guidance without a targeting compound is unreliable and often necessitates repeated biopsy for a positive diagnosis."
Schmitthenner is creating a targeted molecular probe for prostate cancer
for use in conjunction with photoacoustic imaging. This emerging
diagnostic medical technology combines activation by laser light and
emission of ultrasound waves to differentiate between cancerous and
healthy tissue.
Cancer cells coupled with fluorescent dyes light up like fireflies.
Cells capped with these dyes also absorb heat from the laser and expand,
producing acoustic waves like a faint buzzing noise.
"I like to say we make the cancer scream," Schmitthenner said.
The cellular scream detected via ultrasound waves shows up as glowing patch of cancer on a digital screen.
The design of Schmitthenner's compounds represents a new kind of
architecture for targeted molecular imaging agents and is based on his
patent-pending design. The patent application lists Schmitthenner and
three of his former students, RIT graduates Taylor Barrett, Stefanie
Beach and Chelsea Weidman. Their modular approach to building compounds
around a chemical scaffold can be modified to target a variety of
cancers using different contrast dyes and medical imaging technologies.
Guidelines
The NCCN patient guidelines have “come of age” | THE
"NEW" PROSTATE CANCER INFOLINK
Version 1:2015 of the
NCCN Guidelines for Patients | Prostate Cancer is still
not a perfect document. For example:
- Detailed information about active surveillance and watchful waiting as management strategies is limited.
- There is still no reference to focal therapy for men with small amounts of low- or intermediate-risk, localized prostate cancer.
- There is no discussion of intermittent androgen deprivation therapy as a strategy in the management of M0 or M1 disease.
However, as a whole this 100-page booklet now provides the newly
diagnosed patient and his family with a very thorough introductory
overview of the management of prostate cancer. It is neutral in its
views about the different types of therapy. It is freely available on
line. And it gets updated on a regular basis.
Risks
The complexity of assessment of prostate cancer risk | THE
"NEW" PROSTATE CANCER INFOLINK
By creating prostate cancer risk models based on 105 genetic
mutations that have previously been confirmed as being associated with
prostate cancer risk, the research team was able to show that
- Each of these genetic variants has a modest impact on risk for prostate cancer.
- Men with combinations of these DNA variants that placed them among
the highest 10 percent for risk were more than six times as likely to be
diagnosed with prostate cancer compared to the men who ranked among the
lowest 10 percent for prostate cancer risk.
In other words, one’s risk for clinically meaningful prostate cancer
goes up in proportion to the number of mutations you carry that are
significant for such risk. This is hardly a surprise, but it does
emphasize the complexity of the problem. Instead of needing to test a
patient for a single gene modification (e.g., the
BRCA1 or
BRCA2
gene), we are actually going to need to look at models that test for
100+ genes … and then we have to be able to create mathematical models
that can assess clinical risk based on the expression of combinations of
the mutant genes.
Therapies
Prostate cancer devices market to grow at a CAGR of 13.48% over the period 2015-2019
This report covers the present scenario and the growth prospects of the
global prostate cancer devices market
for the period 2015-2019. To calculate the market size, the report
considers revenue generated from the sales of prostate cancer devices
based on their applications.
Types of applications:
- External beam radiation therapy
-
Radical prostatectomy
-
Brachytherapy
-
Cryotherapy
-
HIFU
The report includes revenue generated from the following regions:
Americas, APAC, and EMEA. It presents the vendor landscape and a
corresponding detailed analysis of the top six vendors in the market.
The vendor landscape in this report focuses on those vendors that
provide access to new prostate cancer devices.
Radiation
Hormone
The researchers have
shown that men who start immediately have a 15 per cent greater chance
of being alive six years later than those who wait for symptoms before
commencing therapy.
But there is a price
for starting early. While the complications of the cancer are likely to
occur later, the men are at a greater risk of the side effects of
hormone therapy.
This is the first study to quantify the benefit
of early hormone therapy in the PSA era, according to Gillian Duchesne,
professor of radiation oncology at Melbourne's Peter MacCallum Cancer
Centre.
Statin delays recurrence by an average of 10 months.
Should
all patients starting on ADT be on a statin too? | THE "NEW" PROSTATE
CANCER INFOLINK
Harshman et al. did two things:
- They carried out laboratory studies to demonstrate that the use of
statins can interfere with the uptake of dehydroepiandrosterone sulfate
(DHEAS) — a known precursor of testosterone. (And they had previously
shown that DHEAS is a substrate for another molecule called SLCO2B1, and
that statins use SLCO2B1 to enter cells.)
- They looked back through the available data on the cohort of 900+
patients treated with ADT through the Dana-Farber Cancer Institute in
Boston to assess how many of those patients were on statin therapy at
the time of initiation of ADT and whether being on a statin appeared to
affect patient outcomes over time.
With respect to the second part of the study, here is what they found:
- 283/926 patients in their ADT cohort (31 percent) were taking a statin at the time of initiation of ADT.
- Average (median) follow-up was 5.8 years.
- During the follow-up period, 644/926 patients (70 percent) exhibited disease progression while receiving ADT.
- Average (median) time to disease progression (TTP) while on ADT was 20.3 months.
- For men on statin therapy at initiation of ADT, median TTP was 27.5 months.
- For men not taking a statin at initiation of ADT, median TTP was 17.4 months
- This difference was statistically significant (P < 0.001).
- The association was still statistically significant after adjusting
for predefined prognostic factors (adjusted hazard ratio [aHR] = 0.83; P = 0.04).
Chemo
the results of the STAMPEDE trial were
presented, showing that adding docetaxel up front with androgen
deprivation therapy was useful in men with metastatic disease, positive
nodes, or very high-risk node-negative disease.
[2]
After the trials presented over the past 2 years, there is little doubt
that docetaxel should have a very real role in up-front therapy for
prostate cancer. We do not know that it has a role in biochemical-only
recurrence at this point, however.
Assessing
the “value” of new drugs in the treatment of [prostate] cancer | THE
"NEW" PROSTATE CANCER INFOLINK
As a society, here in America and in other countries around the world,
we are not going to be able, successfully, to sustain the current
business model, in which smaller and smaller health benefits are
associated with higher and higher costs to society and to individual
patients, particularly in the treatment of late stage diseases
of any type.
Trying to cure leukemia in a child who has 60+ years of productive life
ahead of it is one thing. … Adding 3 months of non-productive life to
an 80-year-old person with a possible life expectancy of another 3 years
in quite a different thing. … Are they
really “worth” the same? By comparison, even though they are expensive, some of the new drugs now available to treat hepatitis C
can actually cure
many people of the disease with a single course to treatment. Clearly
that is a whole different scenario … and maybe we do need to work out
how to “pay the piper” for a benefit that high.
Side Effects
ED
worsened, testosterone levels decreased by some treatments of prostate
enlargement - Medical News Today
Men with benign prostate enlargement who used finasteride (also known as
proscar and propecia) to treat their condition, experienced worsening
erectile dysfunction (ED) that did not resolve with continued treatment. In addition, they experienced a reduction in their
testosterone
levels leading to hypogonadism (little to no production of sex
hormones). However, men who used tamsulosin (flomax) experienced none of
these adverse side effects.
The researchers found that in the testing and validation cohorts,
PCCI score and age correlated with similar hazards of other-cause
mortality. Equivalent risks were seen for each 6-year increase in age at
diagnosis of greater than 60 years and for 1 additional PCCI point. The
age-adjusted PCCI scores were strongly predictive of other-cause
mortality. For a score of 0, 1 to 2, 3 to 4, 5 to 6, 7 to 9, and 10+,
the subhazard ratios of other-cause mortality versus 0 were 2.0, 4.0,
8.7, 14.7, and 43.2, respectively; 10-year cumulative incidence of
other-cause mortality was 10, 19, 35, 60, 79, and 99%, respectively.
"The age-adjusted PCCI strongly stratifies the risk of long-term,
other-cause mortality," the authors write. "It may be incorporated into
shared decision-making to decrease overtreatment of older and
chronically ill men with prostate cancer."
There’s life after prostate cancer | USC News
Developing fat and losing muscle mass are common side effects. Some men experience hot flashes and develop osteoporosis and other feminizing effects, including genital shrinkage and breast development.
And while some side effects may subside once treatment is complete, the accumulation of fat and loss of muscle, which can diminish overall physical function, persists even after the treatment is done.
Kiwata knew that many prostate cancer patients need a rigorous program of diet and exercise tailored to combatting the unwanted side effects of hormone therapy to meet their goals.
She designed a 15-week program for men over 50 undergoing ADT and set out to prove scientifically that this course of exercise and protein supplementation can help.
Recurrence
Astellas, Medivation initiate TRUMPET registry study | THE
"NEW" PROSTATE CANCER INFOLINK
The goal of the TRUMPET registry trial is to give us all greater insight
into the management of advanced prostate cancer by describing and
evaluating patterns of care and disease assessment methods, as well as
identifying factors that influence physician treatment decisions and
settings, referral patterns, and patient characteristics associated with
these factors. TRUMPET will also describe factors influencing treatment
decisions — including reason(s) for treatment choices and triggers for
treatment changes for CRPC — and clinical outcomes based on patient
characteristics.
