prostate

A comparison of outcomes of different eras of conservative treatment for localized prostate cancer indicates that overall and prostate cancerspecific survival rates are higher for men diagnosed from 1992 through 2002 compared to men diagnosed in the 1970s and 1980s, according to a study in the September 16 issue of JAMA.

“Among men, prostate cancer is the most common nonskin cancer and the second most common cause of cancer death in the United States. When diagnosed, prostate cancer is contained within the prostate in approximately 85 percent of cases, and standard treatment options usually include surgery, radiation, or conservative management (active surveillance or deferral of treatment until necessitated by disease signs or symptoms),” according to background information in the article. “Despite its potential as a reasonable treatment choice, however, conservative management has been used in only about 10 percent of patients, perhaps because of a limited understanding of and contemporary data on the anticipated course and outcomes of this approach.” The authors add that this lack of reliable contemporary information makes it difficult for patients and their physicians to anticipate outcomes and make informed treatment decisions.

Grace L. LuYao, M.P.H., Ph.D., of the Cancer Institute of New Jersey and UMDNJRobert Wood Johnson Medical School, Piscataway, N.J., and colleagues analyzed data for men with localized T1 or T2 prostate cancer to evaluate the outcomes of conservatively managed localized prostate cancer diagnosed in the contemporary prostatespecific antigen (PSA) era. The populationbased cohort study included 14,516 men age 65 years or older when they were diagnosed (19922002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median (midpoint) of 8.3 years (through December 2007). The median age at diagnosis was 78 years.

The researchers found that tenyear prostate cancerspecific mortality was 8.3 percent for men with welldifferentiated tumors, 9.1 percent for moderately differentiated, and 25.6 percent for those with poorly differentiated tumors. The corresponding 10year risks of dying of causes other than prostate cancer were 59.8 percent, 57.2 percent, and 56.5 percent for each respective group.

Tenyear diseasespecific mortality for men age 66 to 74 years diagnosed with moderately differentiated disease was 60 percent to 74 percent lower than earlier studies. “Survival results in our contemporary PSA era study cohort were more favorable than results previously reported. For example, in the current study, 10year prostate cancerspecific mortality was 6 percent in the contemporary PSA era (19922002) compared with results of previous studies (15 percent23 percent) in earlier eras (19491992) for men aged 65 to 74 years diagnosed with moderately differentiated disease. Improvement in survival among men with older age or poorly differentiated disease was also observed,” the authors write.

“The substantial improvement in survival that we observed in our study compared with previous reports might be explained, in part, by additional lead time, overdiagnosis related to PSA testing, or grade migration, among other factors. Prostatespecific antigen testing identifies disease 6 to 13 years before it presents clinically. Contemporary patients identified through such testing would be expected to live at least 6 to 13 years longer because of this lead time. In addition, previously documented systematic upgrading of modern tumors compared with earlier eras makes more recently graded tumors appear to have a more benign course, resulting in longer survivals. Finally, it is also possible that advancements in medical care might have led to improved outcomes.”

“The net overall effect is that outcomes following conservative management are now significantly better than those reported in previous eras; therefore, physicians and their patients may need to reconsider this management option, particularly in light of randomized trial data from the prePSA era suggesting little if any benefit to more aggressive intervention.”

JAMA 2009;302[11]12021209.

Researchers at the Keck School of Medicine of the University of Southern California (USC) have identified a novel genetic mechanism that may govern an individuals risk of developing prostate cancer.

The findings, published in the Public Library of Science (PLoS) Genetics journal, found mechanisms involved in cancerassociated sites in areas where no genes are present (gene deserts) at a chromosomal region called 8q24. The new findings show that some of these sites have embedded regulatory sequences that act as enhancers of gene expression, modulated by genetic variation, or single nucleotide polymorphisms (SNPs).

The twoyear study, conducted by researchers from USC, Harvard University and the Weizmann Institute of Tel Aviv, Israel, found novel functions of SNPs in areas where no genes were present. They found how the SNPs are able to modulate genetic expression even while they were near no genes. SNPs denote a modest increase in risk for certain diseases; in this particular chromosomal area, the SNPs appear to be influencing gene expression for prostate (and other) cancer at a genetic distance.

“The real contribution of this discovery is that we get a feel for a previously unappreciated mechanism that may be a predisposition to this disease,” said Gerhard (Gerry) Coetzee, Ph.D., professor of urology and preventive medicine at the Keck School of Medicine and principal investigator on the study. “We have unearthed a new way to understand the risk for prostate cancer.”

The study was prompted by discrepancies in prostate cancer risk among ethnic groups. Currently, risk factors for prostate cancer are governed by age, and a disproportionate increased risk chiefly among AfricanAmerican men, with Caucasian men following and Asian men last. This gene desert featuring versions of particular SNPs are found more often in AfricanAmerican men and may explain their increased risk for the disease.

The National Cancer Institute and the L.K.Whittier Foundation funded the study.

Citation
“Functional Enhancers at the GenePoor 8q24 CancerLinked Locus”
Li Jia, Gilad Landan, Mark Pomerantz, Rami Jaschek, Paula Herman, David Reich, Chunli Yan, Omar Khalid, Phil Kantoff, William Oh, J. Robert Manak, Benjamin P Berman, Brian E Henderson, Baruch Frenkel, Christopher A Haiman, Matthew Freedman, Amos Tanay, Gerhard A Coetzee
PLoS Genetics 2009 14 Aug 2009.

A new 12 month hormone therapy treatment is launched for men with advanced prostate cancer. The Vantas® (histrelin) implant is a small and flexible device, made from the same materials as soft contact lenses. Vantas® is the first 12 month implant to treat prostate cancer to be available in the UK.1

The Vantas® implant is unique in that it is placed under the skin in the upper arm and releases luteinising hormonereleasing hormone (LHRH) over a continuous 12 month period, and is an alternative treatment option to other available LHRH therapies which are currently available as treatments given every one or three months.1,2 The aim is to provide a convenient option for men who wish to continue with their lives as normally as possible with minimum disruption caused by their prostate cancer treatment.

Mr John Anderson, Consultant Urologist at Royal Hallamshire Hospital, Sheffield said “Vantas® represents a milestone in terms of opening up treatment choice for men with advanced prostate cancer that is metastatic, late stage and locally advanced types of the disease. Metastatic cancer accounts for 20 30% of men diagnosed with prostate cancer.3 The Vantas® implant is simple and quick to insert2 and means these men can continue to live life, work and travel without the need for more regular injections although it is of course still important that they keep to scheduled checkup appointments.”

Mr Anderson continued “Vantas® is also unique in that the implant can be quickly removed, which is important if side effects need to be quickly stopped.2 The side effects of LHRH hormone therapies such as Vantas® include hot flushes, impotence or decreased libido.1″

Rebecca Porta of the male cancer charity Orchid said, “Around 35,000 men are diagnosed with prostate cancer in the UK each year4 and over 10,000 will die from it.5 We welcome new treatment options that doctors can discuss with patients and their families, especially those which can offer patients an improved quality of life.”

Most men with advanced prostate cancer are recommended to have hormonal therapy6 and one of the options recommended by the National Institute for Health and Clinical Excellence is the use of LHRH agonists7, synthetic versions of the normal hormone released by humans. Vantas® is a LHRH agonist which means it inhibits the production of testosterone in the body, therefore slowing the growth of prostate cancer cells.

References

1 Vantas Summary of Product Characteristics, October 2007
2 Crawford DC, A review of the use of histrelin in the treatment of prostate cancer, manuscript 2008
3 cancerhelp.org.uk/help/default.asp?page=3505 (last accessed June 2009)
4 rostatecancermatters.org.uk/faq.asp (last accessed June 2009)
5 info.cancerresearchuk.org/cancerstats/types/prostate/ (last accessed June 2009)
6 Click here (last accessed June 2009)
7 National Institute for Health and Clinical Excellence, Prostate Cancer Diagnosis and treatment. February 2008 nice.org.uk/nicemedia/pdf/CG58FullGuideline.pdf

A new review published in the Journal of Human Nutrition and Dietetics assessed whether certain modifications in diet have a beneficial effect on the prevention of prostate cancer. Results suggest that a diet low in fat and red meat and high in fruits and vegetables is beneficial in preventing and treating prostate cancer.

Robert W.L. Ma and K. Chapman conducted an evidencebased review of dietary recommendations in the prevention of prostate cancer as well as in the management of patients with prostate cancer.

The researchers found that a diet low in fat, high in vegetables and fruit, and avoiding high energy intake, excessive meat, and excessive dairy products and calcium intake may be helpful in preventing prostate cancer, and for patients diagnosed with prostate cancer.

Specifically, consumption of tomatoes, cauliflower, broccoli, green tea, and vitamins including Vitamin E and selenium seemed to propose a decreased risk of prostate cancer. Consumption of highly processed or charcoaled meats, dairy products, and fats seemed to be correlated with prostate cancer.

“Although not conclusive, results suggest that general dietary modification has a beneficial effect on the prevention of prostate cancer,” the authors conclude. “In patients with prostate cancer, dietary therapy allows patients to be an active participant in their treatment.”

Notes Robert Ma is affiliated with The University of New South Wales. This study is published in the June 2009 issue of the Journal of Human Nutrition and Dietetics. To view the abstract for this article, please click here.

Source
Amy Molnar
WileyBlackwell

An overthecounter prostate cancer test kit could be coming to a pharmacy near you, thanks to the collaborative work of a University of Central Florida chemist and M.D. Anderson Cancer Center Orlando researchers.

UCFs Qun “Treen” Huo and M.D. AndersonOrlandos Dr. Cheryl Baker and Jimmie Colon teamed up about 18 months ago with a very ambitious plan. Huo wanted to develop an effective, inexpensive test to screen for prostate cancer that would be easy enough to use at home or a local pharmacy.

“Now cancer tests are so inconvenient and expensive, and a lot of people dont have insurance, so they are not likely to test if they have no symptoms,” Huo said. “Cancer is really scary because there arent a lot of symptoms in the early stages. So I said, Why not create a test that is easy and inexpensive? Then more people can test and catch cancer early so it can be treated early.”

Prostate cancer affects one of every six men and is the secondmost common cancer among men in the United States, according to the American Cancer Society. It is estimated that more than 2 million American men are currently living with prostate cancer and that one new case occurs every 2.7 minutes. More than 27,000 men die from the disease each year, according to the American Cancer Society.

Huo and her team at the UCF lab developed the new technique involving gold nanoparticles, which she first mixes in a solution. The nanoparticles are engineered to attach themselves to cancerproducing proteins related to the type of cancer she is targeting. When she places a drop of blood in the solution, the gold nanoparticles seek out the protein. If the protein is present, the gold nanoparticles cluster around it. Using a dynamic lightscattering instrument, she looks for the clusters. If there are no clusters, there is no cancercausing protein.

During a test, if cancerproducing proteins are detected at a significant level, the consumer would be directed to see a doctor.

“Think of it like a pregnancy test,” Huo said. “Its the same principle. Women use it to find out if they are pregnant, but once they see the results at home, they go to the doctor to be sure.”

The cancerrelated protein marker that the gold nanoparticles seek out in Huos research is the same one screened for by the FDAapproved ProstateSpecific Antigen (PSA) test. The PSA has a good track record as a protein marker for detecting prostate cancer and has been used by physicians for years. Huo said her new technique is much more sensitive and accurate than the PSA and all current techniques used in diagnostic labs.

“Whats different is the technology,” Huo said. “Its very simple. The dynamic lightscattering technique is highly sensitive and can pick up even the smallest trace amount of protein markers.”

Thats why the technique also can help doctors track any resurgence of cancer once a surgery is performed to remove it.

Dr. Baker, director of M.D. AndersonOrlandos Cancer Research Institute, collaborates with Huo by offering her expertise in cancer research and by providing human blood and serum samples to test Huos technique.

“The excitement for us here at M. D. AndersonOrlando is that we can easily test the validity of the technique in our cancer research program and then on our own patients in a clinical trial,” Baker said. “We are optimistic that we can begin clinical trials with this test within the next two years.”

Huo said that the technique is still years from commercialization, but that in three to five years an overthecounter test kit for prostate cancer is likely. The technique also can be easily adapted to test for many different types of cancer Huo plans to focus first on ovarian and breast cancer.

Source
Zenaida Gonzalez Kotala