July 2014 – God And Prostate

Encouragement from a Friend Experiencing Testing

Sunset over Charlotte Harbor, Florida; BJ Gabrielsen, photo.

As the purveyor of this website, I occasionally hear from other men who relate their experiences with prostate cancer. I’d like to recount the testimonial of one such person whom I know well. He has asymptomatic but metastatic prostate cancer and had been receiving intermittent hormonal therapy for eight years. His PSA had a rapid doubling time which worried his physicians to some degree but his on-going therapy seemed to be starving the prostate cells of the testosterone needed for their growth. His PSA would be reduced to nearly undetectable levels, then would rise again when therapy was discontinued. His hope was that God would enable the on-going intermittent therapy to be effective for many years to come. On a recent visit, his oncologist noticed that the reductions in PSA levels upon receiving therapy were not reaching as low a value (around 0.1 ng/mL) as they had previously and that the times “off” from therapy were getting shorter. These conditions could indicate that he was becoming resistant (refractory) to the therapy. If this were to be the case, then additional therapeutic agents would be needed such as taxotere (with its undesirable side effects), Zytiga or Enzalutamide. The eventual result would be the unrestrained growth of prostate cells which did not require external testosterone for their survival. My friend was initially devastated. His hopes and faith that God would maintain his “chronic” condition indefinitely were being severely challenged. He would see himself running out of therapeutic options and facing a painful death quicker than he had anticipated. After spending a restless night of sporadic sleep, the next morning he decided to read his Bible and related devotionals to seek some answers, if any, from the Lord.

First, he read from Isaiah 61:1-3 where God is speaking through the prophet Isaiah saying the following. “The Spirit of the Lord God is upon me, because the Lord has appointed me (Isaiah) to bring good news to the afflicted. He has sent me to bind up the broken-hearted,……giving them the mantle of praise instead of a spirit of fainting, so they will be called oaks of righteousness, the planting of the Lord that He may be glorified.” The accompanying devotional had a quote from 16th century John Calvin’s sermons from Job which stated “…..if God sends us such great afflictions that we are as it were swallowed up, let it not cause us to despair….but let us resist it, knowing that God still reserves mercy ready for us at the proper time. And if we languish more than we would wish, let us know that God will let the illness ripen in order to heal it better.” My friend went on to recount that when we pray for a specific issue, we must come to the throne of God in submission, trust and gratitude if we are to hear the truth from our caring Father. Thus, when we realign our personal wills with God’s perfect will, then perfect peace is a resulting by-product. God will then give us the desires of our heart according to Psalm 37:4, “delight yourself in the Lord and He will give you the desires of your heart.” Additionally, my friend had been challenged by the question, “do you feel chained to difficult circumstances?” The answer was that only God can provide contentment. Lasting satisfaction can be found only with Him, for in His “presence is fulness of joy; at His right hand are pleasures forevermore” (Psalm 16:11). Our view of changing circumstances and contentment is a personal choice. The way we view our circumstances is more important than the circumstances themselves. The Apostle Paul writes in Philippians 4:11, “I have learned in whatever state to be content.” Paul drew his ultimate satisfaction from His personal knowledge of a God who never changes. “Let us hold fast the confession of our hope without wavering, for He who promised is faithful,” according to Hebrews 10:23. When all we have is God, we have all we need. Finally, it will be interesting to see the next chapter in my friend’s on-going saga. He left me quoting Jeremiah 17:7-8. “Blessed is the man who trusts in the Lord and whose trust is the Lord. For he will be like a tree planted by the water, that extends its roots by a stream and will not fear when the heat comes; but its leaves will be green and it will not be anxious in a year of drought nor cease to yield fruit.”

High-Grade Prostate Cancer Associated with Chronic Inflammation

In an online April 18th, 2014 publication in the journal Cancer Epidemiology, Biomarkers and Prevention, Johns Hopkins researchers reveal a link between chronic inflammation and a greater risk of high-grade prostate cancer. The study included 191 men with prostate cancer and 209 controls without the disease who received a placebo in the Prostate Cancer Prevention Trial, which evaluated the effect of the drug finasteride on prostate cancer prevention. Biopsies conducted at the end of the study provided information on the presence of inflammation in benign prostate tissue. Among men who had inflammation in one or more of the biopsy cores, there was a 78% higher risk of having prostate cancer and more than twice the risk of aggressive disease in comparison with men who had no cores indicating inflammation. This observational study reveals an association between prostate inflammation and prostate cancer, although it is not proof that inflammation is the cause of prostate cancer.

Possible Link Between Low Vitamin D Levels and Prostate Cancer Risk

A recent study published in Clinical Cancer Research, (May 1, 2014; 20; 2289-99) indicated that men at risk of prostate cancer are more likely to develop an aggressive form of the disease if they are deficient in vitamin D. University of Illinois – Chicago and Northwestern University researchers examined data from 667 men aged 40 to 79 who had elevated PSA levels or other prostate cancer risks. The men were screened for vitamin D levels. In general, normal blood levels of 25-hydroxyvitamin D range from 30-80 ng/mL. Typical values for men in the study were under 20 ng/mL. About 44% of men with positive biopsies had low vitamin D levels. Among the men who had a positive cancer biopsy, those with very low vitamin D levels (under 12 ng/mL) had greater odds of more advanced and aggressive cancers than those with normal levels. The lower the vitamin D level, the greater the risk. It should be noted that while 25-hydroxyvitamin D is known to impact growth of both benign and malignant prostate cells, this is the first study to link vitamin D deficiency and biopsy outcomes in high-risk men. The authors note that “vitamin D deficiency could be a biomarker of advanced prostate tumor progression in large segments of the general population”, however, more research is needed. But it would be wise for men to be screened for vitamin D deficiency using the 25-hydroxyvitamin blood test and treated if needed.

Two Blood Tests That Can Help Determine the Need for a Biopsy.

The latest edition of the Johns Hopkins Health Alerts (July 9th) cites two blood tests that can provide important information which, when coupled with a physician’s clinical judgment, can more accurately predict the need for a biopsy to confirm or deny the presence of prostate cancer. The Prostate Health Index (phi test) measures blood levels of PSA, free PSA and an early precursor of PSA called proPSA or p2PSA. The 4Kscore measures total, free and intact PSA and in addition, measures an enzyme called human kallikrein2 (hK2) which is elevated in men with prostate cancer. The significance of these test results in discussed in the linked article. One must keep in mind that these tests are new and do not have a long track record of results. They can also be marketed without proof of benefit. For more information, see the April 24th, 2014 blog post on this website.

TAK-700 Development Halted Due to Poor Phase III Trial Results.

Takeda Oncology Company and Millenium announced recently that they are halting the development of TAK-700 (Ortoronel) due to poor Phase III trial results in men with metastatic prostate cancer who have not had previous chemotherapy. The drug failed to extend survival time. TAK-700 has been previously discussed in blogs published on this website on June 3rd and November 21st, 2011. TAK-700 is an oral, non-steroidal, androgen (e.g. testosterone) synthesis inhibitor. End points of the clinical studies also included delay in disease progression in addition to extending survival time.

New Prostate Cancer Drug, ODM-201, to Enter Phase III Clinical Trials.

It was recently announced that the Finnish drugmaker Orion Corporation and Bayer Pharmaceuticals have entered an agreement to jointly develop Orion’s ODM-201, an oral, androgen receptor inhibitor. Bayer and Orion plan to jointly start the clinical Phase III program in 2014 to further evaluate the efficacy and safety of ODM-201 in patients with non-metastatic castration (hormone)-resistant prostate cancer. These patients are at high risk of developing metastatic disease and can be identified due to rapid Prostate Specific Antigen (PSA) increases. Phase II clinical studies of ODM-201 demonstrated it to be efficacious and well-tolerated. Eighty-six percent of patients who had not received earlier chemotherapy or abiraterone (Zytiga) experienced a greater than 50% PSA decrease at week 12 on a dose level of 700 mg twice a day. ODM-201 disrupts a tumor cell’s ability to use testosterone by binding with high affinity to the androgen (testosterone) receptor (AR) protein on cells, thereby inhibiting its cellular function. The AR normally binds to testosterone (which fuels prostate cancer) inside the cell and ushers it into the cell nucleus where it enhances cell growth. ODM-201 has similar activity to the anti-androgen drug enzalutamide.