Mutations in DNA-repair genes, including the breast cancer genes BRCA1 and BRCA2, are involved in an inherited high risk of prostate cancer and, potentially, the risk of an aggressive cancer, according to researchers at Fred Hutchinson Cancer Research Center and the University of Washington.
The study, “Inherited DNA -Repair Gene Mutations in Men with Metastatic Prostate Cancer” published in The New England Journal of Medicine, (see the following link) found the mutations in about 12 percent of men with the cancer — and found that men with metastatic prostate cancer were five times more likely than most people to have these DNA-repair gene mutations. Results suggest that screening for such mutations could help tailor their treatment and encourage family members to consider their own cancer risk.
Because BRCA1 and BRCA2 mutations have long been associated only with breast and ovarian cancers, it was thought that the mutations only affected women.
The team analyzed 20 DNA-repair genes in metastatic prostate tumors and healthy tissues of 692 men. They found that 16 of the genes were mutated in both malignant and healthy cells in 12 percent of the metastatic cancer patients — much higher than researchers ever suspected, said first author Dr. Colin Pritchard.
The findings are also important because men with advanced prostate cancer who have the mutations in DNA-repair genes could be treated with PARP inhibitors or platinum chemotherapy (cis-platin) which is commonly used in breast cancer patients. Although not yet approved for prostate cancer treatment, the treatments are on fast-track review by the U.S. Food and Drug Administration.
“For men with metastatic disease who are found to have these mutations, there are very clear treatment implications that would not otherwise be considered for prostate cancer. It would essentially expand [the patients’] toolbox of treatments,” Cheng said. The researchers hope the findings will lead to future coverage by insurance companies.
The study authors state that it may be of interest to routinely examine all men with metastatic prostate cancer for the presence of germline mutations in DNA-repair genes. Future work by investigators will focus on determining which mutations predispose patients to the most aggressive type of prostate cancer.
The National Cancer Institute (NCI ) of the National Institutes of Health (NIH) also recently published a Cancer Currents Blog on the same subject. See the following link.
In an article published in the journal Cancer Epidemiology, Biomarkers & Prevention (2016, Jan. 25), researchers at the National Cancer Institute (NCI) of the National Institutes of Health (NIH) document an association between higher serum levels of vitamin D and an increased chance of surviving prostate cancer. The current investigation included 1,000 participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study who were diagnosed with prostate cancer following enrollment. Just over 360 subjects died from their disease over 23 years of follow-up from the time of diagnosis. Serum 25-hydroxyvitamin D levels and other factors were measured upon enrollment and questionnaires concerning diet and medical history were completed by all participants. Among men whose vitamin D levels were among the top 20% of subjects, there was a 28% lower average adjusted risk of dying from prostate cancer compared to those whose levels were among the bottom 20%. The effect was stronger among those who survived more than 3.3 years. If these conclusions are validated, vitamin D supplementation could eventually be considered for men diagnosed with prostate cancer.
Prostate cancer patients who undergo radiation treatment, especially brachytherapy, are at increased relative risk of bladder cancer according to new study findings presented at the American Urological Association 2016 annual meeting by researchers from Albert Einstein College of Medicine in New York. This increased relative risk occurs predominantly after 10 years. Bladder tumors found in men following prostate radiotherapy are generally lower stage but higher grade than tumors found in patients without a history of prostate cancer the study showed. Compared with men without a history of prostate therapy, brachytherapy was associated with a 3.5-fold, 2.9-fold, and 5.5-fold increased risk of bladder cancer after 10 years in Caucasians, African Americans, and patients of other or unknown races, respectively. Albert Einstein researchers arrived at their conclusion by analyzing data from the 1973–2011 Surveillance, Epidemiology and End Results (SEER) database to ascertain the observed and expected number of bladder cancer cases after prostate cancer radiotherapy. Radiation cystitis, often manifested years later, is another potential undesirable side effect of radiotherapy. For further details, see the following link.
Still another large cohort study published in the journal Cancer showed that the risk of colorectal cancer (CRC) is increased following a diagnosis of prostate cancer. This suggests CRC screening should be considered following a prostate cancer diagnosis, especially among those undergoing radiotherapy.
I have written quite a few blogs on this website the purpose of which was to encourage men with prostate cancer. Personally at the time I wrote them, I found them to be an encouragement to me as well. However, at this moment in time, I find myself in the role of “encouragee” as opposed to “encourager”. Hence I am asking myself some hard questions. I have a serious but non-life threatening condition related to prostate cancer. I was told it could be “cured” with 40-60 specific treatment sessions. I also believed that God had opened the doors for me to receive these treatments at this particular time. But after about 40 treatment sessions, I found my condition worsening. It would improve after a few treatments, getting my hopes up, only to have them dashed when my condition worsened somewhat. I found myself questioning why God was not delivering me from this condition as He seemingly promised or at least I had anticipated. Perhaps some of you who read this have found yourself in a similar situation related to prostate cancer or other conditions. So I asked myself, “do I really believe all the things I have written?” and the Biblical references (“spiritual medicines”) I have quoted? When I don’t see God’s hand working in my situation as I had hoped or hear His encouraging words, do I still trust Him? I am not alone in this situation as famous Biblical men such as Abraham, David, Job and Elijah asked the same question many times. For example, early on Abraham struggled with doubt. His efforts to produce a son by his servant instead of his wife was a less-than-successful effort to bring about God’s promise through human effort. But in the end, when his son Isaac was conceived through Sarah his wife, Abraham was strengthened in his faith and gave glory to God being fully persuaded that God had power to do what He promised. God waited until Abraham and Sarah were too old to have children by any other means than divine intervention to show that the promise came from God. Meanwhile, as I continue my multi-week therapy. what have I learned over these weeks?
As stated above, these weeks have been a roller coaster of worry, anxiety, and the “what if” fear that I might have to live my entire life with this condition. Worry defeats us when it replaces needed rest with fearful emotion. Reacting in fear based only on emotion or incomplete facts will detract from our present quality of life status while doing nothing to prepare us for the future. The Bible treats “worry” as an emotion of choice that impedes our relationship with our heavenly Father. The primary New Testament word for “worry” (merimnao) means “to be anxious, distracted or have a divided mind”. It is an emotion or state of mind in direct opposition to “trust”. Anxiety becomes our alternative to relying on the faithful presence and provisions of God. Merimnao is the word Jesus used when He said “do not worry about your life” (Matthew 6:25). Paul also used it when he wrote “Be anxious for nothing” (Philippians 4:6). A familiar hymn states “day by day and with each passing moment, strength I find to meet my trials here. Trusting in my Father’s wise bestowment, I’ve no cause for worry or for fear.”
Over the weeks, I have come to realize, practice and rely on the following four-discipline solution to “worry” namely to “read, pray, trust and submit (obey).” The first discipline “read” means to read at least a small portion of God’s Word daily asking God to specifically show how His Word applies to my individual situation. The second discipline “pray”, basically means to communicate with God, telling Him exactly how I feel and sense my current situation. Pour out my heart and hopes before God. However, it also includes a time to “be still and know that I am God” (Psalm 46:10) thereby allowing God to speak to me through His Spirit. The third discipline “trust”, is often the most difficult. It demands that we trust God for things we cannot control; releasing them, not into thin air, but to God. But who else could we trust other than God for the things we cannot control? The fourth principle is “submit or obey”, laying our burden totally down at Jesus’ feet. Set the burden down and step back from it. God wants us to submit our burdens and obey Him in all things we can control as He reveals them to us.
The four disciplines, reading , praying, trusting and obeying interact with one another. This interaction means that there are some things for us to do. But as we do them, it sets God free to do the things only He can do. So we find less and less reason to worry.
These four disciplines cultivate a more intimate relationship with God through Christ, developing more confidence in Him. He begins to prove His sufficiency at small levels leading to trusting Him more and more. God can do more for us than anything we are feeling at a given moment. We are able to root ourselves in God’s love and promises even when our feelings and emotions are telling us something different.
Great pain often drives us to God. Holding on to hope can be difficult when miserable circumstances show no signs of improving. For believers, this can be even more discouraging because we know God could have fulfilled our hopes but didn’t. Sometimes what we strive to hold can be kept only by surrendering it to God. This applies to our hopes as well as to our very lives (Luke 9:24). He alone can fulfill our desires or change them to match His will.
The bottom line is when “push comes to shove”, medical help carries us just so far for which we are grateful; but God, His Son Jesus and the Holy Spirit may be all we have but are all we need now and forever. Read, pray, trust, obey! Don’t drift but stay anchored in God’s Word and promises. “Peace I leave with you, my peace I give to you; not as the world gives do I give to you. Let not your heart be troubled neither let it be afraid.” ( John 14:27).