Common Hormonal Treatment for Early Prostate Cancer May Pose Cardiac Risk

I have been on a vacation but am now resuming publishing pertinent posts.

As has been written before, several potential side effects accompany hormonal therapy for prostate cancer. A MedlinePlus e mail received today from the National Institutes of Health (NIH) National Library of Medicine discussed the potential heart risk posed by early hormone suppression treatment of prostate cancer. The take-home message from a new study is that “patients with localized prostate cancer should be followed to minimize the health effects of androgen-deprivation therapy on the cardiovascular system,” said study author Reina Haque, a researcher with the Kaiser Permanente Southern California Department of Research & Evaluation. The advice given is that “patients should consider heart-healthy lifestyle changes, and physicians should actively monitor the patient’s health for early signs of heart disease.”

In recent years, there’s been an expansion in use of hormone-suppressing treatment for prostate cancer. The treatment was previously restricted to advanced prostate tumors, but now it’s being given to a growing number of men with early stage prostate cancer that has not spread to other parts of the body. However, the safety and effectiveness of androgen-deprivation therapy for these men hasn’t been investigated, the study authors said.

In the new study, researchers assessed outcomes for more than 7,600 men with early stage prostate cancer. The investigators tracked the men for up to 12 years, starting when they were diagnosed between 1998 and 2008. The researchers factored in certain heart risk factors — things such as overweight/obesity, history of smoking, diabetes, high blood pressure or if they required heart medications. The study found the men with early stage prostate cancer who did not already have heart disease, but who received hormone-depleting treatments had an 81 percent higher risk for heart failure. Meanwhile, those who already had heart disease when they received the anti-hormone treatment also had a greater risk for heart rhythm problems, including a 44 percent increased risk of an irregular heartbeat. These men were also three times more likely to develop “conduction disorder,” which occurs when electrical impulses to the heart are interrupted.

The findings allow men with localized prostate cancer to consider the positive and negative effects of androgen-deprivation therapy and discuss it with their physicians. “If they move forward with the therapy, patients should work with their physicians to adjust their lifestyle to reduce the risk of cardiovascular disease.”

 

 

Removal of Ipilimumab (Yervoy) in Proposed NCI Clinical Trial Due to Toxicity.

On May 15th, this website posted information about a Phase 1-2 clinical trial sponsored by the National Cancer Institute (NCI) of the National Institutes of Health (NIH). The proposed therapeutic regimen initially consisted of the NCI vaccine Prostvac, and two antibodies, ipilimumab (Yervoy®) and nivolumab (Opdivo®). However, toxic events recently surfaced in the use of ipilimumab in several patients necessitating its removal from this particular NCI trial. In addition, a website post dated April 11th, 2017 cited the lack of activity of ipilimumab as a sole agent in prostate cancer clinical trials. However, it was proposed that ipilimumab might be more useful in combination immunotherapy.

Mightier Than All Our Troubles; Never Measure God’s Unlimited Power by Your Limited Expectations.

 Psalm 93 states:

The Lord reigns, he is robed in majesty;
    the Lord is robed in majesty and armed with strength;
    indeed, the world is established, firm and secure.
Your throne was established long ago;
    you are from all eternity.

The seas have lifted up, Lord,
    the seas have lifted up their voice;
    the seas have lifted up their pounding waves.
Mightier than the thunder of the great waters,
    mightier than the breakers of the sea—
    the Lord on high is mighty.

Your statutes, Lord, stand firm;
    holiness adorns your house
    for endless days.

Iguazu Falls, (see this link) on the border of Brazil and Argentina, is a spectacular waterfall system of 275 falls along 2.7 km (1.67 miles) of the Iguazu River. Etched on a wall on the Brazilian side of the Falls are the words of Psalm 93:4, “Mightier than the thunders of many waters, mightier than the waves of the sea, the Lord on high is mighty!” Below it are these words, “God is always greater than all of our troubles.”

The writer of Psalm 93, who penned its words during the time that kings reigned, knew that God is the ultimate King over all. “The Lord reigns,” he wrote. “Your throne was established long ago; you are from all eternity” (vv. 1–2). No matter how high the floods or waves, the Lord remains greater than them all.

The roar of a waterfall is truly majestic, but it is quite a different matter to be in the water hurtling toward the falls. That may be the situation you are in today. Physical, financial, or relational problems loom ever larger and you feel like you are about to go over the falls. In such situations, the Christian has Someone to turn to. He is the Lord, “who is able to do immeasurably more than all we ask or imagine” (Eph. 3:20) for He is greater than all our troubles. You can pray “Lord, I know that You are powerful and greater than any trouble that might come my way. I trust You to carry me through.”

Never measure God’s unlimited power by your limited expectations.

Are there areas in your life that feel out of control? If so, you’re in good company. So many of the psalms were inspired by desperate feelings of fear and confusion. Yet they ended up as songs of hope in the God who has promised to never leave us or forsake us. But who is this God? The author of Psalm 93 identifies Him as the Lord (Yahweh). By contrast to legendary gods of war, fertility, weather, travel, or the hunt, He is the God who created the heavens and the earth (Gen. 2:4).

Consider the implications of such a Creator. Use the measure of modern astronomy. What kind of God speaks into existence billions of galaxies filled with trillions of suns far greater than our own? Yet even the cosmos is not the measure of His greatness. According to the New Testament (John 1:1–3, 14), the God of the Bible is the Lord who, in Jesus, showed that He is greater than our troubles by bearing our sins and diseases. In the weakness of His crucifixion and by the power of His resurrection, He showed that even His love for us is greater than our sin and life’s troubles whatever they may be. For information of how to have a personal relationship with such a Creator, see the following link.

 The above was an excerpt from Our Daily Bread Devotional of July 19th, 2017, published by RBC Ministries.

https://odb.org/2017/07/19/mightier-than-all-2/

If You Are Taking Taxotere for Prostate Cancer, This Blog on Minimizing Hair Loss May Be of Interest.

The Food and Drug Administration (FDA) has cleared a cooling cap—a device designed to reduce hair loss during chemotherapy—for use by patients with any kind of solid tumor. FDA initially cleared the device, the DigniCap® Scalp Cooling System, for patients with breast cancer in 2015. The expanded clearance of DigniCap is for “reducing the frequency and severity of hair loss” in adult patients with solid tumors who are receiving chemotherapy types and doses that are associated with this common side effect.

Scalp cooling, which has been used in Europe for several decades, is thought to prevent hair loss by reducing blood flow to hair follicles. Cooling the scalp causes blood vessels to constrict, which may limit the amount of chemotherapy drug that reaches hair follicles.

The DigniCap system uses a tightly fitted cap in which cold liquid circulates to cool the scalp before, during, and after chemotherapy. This cap, which is connected to a machine that regulates the cooling process, is covered by an outer cap, made of neoprene, that acts as an insulator.

The average total cost of scalp cooling ranges between $1,500 and $3,000 per patient, depending on the number of cycles of chemotherapy. Insurance does not currently cover scalp cooling treatments, according to the maker of DigniCap, Dignitana Inc., of Sweden.

For the  full article, see the following link published by the National Cancer Institute.

Biomarker Test Could Reduce Unnecessary Biopsies to Detect Prostate Cancer

Testing for two biomarkers in urine may help some men avoid having to undergo an unnecessary biopsy to detect a suspected prostate cancer, findings from a new study show.

In the NCI-supported study, researchers from Emory University in Atlanta and M.D. Anderson in Houston tested urine samples from men referred for a prostate biopsy for elevated levels of two biomarkers (RNA biomarkers called PCA3 and T2:ERG) that studies have shown are associated with aggressive prostate cancer. Restricting biopsies to only those men with elevated levels of either of the biomarkers would have reduced the number of these unnecessary biopsies by an estimated one-third to one-half, the researchers report May 18 in JAMA Oncology.

At the same time, this pre-biopsy screening approach would still “preserve the ability to detect the more aggressive cancers,” explained the study’s lead investigator, Martin Sanda, M.D., of the Emory University Winship Cancer Institute.

The PCA3 gene is expressed at high levels in prostate cancers, and a urine test for PCA3 RNA is commonly used in clinical practice to monitor for potential disease in men who have a negative biopsy following an abnormal PSA test or digital rectal exam, Dr. Sanda explained. There is also a urine test for T2:ERG, which is the result of a fusion, or translocation of parts of two different genes, TMPRSS2 and ERG. This translocation is found in approximately half of advanced prostate cancers. Currently, the T2:ERG test is only available at a few academic cancer centers.

Currently, there are hurdles to implementing this testing in everyday care, Dr. Sanda cautioned. But the study findings “clearly demonstrate” that testing for these biomarkers could help to address some of the limitations of the current paradigm for prostate cancer screening and early detection, he said. Implementing this pre-biopsy testing in clinical practice may not yet be practical because of the limited availability of the T2:ERG test.

One of the biggest challenges for researchers has been identifying a way to screen for prostate cancer that can differentiate between indolent and potentially life-threatening cancers. One approach being tested is to develop ways to better triage care decisions following an abnormal PSA test, including making more informed decisions about whether to pursue a biopsy. Prostate biopsies have risks, including pain, bleeding, and potentially serious infections. The resulting oversiagnosis and overtreatment of indolent prostate cancers identified via biopsy have their own harms and costs.

You may find it useful to discuss this article and genetic testing with your urologist if you are contemplating a prostate biopsy. For a full description of the study methodology, see the full article which appeared in the June Cancer News Bulletin published by the National Cancer Institute (NCI) of the National Institutes of Health (NIH).

 

Antioxidants and Their Colors

According to the Prostate Cancer Foundation, antioxidants play a role in the fight against cell damage and cancer development. Consuming them is highly recommended for men with prostate cancer. Different types of antioxidants can be grouped by color. For example, antioxidants in red tomatoes are identical to those in red watermelons or pink grapefruits. Antioxidants fall under six main color categories.

1) Tomatoes, pink grapefruits and watermelons contain the red antioxidant, lycopene.

2) Grapes, plums, assorted berries and pomegranates contain the red-purple antioxidant, anthocyanin.

3) Carrots, mangoes, apricots, cantaloupes, pumpkins and sweet potatoes contain the orange antioxidants alpha and beta carotenes.

4) Oranges, peaches, papaya and nectarines contain the orange-yellow antioxidant beta-cryptoxanthin.

5) Spinach, collard, yellow corn, green peas and avocados contain the yellow-green antioxidants lutein and zeaxanthin.

6) Broccoli, brussel sprouts, cabbage, kale and bok choy contain the green antioxidants sulforaphane, isothiocyanates and indoles.

7) Garlic, onions, asparagus, leeks, shallots and chives contain the white-green antioxidants allyl sulfides.

 

A Simplified Guide to the Immune System and How Immunotherapy Can Fight Prostate Cancer

The last post discussed the concept of vaccines for prostate cancer. The second part of the PCF trilogy is an overall simplified view of the immune system, including the various cell types and how they work under both normal and cancerous conditions. This section also describes checkpoint inhibitors and how they are being developed to fight prostate cancer among other types. I again will not summarize the article here but refer the reader to the well-written review in the following link.

The third section describes checkpoint inhibitors in detail focusing on successful applications as well as those scenarios wherein their effects were less than desired. While prostate cancer is the main focus, application to other cancers is also discussed.

A Must-Read Cutting-Edge Review of Immunotherapy for Prostate Cancer

I just received an e mail from the Prostate Cancer Foundation (PCF) which consisted of a three-part review of immunotherapy as applied to prostate cancer. The review consists of three parts: a) Immunotherapy, a Vaccine for Prostate Cancer; b) Who’s Who in the Immune System; and c) Immunotherapy and Prostate Cancer. The review is so enlightening that I will focus only on part (a) here. The first part discusses how vaccines and checkpoint inhibitors work; when and how they are best administered; specific immune stimulators such as Provenge, PROSTVAC and GVAX; and, combining vaccines and checkpoint inhibitors. I urge the reader to take time and read these sections. There is so much useful information here. Carefully review and digest each section as it applies to your specific cancer issue. You can follow the link above or right here.

To Be Delivered From Pressure, Trust in Jesus, Not In Yourself

Jesus said, “The birds of the air do not sow or reap, yet God feeds them. Are not you worth more than they? “Matthew 6:26;
Photo; BJ Gabrielsen

The great apostle Paul wrote that he and his colleagues were under great pressure, “burdened excessively beyond our strength so that we despaired even of life; indeed we had the sentence of death within ourselves” (as in the case of many cancer patients), “in order that we should not trust in ourselves, but in God who raises the dead.” (2 Corinthians 1:8-9).

“Under great pressure.” Can we identify with that? We all know the feeling when it seems the weight of the world is upon us. We can’t imagine how we’ll ever get through. We may even reach the point of thinking we would rather die and be done with it than have to endure any longer.

“But this happened that we might not rely on ourselves but on God.” Paul’s explanation can be ours too. Of course, we do not know the workings of God’s purposes in allowing suffering in our lives, pain that can even take us to the breaking point. However, we can always know we are to rely on Him and not ourselves while going through circumstances. That is the reason we can accept whatever circumstances we are in: God is with us.

Paul concludes (v.10) God “delivered us from so great a peril of death, and will deliver us, He on whom we have set our hope. And he will continue to deliver us.” God is our hope and deliverer, not just now in this situation. He was there in the past, and He will continue to be.

If you are unsure of your personal relationship with God, you can know for certain. See the following link.

The above was an excerpt from the Haven Ministries daily devotional, “Anchor” from May 9th, 2017.

Game-Changer: Newly Diagnosed with Metastatic Cancer and Have Not Had Hormone Therapy? Ask for Abiraterone (Zytiga).

It isn’t often that information on a “game-changing” treatment is published on four cancer websites. But such is the case herein from the National Institutes of Health MedLinePlus, Prostate Cancer Foundation, the June 12 issue of Prostate Cancer News Today and Reuters Health News.

If you have just been diagnosed with metastatic prostate cancer and your doctor wants to start you on hormone (androgen) deprivation therapy (ADT, such as Lupron), which shuts off the supply of testosterone and other male hormones, ask for abiraterone (Zytiga®) as well.  It could extend your life for years.

About 3% of the 161,000 new cases of prostate cancer diagnosed annually are metastatic where the cancer has spread beyond the original tumor. These hormone-naive men (who are just starting ADT) are often treated with a combination of the chemotherapy drug docetaxel (taxotere®) and hormone therapy. According to two recent studies (LATITUDE and STAMPEDE) presented at the 2017 meeting of the American Societyof Clinical Oncology (ASCO), chemotherapy with its undesirable side effects may now be replaced by the FDA-approved anti-testosterone pill abiraterone acetate (Zytiga®) in addition to prednisone. The studies will shortly be published in the New England Journal of Medicine. The two studies found that abiraterone lowered patients’ risk of death by nearly 40 percent when added to standard androgen deprivation therapy and prednisone. It also appeared to more than double the average time it took for a man’s prostate cancer to progress, one of the studies reports, extending the average time of progression from 14.8 months to 33 months.  It also lowered the risk of the cancer getting worse by 53 percent. Researchers state that this may represent one of the biggest survival gains ever reported in a trial in adults with solid tumor and could change then standard clinical practice overnight. For further details, see the following link to the June 5th report from MedLinePlus published by the U.S. National Library of Medicine.

Testosterone fuels prostate cancer growth, so doctors use androgen deprivation (hormonal) therapy (ADT) to prevent the testicles from producing the male hormone. However, ADT drugs do not prevent the adrenal glands and prostate cancer cells from continuing to produce small amounts of testosterone. Abiraterone, a pill taken once daily, blocks an enzyme that converts other hormones to testosterone, essentially halting production of testosterone throughout the body. The U.S. Food and Drug Administration previously approved abiraterone for patients with metastatic prostate cancer that didn’t respond to regular androgen deprivation hormonal therapy.

One of the researchers stated “what’s dramatic is how much better abiraterone works when it’s given earlier. I have never seen a treatment where you could, five years later, see no progression in some men. There are some extreme responders who get a very significant remission. It may be that abiraterone does not just stop cancer from proliferating, but it also stops, or significantly delays, cancer from mutating and becoming more resistant to treatment. The side effects of abiraterone are minimal, if you take your prednisone.”  (Low-dose prednisone is necessary with abiraterone to help the adrenal gland make sufficient amounts of cortisol.) Unfortunately, most insurance companies may not immediately realize that this is going to be the new standard of care. They may not want to pay for abiraterone, and that’s a problem, because the drug, Zytiga®, made by Janssen, is not cheap.  It costs $9,000 a month; however, a generic form of abiraterone is expected to come on the market within the next two years.