Category: Diagnostics, Genetics, Imaging

1) Researchers at the University of Texas Health Sciences Center in San Antonio have developed a “calculator” to predict probabilities of biopsy results based upon data such as PSA, age, race, results of digital examination and family history.  To access the “calculator” online, go to http://deb.uthscsa.edu/URORiskCalc/Pages/calcs/jsp.  The “calculator” is based on data from the prostate cancer trial that involved more than 5,800 patients to determine the risk of developing prostate cancer based upon PSA and digital rectal examinations. This information was recently cited in the October 19th Johns Hopkins Prostate Disorder Health Alerts.

2) When prostate cancer is first detected, the urologist will describe the extent of the tumor and the course of the disease using a system called the Whitmore-Jewett method or more commonly the TNM (tumor, nodes, metastasis) staging system.  The “T” value describes the extent of the tumor; the “N” value indicates whether the cancer has spread to any lymph nodes; and, the “M” value indicates the presence or absence of metastasis to distant sites. This description will help in the choice of the most appropriate treatment option. The Johns Hopkins Health Alerts (September 13th, 2014) describes the TNM stages in more detail.

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.

1) A recent article was published from the Washington University School of Medicine which compared the results of prostate cancer biopsies as guided by magnetic resonance imaging (MRI) with those obtained via ultrasound guidance. It was concluded that MRI-guided biopsies were more likely to find aggressive tumors than those that rely on ultrasound. For specific details, see the following link.

2) Another article published in Medline Plus, described a Duke University study of the effects of diet and lifestyle on prostate cancer. A diet rich in complex carbohydrates and lower in protein and fat is associated with a 60 percent to 70 percent reduced risk of prostate cancer according to the researchers. In addition, a fiber-filled diet reduced the risk of aggressive prostate cancer by 70 percent to 80 percent. The presence of metabolic syndrome factors also increased the cancer risk. Metabolic syndrome consists of a group of risk factors that increase a person’s risk of heart disease, diabetes and stroke. They include obesity, high blood pressure, elevated blood sugar levels, elevated levels of triglycerides (blood fats) and reduced levels of “good” HDL cholesterol.

3) Lastly, Columbia University researchers have identified two genes that they claim “are likely driving the most aggressive cases of prostate cancer. Other scientists had linked the genes, FOXM1 and CENPF, to cancer, but had not connected them to prostate growths. And more importantly, it was observed that the two genes’ cancer-causing effects only occurred if they are turned on at the same time. These two genes individually don’t do anything, or very little, but only when they are co-active do they produce aggressive forms of the disease.”  The presence of activity in these two genes could be determined at the time of a biopsy.  “If both genes are turned on and highly active, then men would be advised to get immediate treatment such as surgery, radiation or tumor-targeting drugs, or some combination of these. If neither gene, or only one is active, then doctors might recommend less intensive therapy while they monitored the tumors” according to the researchers.

The Johns Hopkins Health Alerts are extremely informative about various health issues including prostate cancer. The latest alert (June 14th)  discussed the Gleason Score, the most important factor in predicting the current state of a prostate cancer. The Gleason Score is based on tumor grade, which is an indication of the tumor’s aggressiveness. The tumor grade reflects how far the cancer cells deviate from normal healthy cells. See the link for the full article.