Genomic Health Inc., a cancer diagnostics company, recently announced they are now marketing a genomic test for men diagnosed with prostate cancer that will provide better information on how likely it is that their prostate cancer is an aggressive form of the disease needing immediate treatment, or a slow-growing, low-risk form of prostate cancer that can safely be monitored over time for signs of progression. The new assay, Oncotype DX Prostate Cancer Test, will potentially give tens of thousands of men increased confidence that they can safely forego aggressive treatment and instead enter a program of active surveillance, where their tumor is monitored over time, deferring surgery or radiation and potentially avoiding the sexual and/or bowel and bladder dysfunction side-effects that can result from those treatments. The new test—a 17-gene predictive “signature”, measures the amount of ribonucleic acids (RNA) expressed by these various genes, with some genes making large amounts of RNA and others making little. Seven separate studies by Genomic Health Inc., involving over 1,000 men diagnosed at biopsy with prostate cancer have shown that in men whose tumors turned out to be high-risk, those men tended to test positive for this 17-gene “signature.” The Oncotype DX Prostate Cancer Test currently costs about $3,800 and is not covered by insurances at this time. For further information, please see the May 9th and May 31st issues of the Prostate Cancer Foundation (PCF) NewsPulse.
Category: Diagnostics, Genetics, Imaging
Predicting Outcomes and Characterizing Prostate Tumors.
bjgabrielsen photo.
For a newly-diagnosed prostate cancer patient, the three most important initial parameters are the blood levels of prostate-specific antigen (PSA) and its rate of increase, the biopsy-based Gleason score that ranks a tumor’s aggressiveness, and the clinical stage of the tumor based on its physical appearance. In the early 1990’s, Dr. Alan Partin, currently director of Urology at the Johns Hopkins Hospital in Baltimore, MD, formulated the Partin Tables using data comprised of the three parameters above as a statistical modeling tool to predict the stage of cancer spread at the time of performing a radical prostatectomy and to assess the chance of a surgical cure. These tables were based primarily on data from men treated in the 1980’s who often were diagnosed with later-stage cancers. The tables have recently been updated with data from over 5,000 men treated at Johns Hopkins between 20o6-2011 and published in the British Journal of Urology International. The revised study found that men treated during this period were more likely to be diagnosed before their PSA had risen significantly and were more likely to have a Gleason score greater than six (6) at the time of biopsy. According to Dr. Partin and his colleagues, the updated Partin Tables show that “surgical cure may be possible for a greater percentage of men especially those whose Gleason scores (such as 8) put them at the high end of intermediate risk.” The updated tables also found that the majority of men who are diagnosed prior to surgery with intermediate Gleason scores of 6 or 7 had a very low (less than 2%) risk of having prostate cancer spread to surrounding lymph nodes. These terms are defined and discussed in more detail in an article published in the January 2013 issue of NewsPulse from the Prostate Cancer Foundation.
The Johns Hopkins Prostate Disorders Health Alerts recently published (Feb. 14th, 2013) a short article defining the terms used in the TNM (tumor, nodes, metastasis) staging system used to define a cancer’s clinical stage or how far it has spread. The TNM prostate cancer staging system is a predictor of the extent of the disease and is useful in choosing the best course of treatment.
A related study describing the effects of exercise on prostate cancer survival was recently published in the Journal of Clinical Oncology and summarized in the January 24th issue of the Johns Hopkins Prostate Disorders Health Alerts. Data was received from 2,705 men followed for a period of 18 years. The study concluded that any type of regular exercise improved overall prostate cancer survival regardless of the intensity of the exercise. However, men who took part in vigorous activity, defined as at least three hours of intensive exercise per week, had a significantly lower (61%) risk of dying from prostate cancer.
Updates on Active Surveillance (AS) for Prostate Cancer.
Active Surveillance (AS) is a monitoring program with possible application for patients diagnosed with low-risk prostate cancer. It is gaining popularity as a means to avoid overtreatment of indolent, slow-growing prostate cancers. The likelihood of harboring small bits of prostate cancer in a man is about equal to his age as a percentage. For example, in men age 50-70 (the key age group for diagnosing prostate cancer), around 60 percent of men will have small bits of prostate cancer. An example of a good candidate for AS would be a man with a mildly elevated PSA (less than 10) whose biopsy shows a relatively small amount of Gleason 6 prostate cancer. During active surveillance, prostate cancer is carefully monitored for signs of progression using a PSA blood test, a digital rectal exam (DRE) and a repeat biopsy of the prostate at one year and then at specific intervals thereafter. Subsequent treatment might be initiated if symptoms develop, or if tests indicate the cancer is growing. Recently, multiparametric magnetic resonance imaging (MRI) has also emerged as a tool in monitoring patients on AS. A new retrospective study published in the Journal of Urology (and summarized in the Jan. 23, 2013 issue of the Prostate Cancer Foundation NewsPulse) looked at a group of 262 men who were placed on a program of active surveillance in order to determine the rate of disease progression and time frames the men remained on active surveillance before moving to active treatments such as surgery, radiation or cryotherapy. During the follow-up period (a median of 29 months), 16 percent of the patients in the study ultimately received active treatment for their cancers. The authors found that the two-year probability of the men to remain on active surveillance was 91 percent; at 5 years, 75 percent. This study “provides short-term evidence that for highly-select patients, AS appears to be safe, durable and associated with low but finite risk of disease progression.” Larger and longer-term studies are needed and on-going. In an important comment, study author Dr. Peter Scardino strongly urged for a “mandatory” restaging, or repeat biopsy prior to men enrolling in an AS program. The researchers base this on their finding that a repeat biopsy prior to the initiation of active surveillance deceased the percentage of men deemed to be low-risk by approximately 30 percent.
Another very interesting review article on AS has also been published in the Feb. 2013 issue of the Prostate Cancer Research Institute (PCRI) insights. One specific note from this article describes on-going research on the effects of capsaicin, the micro nutrient found in hot chili peppers. There is a specific receptor (TRPV-6) for capsaicin in prostate cancer cells which when activated results in inhibition of cell proliferation and invasion. Studies are on-going in mice and humans. The same review of active surveillance also describes a method of specifically killing prostate cancer cells in men using MRI-guided thermal ablation (targeted ultrasound waves which are converted to heat in the prostate tissue).
Finally, it should be noted that the terms “active surveillance” and “watchful waiting” differ as applied to prostate cancer. AS is a disease management strategy that delays curative treatment until it is warranted based on defined indicators of disease progression. In contrast, the strategy of “watchful waiting” foregoes curative treatment and initiates intervention only when symptoms arise.
Recent Information on Prostate Cancer Screening and Active Surveillance.
The National Cancer Institute (NCI) is the largest of the numerous institutes comprising the National Institutes of Health (NIH) in Bethesda and Frederick, Maryland. The NCI publishes a monthly cancer bulletin focused on all types of cancer. The current special issue (NCI Cancer Bulletin, Vol. 9, November 27th, 2012) is specifically devoted to cancer screening. Screening is an important part of the effort to reduce the number of lives lost to cancer. A tremendous amount of research is currently focused on improving the effectiveness and efficiency of cancer screening. Some studies suggest that about one-third of screen-detected localized breast cancers and up to 70 percent of localized prostate cancers are overdiagnosed. As more has been learned about the benefits and harms of PSA screening for prostate cancer, organizations have begun to recommend against routine screening. Screening is a personal decision that, according to most experts, a man should make in consultation with his doctor, after he has been informed in detail about the potential benefits and harms. An infographic published in the latest NCI Cancer Bulletin depicts the benefits and harms of PSA screening for prostate cancer. The estimates appeared in the U.S. Preventive Services Task Force Recommendation Statement, published July 17 in the Annals of Internal Medicine. The estimates were based on 13- and 11-year follow-up data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer. According to the two trials, the best evidence of possible benefit of PSA screening is in men aged 55 to 69.
If prostate cancer is diagnosed, active surveillance is recommended by the National Comprehensive Cancer Network as a first-line option for older men at very low or low risk of developing advanced prostate cancer. Findings from the Johns Hopkins active surveillance program — the largest and longest-running in the world — provide important insights. It should be noted that Johns Hopkins Urology has been consistently rated #1 in the annual U.S. News and World Report survey and review. “In one promising development, researchers were able to identify risk factors present at diagnosis and the first surveillance biopsy that were associated with disease progression and to use that information to restratify men into new risk categories. This strategy will make it possible for doctors to predict earlier and more accurately the likelihood that the prostate cancer will progress after a man enters the surveillance program. Even when a cancer appears to be low risk, there is always a chance that it will grow and become more aggressive. One challenge is to determine the mathematical likelihood of that happening. To that end, researchers at Hopkins have been using a mathematical formula that helps predict which men in the active surveillance program will need treatment. Called the Prostate Health Index, or PHI, this mathematical equation takes into account PSA, percent-free PSA, and proPSA (a variant of PSA that increases in men with prostate cancer).” This and other valuable information can be obtained by subscribing on-line to the Johns Hopkins Prostate Disorders Health Alerts written by Drs. Jacek Mostwin and H. Ballentine Carter. The most recent issue was published on November 22, 2012. On a personal note, I personally have interacted with Dr. Mostwin for the past seventeen years and recommend him most highly. Dr. Carter is also highly esteemed.
Identification of Localized Prostate Cancer Recurrence Using PET/CT Imaging.
It would be useful if one could detect and identify the location of localized prostate cancer recurrences and metastatic disease in early PSA recurrence in men who had previously failed initial cancer treatments. For example, such identified “focal” or local recurrences in 1-2 specific areas of the body could then be treated surgically or with targeted radiation. These areas of recurrence might not have been detectable by bone, CT or other scanning methods alone. Physicians at the Mayo Clinic in Rochester, Minnesota and at the Arizona Molecular Imaging Center in Phoenix, Arizona describe the use of positron emission tomography (PET)/CT scanning to identify such localized areas of recurrent prostate cancer in men who have failed surgery, radiation, hormonal and/or chemotherapies. The specific tumor-targeting agents are C-11 choline and C-11 acetate administered intravenously. These radioactive agents emit positrons (positively-charged electrons) over a short period of time; their half-life is about 20 minutes. Therefore, the agents have to be prepared in an on-site cyclotron just prior to their use. In preliminary results reported in the August, 2012 issue of the Prostate Cancer Research Institute (PCRI)Insights, Arizona researchers report an overall detection rate of 85% for recurrent or metastatic disease using C-11 acetate PET/CT imaging. Detection was followed by radiation therapy or surgical removal of the identified lesion. Access to C-11 acetate requires participation in an approved clinical study. For information about participating in this on-going Phase II clinical trial see the ClinicalTrials.gov website at http://clinicaltrials.gov/ct2/show/record/NCT01304485. The C-11 choline agent available at the Mayo Clinic has already been approved by the Food and Drug Administration (FDA) as an agent for prostate cancer imaging. It has demonstrated accuracy in detecting lesions in both bone and lymph nodes. Examples of its usefulness are provided in a 17-minute video presentation given by Mayo’s principal investigator, Dr. Eugene Kwon. Both of these studies are relatively small in scope. The usefulness of this technique rests on its ability to identify the specific location of localized cancer recurrences and then the ability to treat them surgically or with radiation. The PET/CT imaging therapy described above would not be applicable to systemic disease covering multiple areas of the body. Its value would be in cases where recurrent tumors / metastases could be identified and localized in a specific area of the body which would allow the tumors to be removed surgically or with radiation.
While PET/CT imaging is not currently widely accessible, it may be very useful in specific cases. On a personal note, I know of a prostate cancer patient who might well have benefitted from the techniques described above. He had undergone a seemingly-successful radical prostatectomy. His PSA remained undetectable for about eight (8) years. Shortly thereafter, he began to experience a strong pain in his lower back / spinal area. X-rays, bone and CT scans were inconclusive in determining the origin of his pain. Meanwhile, his PSA escalated very rapidly to 25 ng/dL. An MRI revealed a mass in his lower back/spine which was removed surgically within two days of diagnosis. The patient’s PSA has been undetectable for the last two years.
Active Surveillance May Be the Preferred Option in Some Men with Prostate Cancer.
A recent study from Johns Hopkins University School of Medicine published in the Journal of Clinical Oncology concluded that for men over 65 “active surveillance is the first option for men in this category with very-low-risk disease” according to senior investigator Dr. H. Ballantine Carter. The initial question for such patients should be “whether any therapy is appropriate for them, not which therapy.” The clinical definition of “very-low-risk prostate cancer is provided in the article initially published in the April 19th, 2011 issue of the National Cancer Institute (NCI) Cancer Bulletin. At Johns Hopkins, the active surveillance program involves a semi-annual check up and an annual biopsy. Among the 769 men enrolled in the Hopkins active surveillance program from 1995-2010, approximately 80% had very-low-risk disease as defined by their Gleason score and other factors listed. Overall, 41% of the men in this study did not require any form of treatment even after ten years of follow-up, providing evidence that “active surveillance” is safe. For additional information, see the July 24th, 2012 issue of the NCI Cancer Bulletin.
PSA Screening Recommendations from the American Society of Clinical Oncology (ASCO).
The American Society of Clinical Oncology (ASCO) is a highly respected organization. On July 16th 2012, a committee of experts from ASCO published a provisional clinical opinion regarding PSA screening in the Journal of Clinical Oncology. This information is also summarized in the July 24th, 2012 issue of the National Cancer Institute (NCI) Bulletin. Briefly, ASCO experts concluded that for men with a life expectancy of 10 years or less, “it is recommended that general screening for prostate cancer with total PSA be discouraged, because harms seem to outweigh potential benefits.” However, for men with life expectancies of greater than ten (10) years, “it is recommended that physicians discuss with their patients whether PSA testing for prostate cancer screening is appropriate for them. PSA testing may save lives but is associated with harms, including complications, from unnecessary biopsy, surgery, or radiation treatment.” Thus younger men may have meaningful benefits from PSA screening but this can be accompanied by a risk of harms. These aspects must be balanced in order to arrive at a plan of action if warranted.
The U.S. Preventative Services Task Force Advises Against PSA Screening; a Summary of Responses.
Since its October, 2011 initial advisory, and after receiving input from the medical community including many leading urologists and oncologists, the United States Preventative Services Task Force (USPSTF) recently issued its final recommendation against screening asymptomatic men for prostate cancer using the prostate-specific antigen (PSA) test. (An earlier 2008 recommendation had advised against screening men over the age of 75.) The USPSTF conclusions are discussed in the May 29th, 2012 issue of the National Cancer Institute Bulletin among other sites below. The USPSTF panel concluded that routine diagnostic PSA screening could not be clearly demonstrated to save lives and its potentially-significant harms (such as false positive results, biopsy-related infections, potential incontinence and erectile dysfunction) outweigh any small potential benefits. However, PSA testing will still be used to monitor progression of prostate cancer after its diagnosis or treatment. Medicare is expected to continue to pay for such PSA evaluations. It must be noted that the USPSTF did not include any urologists nor medical oncologists on their panel. For a full listing of the Task Force members, their affiliations and their specific fields of expertise see http://www.uspreventiveservicestaskforce.org/members.htm. Strong criticisms of this recommendation have been issued by noted American urologists as well as medical and professional organizations such as the American Urological Association and the National Comprehensive Cancer Network. Additionally, a dissenting opinion was published in the Annals of Internal Medicine by some of the leading clinical scholars in prostate cancer care, including Dr. William Catalona, Medical Director of the Urological Research Foundation and Dr. Patrick C. Walsh, University Distinguished Service Professor of Urology at Johns Hopkins. These experts believe the USPSTF overestimated the harms and underestimated the benefits of PSA screening in the United States. Much of the discussion centered upon two separate clinical trials; the National Cancer Institute (NCI)-funded Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). A recent study involving 20,000 Swedish men over a 14-year period has been cited as strong evidence that PSA screening does indeed save lives. (See the May 29th issue of the ZeroHour Newsletter). For an overview of affirming and dissenting opinions from various groups, see the Prostate Cancer Research Institute (PCRI) Weekly for May 30th, or the May, 2012 PCRI NewsPulse.
In light of these new recommendations, what should a man do at this point? The most important need is a shared decision-making process between a man and his trusted physician. Individual patient factors such as age, medical condition, symptoms (or lack thereof), family history, ethnicity or concerns about prostate cancer must form the basis of a rational decision between a patient and his physician to undergo PSA testing. As stated in the Prostate Cancer Foundation Newsletter, “the USPSTF’s position provides a teachable and actionable moment for the medical community to improve targeting of PSA screening in patients, reduce over-testing and improve processes of patient education on the risks of overtreatment from PSA screening.” See also the June 2012 edition of Prostate Cancer Advances, “PSA: Better Patient Education.”
Finally, targeted screening using specific biomarkers is urgently needed to identify and differentiate between aggressive cancers requiring treatment and those best followed by “active surveillance”. Examples of such biomarkers include a urine test to identify abnormally high levels of genetic RNA made from the PCA3 gene in prostate cancer cells. This urine test commercialized by Gen-Probe and known as PROGENSA PCA3, was approved by the Food and Drug Administration (FDA) in February of this year. A National Cancer Institute (NCI) study examined the predictive value of using PROGENSA PCA3 to detect prostate cancer. A positive PCA3 test predicted a positive biopsy of 80 percent of the time at initial biopsy; and, for men undergoing repeat biopsies, a negative urine test predicted a negative biopsy 88 percent of the time.
Still another example of a potential biomarker being studied at Cornell, MIT and Harvard Universities is the identification of mutations in a gene called SPOP. Such genetic alterations may be unique to early stage prostate cancer. These are just two examples of potential targeted screens which hopefully will one day replace the PSA test to provide more precise information to guide physicians and their patients in their diagnoses and possible treatments if necessary.
New Developments in Prostate Cancer Biomarkers.
Two articles discussing the development of new genetic tests which could potentially be used to detect and determine aggressive prostate cancers were published in the May 2nd and May 15th issues of the Zerohour Newsletter of the Project to End Prostate Cancer.
The biggest problem facing men who have been diagnosed with prostate cancer is to determine whether the cancer is potentially aggressive and therefore requires treatment or whether it can be subject to “active surveillance”. PSA values alone will not answer this question. However, genetic changes or biomarkers are being actively sought by researchers to help determine the aggressive nature of the cancer. Three such genes are named ERG, ETV1 and PTEN. Researchers at Stanford University and Abbott Molecular are working to develop a molecular assay to detect rearrangements of the ERG and ETV1 genes and measure loss of the PTEN gene. A study published in the British Journal of Cancer evaluated 308 prostate cancer patients who were treated conservatively. “Those who did not show abnormal ERG/ETV1 genetic changes with no PTEN gene loss had excellent prognosis, as evidenced by an 85 percent survival rate after 11 years. Men who showed PTEN gene loss in the absence of the gene rearrangements had a poor survival rate of 13.7 percent. The study showed the promise of the new biomarkers to identify patients who would benefit most from intensive therapies.”
In another study, researchers at the Mayo Clinic have found that changes to the “on-off” switches of genes occur early in the development of prostate cancer and could be used as biomarkers to detect the disease months or even years earlier than current approaches. “These biomarkers — known as DNA methylation profiles — also can predict if the cancer is going to recur and if that recurrence will remain localized to the prostate or, instead, spread to other organs. The study, published in the journal Clinical Cancer Research, is the first to evaluate the methylation changes that occur across the entire human genome in prostate cancer. The discovery could someday help physicians diagnose prostate cancer earlier and make more effective treatment decisions to improve cure rates and reduce deaths. It also points to the development of new drugs that reverse the DNA methylation changes, turning the “off” switch back “on” and returning the genetic code to its normal, noncancerous state.”
A New Urine-Based PC Assay, Clinical Trials Providing Earlier Access to New Therapies and Other News from February-March, 2012.
It has been a month since I last updated this website and there have been significant news items which are summarized below.
1) FDA Approves a PCA3 Urine-Based Assay for Prostate Cancer that Could Reduce Unnecessary Prostate Biopsies. On February 15th, 2012, the U.S. Food and Drug Administration (FDA) approved a urine-based molecular diagnostic test that aids clinical decision-making for repeat prostate biopsies in men who have had a previous negative biopsy. The test, developed by Gen-Probe, is called PROGENSA PCA3 (Prostate Cancer Antigen 3) assay. It tests for levels of PCA3 in the urine of men immediately after a digital rectal examination. PCA3 is produced by a gene that is normally expressed only in human prostate tissue and is highly expressed in 95% of all prostate cancer. Thus the product of this gene is excreted in the urine of men with prostate abnormalities. The current prostate-specific antigen (PSA) screening test for prostate cancer is prostate-specific but not highly cancer-specific which is the case for PCA3 testing which has better positive and negative predictive values. Therefore, this test will aid faster and more efficient diagnosis of prostate cancer thereby minimizing additional repeat biopsies and their undesirable side effects including infections. Additional details are available from Gen-Probe, in the March 20th, 2012 issue of the ZeroHour Newsletter and the February 27th, 2012 issue of the Prostate Cancer Foundation NewsPulse.
2) Patients Being Recruited for Clinical Trials Involving Provenge, Zytiga and/or Hormonal Therapy. During the last 1-2 years, several new therapeutic agents have been approved by the FDA for treatment of men with metastatic prostate cancer or who have had prior chemotherapy. The strategy now seems to be the application of these agents in men with earlier stage prostate cancer. To determine the effectiveness of such strategies, two clinical trials are described involving Sipuleucel-T (Provenge), abiraterone acetate (Zytiga) and androgen deprivation (hormonal) therapy (ADT). The first is entitled “Concurrent Versus Sequential Treatment with Sipuleucel-T (Provenge) and Abiraterone (Zytiga) in Men With Metastatic, Castration-Resistant Prostate Cancer (mCRPC).” This trial may provide earlier access to Zytiga for men who have not had chemotherapy. It is currently recruiting patients in the following locations: Denver, CO; Seattle, WA and Virginia Beach, VA.
The second trial entitled “Sequencing of Sipuleucel-T (Provenge) and ADT in Men with Non-Metastatic Prostate Cancer”, may provide earlier access to Provenge for men who have recurrent but non-metastatic prostate cancer. The trial is designed to determine whether ADT (hormonal therapy) started before or after sipuleucel-T leads to superior augmentation of immune response to sipuleucel-T. This trial is currently recruiting patients in the following states: Alabama, California, Colorado, Maryland (Johns Hopkins), New York, South Carolina, Texas and Washington. For details of both trials, see the Prostate Cancer Research Institute (PCRI) Weekly (Volume 2, Issue 2) of March 2nd and 8th, 2012.
3) Oligometastatic Prostate Cancer; an Intermediate Stage? The February 27th, 2012 issue of the Prostate Cancer Research Institute (PCRI) Insights contained several articles of interest including an update on brachytherapy and especially an article on an intermediate stage of prostate cancer termed oligometastatic prostate cancer. The authors, including Dr. Charles “Snuffy” Myers, outline the concept of this intermediate stage wherein cancer has spread outside the prostate gland but is not widespread. Pros and cons of various imaging techniques used to identify such metastatic sites are described. These sites are not always easily observed by CT or MRI scans. The authors’ focus is not merely on bone metastases but lymph node metastases as well. Identified metastatic sites are then subjected to carefully focused radiation therapy such as provided by advanced versions of Intensity Modulated Radiation (IMRT) such as Image-Guide (IG) IMRT and Dynamic Adaptive Radiotherapy (DART 4D) therapy.
4) Continued Development of OncoGenex’s OGX-427, a New Type of Anticancer Therapy. OGX-427 is a second-generation antisense drug designed to reduce the production of heat shock protein 27 (Hsp 27), a protein that regulates multiple cell mechanisms that cancers use to survive. Hsp 27 inhibits apoptosis (cell death), is found at high level in many human tumors especially hormone-resistant prostate cancer and is implicated in cancer progression and treatment resistance. Hsp 27 can also be induced by cell stress through chemotherapy, radiation or hormonal therapy. When co-administered with prednisone, OGX-427 demonstrated promising results in a Phase II clinical trial versus prednisone alone. A new Phase II trial of OGX-427 in men with minimally symptomatic or asymptomatic advanced prostate cancer who have not yet received chemotherapy has recently been announced. This Phase II trial will measure disease progression at 12 weeks, PSA levels, time to progression by PSA or measurable disease, numbers of circulating tumor cells (CTCs) and other endpoints. For additional details, see the Prostate Cancer Foundation NewsLetter, February 27th, 2012 and the OncoGenex website.
5) Custirsen (OGX-011) to be Further Evaluated in Phase III Trials. OncoGenex Pharmaceuticals and its partner Teva Pharmaceuticals plan to start a new Phase III trial for custirsen in combination with Sanofi’s approved taxane chemotherapy drug, Jevtana with the goal of improving survival in prostate cancer patients. A separate trial called Synergy, which aims to test custirsen in combination with chemotherapy in hormone-resistant prostate cancer patients, is boosting its patient enrollment. For further information see the March 20th, 2012 issue of the ZeroHour NewsLetter.
6) Alpharadin Update. The February 27th, 2012 issue of the Prostate Cancer Foundation NewsPulse had several articles of interest. One was an update on the therapeutic effects of the alpha-particle emitting Alpharadin (Radium-223) which is targeted to bone metastases and potent, localized, tumor cell-killing activity within a 10-cell radius. It’s half-life of 11.4 days seems to make it an ideal candidate for cancer therapy.