Category: General Patient Information
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.
Why Cruciferous Vegetables Like Broccoli Are Recommended for Prostate Cancer
Researchers at Oregon State University have discovered one of the reasons why broccoli may be good for your health. They found that sulforaphane, a dietary compound from broccoli that’s known to help prevent prostate cancer, may work through its influence on long, non-coding RNAs. This is another step forward in a compelling new area of study on the underlying genetics of cancer development and progression. The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.
The research provides more evidence for how these lncRNAs, which were once thought to be a type of “junk DNA” of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread. Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or “expressed” to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated (uncontrolled) they can contribute to multiple disease processes, including cancer. The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.
Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells. “This could be a turning point in our understanding of how cancer may be triggered and spreads,” said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute. “It’s obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control.” For more information, see the following link.
It is a good idea to add cruciferous veggies to your diet. However, while cruciferous extracts from broccoli, kale, cabbage etc. containing small amounts of sulforaphane are commercially available as supplements, it should be noted that the amounts of sulforaphane needed for activity against prostate cancer in men is not known and usually requires considerable amounts of the extract or vegetable to be ingested. Therefore, before taking any extracts, please consult with your health provider.
A Concise Prostate Cancer Resource Starting With Early Detection and Screening.
The Prostate Cancer Foundation published a fairly comprehensive yet concise e mail resource describing various facets of prostate cancer beginning with early screening and detection. The reader is urged to spend some time perusing this article. There is so much information here that I am simply linking the article at this point. The initial portion of the article deals with screening and biopsy.
A section entitled “For Patients- Recently Diagnosed? Read This Section First,” describes finding a doctor and treatment center, treatment options, side effects, clinical trials, financial resources, guides and even videos. Information by stage is also provided which includes information on screening, detection and diagnosis, active surveillance, recurrence and advanced disease. A section entitled “Understanding Prostate Cancer” describes risk factors, symptoms and prevention among others.
One Study Comparing Urinary and Sexual Outcomes for Robotic Prostatectomy Versus Brachytherapy.
Men with low-risk prostate cancer have similar recurrence-free survival rates when treated with surgical robotic prostatectomy or brachytherapy, but those who received surgery had fewer urinary or sexual problems two years after treatment, a randomized trial in Italy has concluded. The study was recently published in the April 2017 issue of the Canadian Journal of Urology [Claudio et al, 24 (2), 8728-8733].
Treatment of early-stage or low-risk prostate cancer relies on active surveillance, surgery or radiation therapy. In particular, both robot-assisted radical prostatectomy (RARP) and brachytherapy (BP) — a type of internal radiation therapy in which radioactive seeds are placed inside or near a tumor — have been shown to effectively treat prostate cancer. However, until now little was known about their long-term effects. “Treatment decisions that men with low-risk prostate cancer have to make can be difficult, as a lot of it depends on what the patient is looking for and what type of experience their physician has to offer,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at New York’s Lenox Hill Hospital
Italian researchers at Milan’s San Paolo Hospital conducted the single-center, prospective study from January 2012 to January 2016 to compare the outcomes of 165 patients randomly assigned to receive either RARP or BT. They followed all patients for up to two years after treatment, including clinical evaluation and determination of prostate-specific antigen (PSA) levels.
Researchers also evaluated urinary and erectile functions, and found that overall biochemical recurrence-free survival rates were similar among the two groups. Patients undergoing RARP had a 97.4 percent recurrence-free survival rate, compared to 96.1 percent reported in the BT-treated group. Biochemical recurrence is the term used when a patient’s PSA levels start rising again. “This was actually expected,” said Dr. Samadi. “A two-year follow-up is a short period of time to ascertain much difference between the two procedures.”
While the recurrence-free survival was similar in both groups, researchers saw different outcomes when analyzing sexual or urinary symptoms. Men undergoing BT regained continence faster than those who received RARP during the first six months of follow-up. But this difference was no longer significant after 12 months and 24 months. Interestingly, men in the BT group had more urinary symptoms during the two-year follow-up.
Regarding sexual function, both groups showed a decreased ability to maintain an erection right after treatment. However, RARP-treated men recovered potency much more quickly than their BP-treated counterparts. By the final follow-up, 90 percent of RARP-treated men were back to normal, compared to only 60 percent of men in the BT group. “These are factors any doctor and the men they see with low-risk prostate cancer need to take into consideration when making any treatment decision,” Dr. Samadi said. “When they make the comparison between RARP and BT, RARP clearly shows the upper hand in treating prostate cancer effectively and managing symptoms better at this stage.”
It must be noted that these results may vary somewhat with the experience of the medical personnel involved and should be discussed with one’s physician if applicable.
My Presentation With Dr. Jacek Mostwin (Johns Hopkins) at the 5th Conference on Religion and Medicine, March 25th, 2017, Houston, Texas
A few months ago, my long-time Johns Hopkins urology surgeon, Dr. Jacek Mostwin, suggested that we prepare a joint presentation for the meeting cited above. I readily agreed. The annual conference on Religion and Medicine encourages physicians, care-givers and hospital pastoral staff to see their patients as more than data, results and medical information but instead as unique, multi-faceted, spiritual individuals. The effects of spirituality on medical conditions and outcomes is a general theme. The conference is a way to support the religious experience that is often left behind by more secular bioethics in modern medicine. This meeting has also created a growing community of many different types of people who are interested in the human side of medicine. This interfaith forum and growing community includes practitioners who feel the religious dimension of their work is important, and theologians and chaplains who may feel otherwise quite marginalized in secular medical centers – here they find a sympathetic medical collegiality.
The text of our 15-minute talk is as follows.
God and Prostate.net; Illness, Mortality, Faith, Evangelism and the Doctor-Patient Relationship in the Digital Age
Introduction as presented by Dr. Jacek Mostwin, Johns Hopkins. “I am here today with my friend and colleague, Dr. Bjarne Gabrielsen, to talk about his website, Godandprostate.net, and its intertwining, related themes: Illness, Mortality, Faith, Evangelism and the Doctor-Patient Relationship in the Digital Age. In 1995, Dr. Gabrielsen became my surgical patient for treatment of prostate cancer. It quickly became clear that we shared a belief in the role of faith in medical experience. We have remained in close contact over these 22 years. For Dr. Gabrielsen, faith is the heart of life. The website Godandprostate.net is a public extension of his spiritual diary; a personal blog integrating medical and spiritual entries. It is a bold testament of belief in God’s faithfulness and an affirmation that life’s many stages have meaning.”
My presentation. “My name is Bjarne Gabrielsen. I have a Ph.D. in organic chemistry with research interests in medicinal organic chemistry and natural products. My career was spent equally in academia (University of Florida) and government, the last 20 years at the National Cancer Institute (NIH) where I retired as a Senior Advisor in Drug Discovery and Development. I am first generation Norwegian-American, raised in a conservative Lutheran background, and married for the first time in 2000 at the age of 58 (very happily). I am also a prostate cancer survivor since 1995 now classified as having advanced prostate cancer though asymptomatic (thank God). Through the years, I have been blessed with first-class medical support.
My personal story starts in 1995 when I received the dreaded phone call from Johns Hopkins that my biopsy had revealed prostate cancer. It didn’t take long for God to intervene and make His presence known. Sharing the news with a close friend later that morning, I noticed a sparrow walking unafraid at my feet. Immediately, the word came to me from Luke 12:6-7, “Are not five sparrows sold for two pennies? Yet not one of them is forgotten by God. Don’t be afraid; you are worth more than many sparrows.” Shortly thereafter, God gave me Dr. Mostwin who performed successful surgery at Hopkins in late 1995. The night of my surgery, I was reading my Bible when Dr. Mostwin visited me. We had a brief but meaningful conversation about how one can believe and trust the words written in the Bible. Looking back on this incident, the theme of the truth and relevance of God’s Word would dominate my future years. My cancer, though treated at a very early stage, recurred biochemically in 2002, which devastated me at the time. Additional radiation therapy did not eradicate it completely. Looking back now, I see that God allowed this in my life so I could create my website among other reasons. God always has a long-range purpose for us even in what we perceive at the moment to be devastating developments.
I had started a personal spiritual diary in 1995 expanding it from 2002-2010. During these years, Dr. Mostwin asked me to examine a book written by a prostate cancer survivor to comment on its value for others. I read it and concluded the author provided limited encouragement even though he had been anointed with oil by his church leaders as described in James 5:14-15, and performed in many Christian denominations. Such anointing with oil would play a huge role in my own life in 2004. Dr. Mostwin then seriously suggested I write my own book. I decided on a website instead since books have endings and websites go on. Godandprostate.net now comprises over 250 separate posts and has over 820,000 hits. There are medical posts from journals and periodicals and spiritual ones from various devotional books in a 2:1 ratio. A Medical Resources section includes information from the National Cancer Institute, Prostate Cancer Foundation, Prostate Cancer Research Institute, Johns Hopkins etc. Medical topics are updated regularly such as; finding the right physicians, resources for newly diagnosed men, prostate cancer for beginners, scans and imaging, pathology, approved treatments and side effects, immunotherapies, clinical trials, life style, diet, nutraceuticals and vitamins like D3. Spiritual sections include: a) “Scriptural Medicines” (Biblical verses and promises of encouragement); b) “God Still Heals Cancer” (two personally known examples of healing from brain and breast tumors); c) “How to Enter a Personal Relationship with God” (a general and personal testimony) and lastly, d) “Lessons Learned” (or being learned on a personal level).
Can there be a major purpose of disease? Isaiah 40:1 says “comfort, comfort my people says your God.” Isaiah’s mission was to comfort the hurting people of Israel. Likewise today there are countless hurting people who need God’s comfort. Illness of any kind can be a training ground to prepare us to share comfort with another. I may be asked to endure the same afflictions that are plaguing others before I can truly be of comfort and help.
Now I will present nine lessons learned or being learned:
1) God has a specific goal for all aspects of our lives. Jeremiah 29:11-12 states “for I know the plans that I have for you declares the Lord, plans for welfare and not for calamity, to give you a future and a hope.” But can those God-ordained plans include prostate cancer? Our abstract states that “diseases of one kind or another and eventual death are things we will all experience. We all want every aspect of our lives to have significance, be of value to others, be meaningful and fulfilling including our education, career, family, friends, specific interests and talents. But what about sickness, disease and eventual death? Can these fit the “meaningful” category? My answer is “yes”, hence my website written to empower and encourage men. Many people desire that a higher power be involved in many aspects of their lives. Why shouldn’t God be involved in diseases and eventual death? We don’t cease to exist if a disease such as prostate cancer takes our lives. God has a purpose for everything even prostate cancer. Jesus and His disciples once encountered a man who had been blind from birth. His disciples asked Jesus why the man had been born blind to which Jesus answered that “it was in order that the works of God might be displayed in him” (John 9:3). And so it can be with prostate cancer. God’s ideal plan consists of two main goals; a) to glorify Himself and His Son Jesus through all aspects of our lives including sickness and disease; and, b) to experience that “God causes all things to work together for good to those who love God.” (Romans 8:28). God uses sicknesses to glorify Himself, to increase our faith, to allow others to see God and Jesus in us, and, to make us more sensitive to people around us and their specific conditions.
2) God speaks to us about our conditions predominantly from His Word, the Bible. God may speak through prayer, circumstances, our experiences or interactions with others but these are always coupled with a specific scriptural promise or reference. We can even question God about our conditions. But we should reject the tendency to focus on our circumstances, negative emotions and fears, but instead trust on God’s promises in His Word. His Word is filled with scriptural anchors (see scriptural medicines section) to keep us steady in the faith.
3) We have the assurance that through our relationship with God through faith in Jesus, we will live forever, in a new heaven and a new earth with a new, perfect body. Life is a series of “anticipations.” When we were 12, we looked forward to being a teen, then graduating, then a successful career, then marriage and family, then retirement, but then what??? We should always have a goal to which we aspire and live each day intentionally. We all will eventually die of one cause or another. Having the assurance of eternal life in spite of potentially life-threatening conditions, totally changes our outlook. This assurance based on God’s Word (e.g. John 3:16) removes the fear of death (though we often fear the process of dying). It also gives true inner peace knowing that the best is yet to come in “the twinkling of an eye” when we are transported from this life to the next, immortal phase.
4) God’s purposes can often be to change us rather than our circumstances. While our own circumstances may not change, God may use other people, events and especially His Word to change us inwardly, “perfecting” us for any task we need to accomplish according to His will.
5) Focus on issues and relationships in our lives which would have the most lasting or eternal effects. I must accept that in my life, I can care for others as unique individuals and possibly affect them. Writing a personalized “legacy letter”, I can share the most important issues and experiences in my own life as they would relate to any one friend, colleague or family member, voicing specific thanks for past experiences and a hope for an eternal future together.
6) Remember the times God has previously protected and delivered us. In the Old Testament, God often instructed Israel to erect a monument at a specific site in remembrance of God’s previous miraculous deliverances. They were constantly reminded to “remember when God…..”. We likewise are instructed to celebrate God’s faithfulness and remember what God has done previously in our lives and how He has delivered us in the past. His faithfulness remains to this day and forever.
7) Learn to cope with life’s “thorns”. Acknowledge our own weakness. Like the apostle Paul, many of us are given “thorns in the flesh”, namely conditions which we’d rather not have but which God has not chosen to remove. Mine has been prostate cancer. The apostle Paul had his “thorn” most likely a condition involving his eyesight. But through it all, God’s message is that “His grace is sufficient” and God’s “power is perfected in our (my) weakness.” Recognition of my helplessness unleashes God’s power. I need to affirm as the apostle Paul did, that when I am weak (in myself), then I am strong (in Christ). What God can accomplish through me and my life experiences is directly proportional to my level of dependence on Him.
8) Learn to experience the peace of God. Even though it is hard not to think about the fact that there are cancer cells in me, instead I should receive the gift of peace offered in John 14:27, “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 nor let it be fearful.”
9) Lastly, be thankful for everything, taking nothing for granted. I have so much for which to be thankful including a wife whom I cherish, many supportive friends, a career that I could not have planned nor imagined for myself, and most of all, an eternal life in God’s presence in a new heaven and a new earth with a new body to which I can aspire. Finally I am very thankful for the opportunity you all have given me to share with you today.”
Concluding remarks from Dr. Mostwin. “When I was a surgical resident at the University of Michigan in Ann Arbor in the late 1970’s, surgical attendings would invite their patients to come before the entire department to speak about their experiences. A subliminal message conveyed to us was the unique bond between surgeon and patient that extended beyond the operating room and the hospital bedside, something that seemed special for me then, though I did not understand how and why. We don’t do that sort of thing very much in medical education now. But in this presentation, we have done just that and in doing so have shared with you the closeness of medicine, faith and the unique circumstance of life that brought us together and kept us that way. We are grateful for your attention.”
P.S. Only an hour or so before the presentation, Dr. Mostwin shared with me two very pertinent verses he had just read in his daily devotional as follows. “I have told the glad news of deliverance in the great congregation. I have not restrained my lips, as Thou knowest O Lord. I have not hid thy saving help within my heart. I have spoken of Thy faithfulness and Thy salvation; I have not concealed Thy steadfast love and Thy faithfulness from the great congregation.” (Psalm 40:9-10).
Men in Their 20’s and 30’s With a Specific Early Balding Pattern May Be at Higher Risk of Aggressive Prostate Cancer
When I come across a newsworthy article of interest, I usually summarize it on this post and link the reader to the entire article for more information. This is an exception as the original article from the Prostate Cancer Foundation (March 30th, 2017) contains specific visual and verbal information; hence I refer you to the following link.
Finding Useful Prostate Cancer Clinical Trials
Clinical trials are on-going at many institutions across the United States. Many men think about enrolling in a clinical trial only when there are no further treatment options for them. But trials are not just for advanced stages of disease. They can also include men recently diagnosed and treated. The trials cover areas such as screening, diagnosis, imaging and scans, quality of life, as well as surgery, radiation and other specific treatments and combinations. At some time, you might want to go to the clinicaltrials.gov site, and enter your pertinent areas of interest under “Search for Studies”. Hundreds may appear but they can be filtered under categories such as “recruiting”, “active not recruiting”, “completed”, “terminated” etc. You can also search them by location as well. You might want to ask your physician to demonstrate the site by incorporating your specific health status and generating a shorter list of pertinent recruiting trials. An excellent review of clinical trials (see the link) was recently published online by the Prostate Cancer News Today. It is concise and informative but will not be summarized here. The article also leads the reader to a Bayer Oncology Clinical Trial Finder wherein you can enter specific data and a listing of available trials can be sent to you. There is a wealth of information here and the reader is urged to spend some time perusing these sites. They also provide a picture of the current cutting-edge areas of research.
Please Consider Subscribing to and Commenting On This Website
This post was originally sent on Feb 21st. Another post (about Decipher) was sent the same day which generated some confusion. Hence I am trying to separate them the sake of clarity. Please forgive the confusion as both posts are important.
Godandprostate.net contains posts that deal with both medical (prostate cancer) and spiritual issues. Every blog may not be applicable to your personal situation or interest but hopefully, occasionally one might be very useful. Therefore, please consider subscribing to the blogs by e mail as they are posted. If a specific subject title does not apply, just delete it. Simply go to the home page and write your e mail address in the area on the right side of the page under “get blog posts by e mail.” Your personal comments to a specific post are always welcome and often published.
Identifying Suitable Candidates for Active Surveillance in Prostate Cancer
This review is designed for physicians and patients who have access to multiparametric MRI technology available in several major health research institutions.
A recent article by Drs. Peter Choyke and Stacy Loeb (from the National Cancer Institute, NIH) in the journal Oncology and e mailed through the CancerNetwork provided a important summary of active surveillance, a safe, appealing approach that spares radical treatment and does not increase disease-specific mortality. However, the authors conclude that current methods of identifying low-risk patients are flawed and cannot always accurately predict candidates for active surveillance. In the article, the authors focus on the role of active surveillance for patients with low-risk disease and how multiparametric MRI (mpMRI) can impact decision making for entering and monitoring patients on active surveillance. The article is written mainly for physicians and should be discussed with them if you are considering active surveillance as an option.
The active surveillance decision-making process begins with a prostate biopsy, for which there are two main triggers: elevated PSA and/or a palpable lesion on digital rectal examination. The current standard of care is to obtain a 12-core biopsy under transrectal ultrasound (TRUS) guidance, in which two samples are obtained from the apex, the middle, and the base of the prostate on two sides (six samples per side). Each sample is interpreted by a pathologist using the Gleason scoring system ranging from 3+3 to 5+5. Patients who harbor low-volume 3+3 tumors or 3+4 tumors with only a small percentage of grade 4 are eligible for active surveillance. The use of active surveillance in the United States has increased in recent years, with over 40% of low-risk tumors managed in this manner, and even higher rates for men over 75 years of age. Active surveillance is different from watchful waiting, which is usually reserved for elderly men with reduced life expectancy. In watchful waiting, the physician will not perform serial tests such as biopsies because there is no curative intent, so treatment is only given for symptomatic progression. In contrast, active surveillance infers that the patient is followed with a schedule of serial PSA tests and biopsies, with the latter meant to detect patients who convert from a low-grade to an intermediate- or high-grade tumor over time.
Implementing active surveillance varies with the medical institution and presents its own problems. At this point, for this discussion, I would refer you the reader to the linked section entitled “Implementing Active Surveillance”.
The next section discussed the role of mpMRI in identifying active surveillance candidates. mpMRI can identify lesions missed by the standard TRUS biopsy or can more properly characterize cancers detected at TRUS biopsy. “Because a standard TRUS-guided biopsy predominantly samples the posterior peripheral zone, the rest of the gland is undersampled. Moreover, since TRUS-guided biopsies are really blind samples of the prostate, tumors in the posterior peripheral zone may be incompletely sampled or their size greatly underestimated. Therefore, before placing a patient on active surveillance, we perform an MRI to identify any lesions that were potentially missed or undersampled. In the case of active surveillance candidates, approximately 20% to 30% of patients who were initially considered good candidates for active surveillance are directed toward active treatments such as surgery or radiation as a consequence of finding additional lesions or resampling known lesions with MRI guidance. For patients in whom the MRI is negative or reveals nothing more than was discovered by TRUS biopsy, active surveillance is an excellent choice. Thus, an initial MRI followed by MRI-TRUS–guided biopsy has become routine in our institutions to identify patients who are ideal candidates for active surveillance. This provides greater assurance to the clinician and patient that the proper management has been selected.”
“It would seem logical that MRI could also be used in place of repeat biopsies to monitor patients who are on active surveillance. Although this is a very attractive possibility for patients due to the risk and burden associated with multiple biopsies over time, good long-term data are not yet available to support this policy. In our own institutions, MRI is commonly performed on a routine basis (annually in the case of the National Cancer Institute), and changes in the appearance of the MRI can trigger a repeat targeted biopsy.” …..” In our own experience, the vast majority of active surveillance patients who have an initial qualifying MRI and MRI-TRUS biopsy exhibit minimal or no change in their MRI over many years, making this approach quite promising.”
A variety of other commercially available serum, urine, and tissue biomarkers have been introduced to help clinicians decide whether to initiate and maintain a patient on active surveillance. Their value relative to MRI has not been tested adequately to draw conclusions as to whether these can be used in place of MRI or as an adjunct to MRI. One of these serum markers is the Prostate Health Index, which combines total, free, and proPSA using a mathematical formula. This test was previously shown to predict changes on biopsy in men on active surveillance, and in the future might be used to monitor patients in conjunction with mpMRI. Several genomic tissue tests including Prolaris, Oncotype DX, and Decipher are also commercially available to help determine aggressiveness beyond the information provided by Gleason score. These may be used to help assess eligibility for active surveillance in borderline cases such as high-volume Gleason 6 or low-volume Gleason 3+4; however, there are no published data on their utility for monitoring during surveillance, and they require tissue from a biopsy.”
The authors conclude that “active surveillance is an excellent alternative to surgery or radiation in patients with low-risk cancers. However, the current methods of ascertaining whether a patient harbors a low-risk cancer are flawed, and data obtained by PSA or traditional TRUS biopsy do not accurately predict good candidates for active surveillance. MRI- and MRI-TRUS–guided biopsies of the prostate appear to assist in the decision to place a patient on active surveillance by detecting lesions outside the normal biopsy template or by providing more information about a lesion within the potentially undersampled template. Less certain is the role of MRI in delaying or eliminating subsequent biopsies, although it is increasingly being used in this manner, since repeat prostate biopsies are a source of patient noncompliance. The role of other new biomarkers in the decision-making process and their utility compared with MRI remains to be determined. What is most encouraging is that more men can now safely and confidently delay or avoid unnecessary radical surgery for low-risk prostate cancers and retain a high quality of life even with a prostate cancer diagnosis.” The full article can be accessed in this link.