The following is a summary of an article written by Mark Moyad M.D., Jenkins/Pokempner Director of Complementary & Alternative Medicine at the University of Michigan Medical Center. It was published in the August 2016 issue of Prostate Insights from the Prostate Cancer Research Institute (PCRI). Cancer-related fatigue (CRF) can occur in as many as 60-90% of patients. It is the primary side effect of the approved prostate cancer drug Xtandi® and most other treatments such as Zytiga®, hormone therapy and of course, chemotherapy. In 2014, researchers at Mayo Clinic published the following in the Journal of Clinical Oncology (Ruddy et al, 2014;32:1865-1867). “For patients who want to try a pharmacologic product and physicians who are early adapters of new promising agents, the pure ground root American (or Panax) ginseng product as used in the above studies may be an option to consider.” Recent studies of the use of ginseng in breast, colon and prostate cancer involved 364 participants in 40 medical centers. After two months of receiving 2000 mg of Wisconsin ginseng (a high quality American ginseng), the study revealed a significant difference as ginseng was twice as effective as placebo in reducing fatigue. In the Phase 3 trial, Mayo researchers also found similar results administering 1000 mg (1 gram) per day in a trial of 290 cancer patients. The ground root ginseng was obtained from the Ginseng Board of Wisconsin. (See www.ginsengboard.com or www.ginseng-herbco-op.com.) In a study at M.D. Anderson Cancer Center, ginseng was found to also improve sleep, appetite and pain issues. Ginseng also appeared to reduce the inflammatory process associated with chronic fatigue. It may reduce cortisol thus reducing overall stress and improving energy. Whether or not the primary anti-fatigue effects are being derived from the standardized ginsengoside and/or polysaccharides content or another active compound in the supplement is a matter of research and debate. Ginseng produced no real side effects, had no real current strong drug interactions, and did not seem to interfere with major drug metabolism. Ginseng from water extraction or from pure ground root has been associated with the best results and safety. Ginseng extraction methods due to alcohol or methanol-based procedures could be less effective and some researchers believe toxic with long-term use. Ginseng can be ingested with or without food but with a meal gastrointestinal side effects like acid reflux could be reduced. Purchasing ginseng from the Ginseng Board of Wisconsin or from the herb-co-op (see above) eliminated potential quality control and contaminant issues that may arise when purchasing from a local health food store.
In the light of recent discoveries (recently posted on this website) that some advanced prostate cancer patients harbor specific genetic mutations, a recent study summarized in the July 7th National Library of Medicine MedLine Plus suggested that testing for inherited abnormalities in DNA repair genes could provide patients and family members important information about their health and cancer risk. The research team led by Dr. Michael Walsh, a geneticist and pediatric oncologist at Memorial Sloan Kettering Cancer Center in New York states that “historically, the main benefit of identifying cancer-causing mutations has been prevention and early detection in families. Now we can use inherited genomic information to target treatment, with specific therapies shown to be effective in those with specific genomic subsets of prostate cancer.”
The research team found a link between advanced prostate cancer and mutations in DNA repair genes. The mutations occur far more often in men with advanced disease than in those with prostate cancer that hasn’t spread, the study authors said. In addition, men with the abnormal repair genes are more likely to have close relatives with cancers other than prostate cancer compared to men without the mutations. These findings could help identify families that are at high risk for cancer and help prevent it in future generations, the researchers said.
The Phase 3 AFFINITY Trial failed to met its primary endpoint of significantly improved overall survival in men with metastatic castrate-resistant prostate cancer (CRPC) being treated with custirsen, the therapy’s maker, OncoGenex announced.
The international, randomized, open-label study evaluated 634 men with CRPC whose disease had progressed despite treatment with docetaxel (taxotere). In the trial, patients received weekly doses of cabazitaxel or prednisone with or without the addition of custirsen (OGX-011). Treatment continued until disease progression, unacceptable toxicity or completion of 10 cycles.
Results showed that adding custirsen did not provide significant overall survival benefit. Adverse events were consistent with those observed in previous trials of custirsen in men with CRPC.
Custirsen is designed to inhibit the production of clusterin, a protein involved in cancer cell survival and treatment resistance. Clusterin is upregulated in tumor cells in response to treatment interventions such as chemotherapy, hormone ablation, and radiation therapy, and is overexpressed in a number of cancers, including prostate cancer.
Increased clusterin production is associated with faster rates of cancer progression, treatment resistance, and shorter survival duration. By inhibiting clusterin, custirsen aims to alter tumor dynamics, slowing tumor growth and resistance to other treatments to amplify the benefits of therapy, including survival.
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.
Zero, the Project to End Prostate Cancer, is sponsoring a videocast on July 13th from 3-4 PM. The video conference will discuss various treatment options for treating localized prostate cancer. These include surgery, external radiation, brachytherapy, high-intensity focused ultrasound (HIFU), cryotherapy, active surveillance and other options. The speakers are Dr. Kelvin Moses from Vanderbilt University Medical Center and Dr. Eric Shinohara from Vanderbilt Ingram Cancer Center. To participate in this video event, see the following link for information and registration.
In a very informative seven minute video clip recently posted on Prostate Cancer News Today, Dr. Alicia K. Morgans, an Assistant Professor of Medicine in the subject of hematology and oncology, at the Vanderbilt-Ingram Cancer Center discusses prostate cancer and bone metastasis. She discusses what these diseases entail, how they spread, where in the body they spread, how they are detected and treated and how patients are affected.
Prostate Cancer News Today is a weekly e mail from Bayer Healthcare that contains 3-4 articles referencing various aspects of prostate cancer. An e mail received May 16th, 2016 contained an article called “Finding Out About Prostate Cancer Clinical Trials.” The article was one of the best references I have seen to provide information about the benefits of clinical trials and how to find institutions sponsoring them including the U.S. government National Institutes of Health / National Cancer Institute at https://clinicaltrials.gov. The article also discussed what a patient should ask his physician about trials as well as an article describing reasons to participate and benefits received in trials. Lastly, the weekly e mail also contained details about a specific clinical trial involving a cutting-edge therapy called stereotactic body radiotherapy (SBRT) as a means of delivering radiation to the exact area affected by prostate cancer instead of irradiating the entire gland.
In addition, the May 30th e mail from Prostate Cancer News Today contained an excellent review entitled “How Prostate Cancer Clinical Trials Work, from Research & Development to Human Trials.” Please check out this brief but informative link.
I also strongly suggest that you subscribe directly to this valuable e mail service.
The good news according to Johns Hopkins urologists, including Drs. Patrick Walsh, Mario Eisenberger and Alan Partin among others, is that there is no need to panic if your PSA levels begin to rise after surgical prostate removal. You may not have to do anything for years. Hopkins doctors have developed guidelines to help doctors and patients know what to do if your PSA comes back. On the average it took eight years from the time a man’s PSA first went up until he developed metastatic disease as detected by bone scans or other imaging techniques. Hopkins researchers found that this interval can be predicted using three pieces of information. These parameters include the Gleason score of the pathologic specimen of the removed prostate, the time it takes for PSA to come back and thirdly, how rapidly the PSA is doubling. The guidelines are excellently summarized in the linked article published in the Journal of the American Medical Association and summarized in the Johns Hopkins Prostate Cancer Update.
Prostate Cancer News Today recently sent an e mail summarizing the twelve currently-approved drug treatments for prostate cancer. Rather than reproducing the list here, I am providing a link to the article.
After writing the somewhat depressing April 13th blog, I had to add some personal words of encouragement which appear in bold type at the end of the linked revised post. If you have already read the un-edited April 13th blog, please go back and read the revised personal notes at the end of this link.