Category: Treatment Information
Surgery May Beat Radiation for Men With Early Stage Prostate Cancer
A new Canadian study has concluded that men with organ-confined prostate cancer are more likely to survive if they have surgery rather than radiation therapy. The authors of the study analyzed data from 19 previous studies involving 119,000 men with localized cancer. Findings from fifteen (15) of the studies showed that those who received initial radiation therapy were twice as likely to die from prostate cancer as those who had surgery. Findings from ten (10) of the studies also showed that men who had radiation therapy were 50% more likely to die sooner of any cause, compared to those who had surgery. The results of the study analyses were published on Dec. 14th, 2015 in the journal European Urology.
The authors add however that “prostate cancer treatment is never a one-size-fits-all matter.” There are times when radiation therapy may be more appropriate than surgery so it is vitally important that a patient discusses treatment options with his physician. It is also noted that radiation is still possible as a secondary treatment after surgery. So patients have yet another way of combating their cancer if necessary. In addition, a radiation oncologist pointed out that this review may not have accounted for recent improvements in radiation therapy that could boost patient outcomes. For an additional reference, see the December 29th edition of Prostate Cancer News Today (linked).
Hormonal Prostate Cancer Treatment May Double the Risk of Alzheimer’s Disease.
A recent study published in the Journal of Clinical Oncology comprising a large-scale analysis of medical records revealed that men undergoing androgen deprivation (hormonal) therapy (ADT) for prostate cancer treatment may be at almost twice the risk of eventually developing Alzheimer’s disease, and that the increased likelihood of the disease is proportional to ADT duration. The researchers emphasized that their findings do not prove that ADT increases the risk of Alzheimer’s disease but clearly point to that possibility. It is thought that low levels of testosterone produced by androgen deprivation (hormonal) therapy may diminish the body’s protective effect on brain cells. There may also be evidence suggesting that the production of amyloid beta, a protein involved in Alzheimer’s pathogenesis, increases as testosterone levels diminish. The researchers are not suggesting that today’s clinical practice of treating prostate cancer with hormonal therapy be changed. However, it adds another potential undesirable side effect to those already associated with ADT such as osteoporosis, cardiac effects, loss of muscle mass and metabolic syndrome. See the entire article as published in the December 14th issue of Prostate Cancer News Weekly Digest.
Prostate Cancer Patients Undergoing Active Surveillance Are Not Receiving the Proper Follow-Up.
A recent study from UCLA published in the December 1st issue of Cancer, included 3,600 men who had opted for active surveillance in place of aggressive treatment as a means of following the status of their prostate cancer. The study found that only 4.5% received proper monitoring in collaboration with their physician. Recommended monitoring includes regular prostate-specific antigen (PSA) screening, physical exams and at least one prostate biopsy every two years. The study urges that before a patient and his physician decide on a prostate cancer strategy of active surveillance, they should mutually commit to closely monitoring the cancer via such PSA testing, physical exams and repeat biopsies as necessary. A summary of the study was published in MedLine Plus from the National Institutes of Health (NIH). For further details, see the following article published online in Prostate Cancer News Today on December 2nd. A excellent summary of these developments was also published in Cancer Network of the journal Oncology, December 3, 2015.
Ovarian and Breast Cancer Drug, Olaparib, is Effective in a Significant Number of Men with Advanced Prostate Cancer.
A major trial has concluded that a pioneering drug from AstraZeneca, olaparib, developed to treat women with inherited cancers, can also benefit men with certain types of advanced prostate cancer. Olaparib inhibits the enzyme, poly (ADP ribose) polymerase (PARP), a protein used by cancer cells to carry out DNA repairs. PARP inhibitors work on cancers caused by a faulty BRCA1 or BRCA2 gene. Cancerous cells of this type depend on the PARP protein to carry out DNA repairs. If PARP is blocked, cancer cells cannot repair themselves and die.
Olabarib is the world’s first therapeutic agent approved by the FDA in December, 2014 for the treatment of ovarian cancer patients with mutations of the BRCA1 and BRCA2 genes, which play key roles in DNA damage repair. Mutations in these genes have been linked with the development and progression of many tumor types, including prostate cancer. In a recent study published on October 28th, 2015 in the New England Journal of Medicine, researchers found that olaparib is effective in treating the approximately 30% of men with DNA repair defects in their tumors. This illustrates the principle of precision medicine that one can detect prostate cancers with specific targetable mutations using genomic sequencing to deliver more precise cancer care by matching treatment to those men who are most likely to benefit. The trial is also very significant in that it exploits the similarities between prostate, breast and ovarian cancers. In the phase II trial called TOPARP-A, olaparib was found to benefit as many as a third of men (17 out of 49) with metastatic, hormone-resistant prostate cancer, including those who did not inherit cancer genes, but whose tumors acquired defects in DNA repair overtime. Six men had radiological (CT and MRI scan) responses, and eleven had biochemical responses as evidenced by PSA reductions of greater than 50%. Four of the patients had responses that lasted for more than 12 months. Anemia and fatigue were the most common side effects. Olaparib was determined to be effective in stopping prostate cancer growth, generating lasting decreases in prostate specific antigen (PSA) levels, decreases in circulating tumor cell (CTC) counts in the blood, and radiological responses on CT scans and MRI. If approved as a new therapy, men would have to undergo genetic testing looking for defects in DNA repair genes in order to qualify for olaparib. For additional information, see the following linked short article. TOPARP-A, is a major milestone in cancer treatment because it is the first to show the benefit of “precision medicine” in prostate cancer. Precision medicine is a new, transformative model of healthcare that utilizes information from tumor DNA to match a patient with the most effective course of treatment. It is conceivable that drugs such as PARP inhibitors could also increase the effectiveness of common DNA-damaging therapies such as chemotherapy and radiation. For additional information on precision medicine for treatment of certain prostate cancers, see the following linked article published in the OncoTherapy Network.
Should Men with a Rising PSA After Surgery Add Taxotere to Their Hormone Therapy?
A total of 413 relapsing prostate cancer patients whose PSA doubling time was less than nine (9) months and whose PSA was over 1.0 were evaluated. Half of the men were treated with Lupron and the other half received Lupron and Taxotere (docetaxel®). The study information is preliminary after only 2.5 years of follow-up but a statistical trend toward an improvement in cure rates was observed in men treated with Taxotere (docetaxel®) and Lupron.
The preceding abstract was presented at the 2015 meeting of the American Society of Clinical Oncology (ASCO) by Dr. Michael J. Morris of the Memorial Sloan Kettering Cancer Center in New York.
Don’t Let Yourself Go! The Benefits of Exercise During Hormone Therapy
A recent article written by researchers from the University of Southern California was published in the August 2015 issue of Prostate Insights from the Prostate Cancer Research Institute. The article discussed how exercise may help with treatment-related side effects of hormone therapy (ADT) and what types of exercise were most effective. Two of the primary side effects of ADT are the loss of muscle mass and increase in body fat within 3-12 months of starting treatment. These effects, termed sarcopenic obesity, also contribute to insulin resistance and greater risk of diabetes. Prevention of muscle loss was observed with exercise programs that were at least three (3) months in duration and involved resistance exercise rather than aerobic exercise although both were recommended. Resistance exercise utilizes weights (machines or free weights), while aerobic exercise such as walking, cycling or swimming, elevates heart rate. Weight exercises should be done two (2) or three (3) times per week targeting the major muscle groups beginning at moderate intensity and progressing to more vigorous intensity with limited rest periods. For example, a chest press exercise which involves more muscle mass is preferred over a biceps curl exercise. In addition, the exercises should start at light weight and high repetitions (>12) and slowly progress throughout the weeks to heavier weight and less (around 8) repetitions. Minimal rest sessions of less than one minute should be taken between sets as a way of keeping the heart rate elevated in a manner similar to aerobic training. It was also found that performing either aerobic or resistance exercise at least twice a week reduced fatigue, another side effect of ADT. In summary, regular exercise incorporating resistance and aerobic training should be carried out 2-3 times per week. Resistance exercise should focus on large muscle groups (e.g. chest press, leg press and leg curl) combined with dynamic movements e.g. squats, lunges. Also, remember to discuss starting any rigorous exercise program with your physician.
AR-V7: A Genetic Test to Determine Effectiveness of Enzalutamide and Abiraterone.
When prostate cancer becomes “hormone resistant” or refractory, anti-androgen drugs such as enzalutamide (Xtandi®) and abiraterone (Zytiga®) are often prescribed. But not all patients respond equally. Some 30 percent of men with advanced prostate cancer have an abnormal version of a prostate cancer protein that connects with testosterone. The protein is missing a key connector that binds to abiraterone and enzalutamide. The abnormal protein is caused by a genetic variant called AR-V7. Most patients who test positive for AR-V7 get limited or no benefit from abiraterone or enzalutamide. Researchers at Johns Hopkins in Baltimore have invented a test for the genetic variant, AR-V7. However the test is available for research purposes only at this time. More information can be found in the linked article and in a blog published on this website on May 7th, 2015.
Earlier chemotherapy may extend patient survival in multiple prostate cancer settings
Whether a prostate cancer patient is just presenting with localized high risk prostate cancer, presenting with metastatic prostate cancer, or experiencing a metastatic recurrence, earlier treatment with taxane chemotherapy may prolong survival.
June 19, 2015 — Chemotherapy with docetaxel® (taxotere) has traditionally been used to treat prostate cancer patients only after they have developed resistance to hormone therapy. However, two new studies presented at the 2015 American Society for Clinical Oncology (ASCO) Annual Meeting found that the addition of taxane chemotherapy extended survival in several groups of patients initiating hormone therapy: in patients with primary metastatic disease or relapse with metastases after definitive local treatment, and as a first-line therapy in previously untreated patients with localized high-risk prostate cancer.
Upfront Therapy with Docetaxel® Prolongs Overall Survival in Men with Hormone-Naïve Metastatic Prostate Cancer Commencing Hormone Therapy
Prostate cancer patients who present with primary metastatic disease or relapse with metastases after definitive local treatment with prostatectomy or radiotherapy (RT) typically receive androgen deprivation therapy (ADT) with or without RT as the standard of care. Taxane chemotherapy or 2nd generation anti-androgen medications are only prescribed following the onset of ADT resistance. However, it is hypothesized that earlier administration of these therapies may extend patient lives.
Dr. Nicholas James of the University of Warwick and Queen Elizabeth Hospital Birmingham presented the first survival results released from the STAMPEDE CLINICAL TRIAL, the largest randomized clinical trial ever conducted in prostate cancer patients. This study tested the outcome of adding various therapies to the standard of care—ADT with or without RT—in hormone-naïve patients either presenting with metastatic disease or relapsing after prostatectomy or RT. The addition of docetaxel + prednisolone to standard of care treatment extended the median failure-free survival time from 21 months to 37 months, and extended the median overall survival time from 67 months to 77 months.
These results support previous results from the CHAARTED trial, presented at the 2014 ASCO annual meeting, where the addition of docetaxel® to ADT improved median overall survival from 44 to 57.6 months in a cohort of hormone-sensitive metastatic prostate cancer patients. Collectively, these results support a paradigm change in clinical practice. Docetaxel® in combination with ADT should now be considered much earlier in the treatment regimen for men with hormone-naïve metastatic prostate cancer.
The 2015 ASCO Annual Meeting was held from May 29 – June 2, in Chicago, IL. The preceding article was adapted from the July 2, 2015 issue of the Prostate Cancer Foundation Publication, NewsPulse.