NewsPulse, a Medical Resource from the Prostate Cancer Foundation. Biomarkers in Urine for the Detection of Prostate Cancer.

Sources of current medical information concerning prostate cancer are listed on this website under the section Medical Resources.  Recently, a new August 2011 electronic newsletter entitled NewsPulse was received from the Prostate Cancer Foundation. The issue contained very current information on specific diagnostic methods, biomarkers for cancer detection, targeted therapies and drugs under development, nutrition and genetics. One example follows below. Their e mail address is I would strongly recommend a subscription.

Biomarkers in Urine for the Detection of Prostate Cancer.

Biomarkers are usually genes, gene products or proteins and are found in various body fluids (blood, urine, cerebrospinal fluid). Their presence, absence and quantities are measured and used to diagnose various diseases and their stages. An example is prostate-specific antigen or PSA used to detect prostate conditions. The availability of an easy-to-use urine test that is specific in identifying the presence of cancer has the potential to eliminate thousands of unnecessary prostate biopsies in the U.S. each year. Thus the benefits of such biomarker tests below include identifying which patients actually require biopsies.

The June 1st, 2011 issue of the Johns Hopkins Health Alerts and the August issue of NewsPulse both describe two new biomarkers found in urine which may potentially be useful in detecting prostate cancer as opposed to other non-cancerous prostate conditions such as BPH (benign prostatic hyperplasia or enlarged prostate). The two specific biomarkers are: a) prostate cancer antigen or PCA3, which is expressed at high levels in 95 percent of prostate cancer patients; and, b) the DNA marker TMPRSS2:ERG gene fusion, a hybrid gene made from two previously separate genes, specifically the ERG and TMPRSS2 genes. This DNA marker is present in 50 percent of prostate cancer patients. The presence of this gene fusion is “thought to promote the development of prostate cancer and possibly a more aggressive form of the disease.”

PCA3 is made by a specific gene that produces the protein in 60-100 times more abundance in prostate cancer cells as compared to non-cancerous ones. According to Johns Hopkins, in order to be most predictive, the test for PCA3 should be done in conjunction with a digital rectal examination. PCA3 testing would not replace the usual PSA blood test but would help to either confirm or rule out the prospect of cancer in men with elevated PSA levels.

Patients with high levels of these biomarkers have been shown to have a 70 percent chance of having cancer with a 40 percent of it being a high grade cancer. There is also an association between test results and the size of the tumor in patients who do have cancer. It will take some time before the combined urine-based assay is widely introduced into practice. However, NewsPulse reports that the “University of Michigan has been offering the PCA3 test alone since earlier this year. They expect to be offering it in combination with TMPRSS2:ERG by the end of this year under a license agreement with GenProbe. Another trial using the combined assay will soon be conducted in cooperation with the Early Detection Research Network (EDRN). EDRN, an initiative of the National Cancer Institute (NCI), brings together dozens of institutions to help accelerate the translation of biomarker information into clinical applications and to evaluate new ways of testing cancer in its earliest stages and for cancer risk.”

“Once the University of Michigan begins offering the combined TMPRSS2:ERG/PCA3 test, physicians can send urine samples for analysis until the combined test is more widely available. For more information on this, men with questions about prostate cancer screening should speak to their doctors or call the U-M Cancer AnswerLine at 800-865-1125.”

As previously stated, the contents of this website are intended solely for information and encouragement. All medical decisions and actions should be made in consultation with a physician or appropriate medical personnel.

Information from Johns Hopkins: a) Use of Immunotherapies (Provenge, Prostvac) Against Prostate Cancer; and, b) Gleason Scores.

Broad Run-Middletown, MD; bj gabrielsen photo

Provenge (sipuleucel-T) was the first approved prostate cancer therapy which uses a person’s immune system to fight the disease.  Its approval was limited to men with advanced prostate cancer who have not responded to other treatments like hormonal (androgen deprivation) therapy and are experiencing few or no symptoms. Cost and supply remain significant issues hindering its widespread use. A recent article in the Johns Hopkins Health Alerts (September 8th, 2011) describes on-going studies involving the administration of Provenge under differing conditions. These include: a) combining Provenge with hormonal therapy in patients with earlier stage disease; b) combining Provenge with radiation therapy in hopes that the combination will have a greater effect than either of the two therapies alone (synergism); and, c) Phase 3 studies in men with early-stage, non-metastatic prostate cancer. Other immunotherapies in clinical trials include Prostvac (from the National Cancer Institute, National Institutes of Health) which may be less costly.

In another earlier issue of the Johns Hopkins Health Alerts (August 24th, 2011), the concept of the Gleason score is described. It is defined as a grade assigned to biopsied tumor cells to indicate a tumor’s potential aggressiveness. This tumor grade “reflects how far the cancer cells deviate from normal, healthy cells.” Gleason scores of 5 and 6 are generally classified as low-grade tumors, a Gleason score of 7 as intermediate and Gleason scores of 8, 9 and 10 as high grade, with the least favorable outlook.

 These Johns Hopkins Health Alerts and additional Bulletins written by Dr. Jacek Mostwin and colleagues are invaluable sources of current information for prostate cancer patients.

Do you feel like you’re not your old self anymore? Has your cancer recurred? THERE IS HOPE!

In the last few weeks, I received word that prostate cancer had unexpectedly recurred in two men I know. Both men understandably expressed discouragement, apprehension and fear. What now??? I experienced a similar recurrence in 2003 (see My Story, 1994-2003,    “December, 2002 – January 11th, 2004. The cancer recurs. What do I do now?”.) In addition to the emotions experienced by the two afore-mentioned men, I experienced anger at God for allowing His seemingly curative surgical process to fail. But looking at this situation now eight years later, I see not only how God can allow us to experience many years of normal life through the use of existing and newly-approved medical treatments, but how He can use such seemingly negative outcomes in our lives to glorify Himself to people around us.

Anne Graham Lotz, the daughter of Billy Graham, tells a story about receiving a gift from her aging mother. The gift came wrapped in a plain brown paper bag packed with lots of decorative wrapping paper. After examining the contents of the bag and finding nothing of value, Anne Graham Lotz was about to discard the package as a mistake when her aging mother informed her that the package contained a small yet very valuable and historical ring. Anne Graham Lotz had nearly missed a very valuable gift simply because it had come packaged in a common, un-appealing, brown paper bag. The moral of her story was as follows: what “gift” have we been given by God wrapped in an un-assuming package and can He use such a “gift” to bring honor and glory to Himself and fulfillment to our lives if we choose to use it as such? Amazingly, recurring prostate cancer could be such a gift.

Following the recurrence of my own aggressive prostate cancer (my PSA was doubling every three months) in 2002-3 after a very promising and successful radical prostatectomy surgery in 1995, I received an unsolicited, encouraging letter from a friend. The letter writer pointed out to me that every time an angel appeared to someone in the Bible, usually the first words spoken by the heavenly being were “do not fear” or “don’t be afraid.” Familiar Biblical recipients of such angelic messages include Hagar, Gideon, Mary, Joseph, the shepherds in the field, and the two Marys at the tomb of Jesus. I was informed that the phrase “do not fear” is cited 365 times in the Bible, once for each day. This is because God knows how prone we are to fear, anxiety, apprehension and mis-trust when we encounter something we do not understand or expect. But when the phrase “do not fear” is stated, it is invariably linked with a specific characteristic about God or Jesus, such as their presence, power, past performance or promises. Words such as “do not fear for I am……” or “do not fear for I have…..” appear countless times. For example, Isaiah 41:10 states “do not fear for I am with you. Do not be dismayed for I am your God. I will strengthen you and help you. I will uphold you with my righteous right hand.” Such personal knowledge of and trust in the natures, characteristics and promises of God and His Son Jesus are the antidotes to fear and apprehension.

What can the Lord do with your unexpected, un-welcome “gift” of recurrent prostate cancer? Psalm 90:10 states that “as for the days of our lives, they contain seventy years, or if due to strength, eighty years.” I turn 70 next month. Our biological clocks are running. In our cells, our telomeres are shortening. We have the remainder of our earthly life to look forward to followed by our eternal destiny which depends on our relationship with God through Jesus. Instead of our disease, our focus should now be on actions which will benefit our family, friends and acquaintances in this life and especially actions which will have eternal significance for ourselves and those around us. Let all we do glorify God and Christ. Examples of this abound in the Bible. In John 11, Jesus was urgently summoned to the house of his close friends, Lazarus, Martha and Mary. Jesus delayed and meanwhile his friend Lazarus died. After the crowd accused Jesus of arriving too late to help, Jesus said in John 11:4 that Lazarus’ sickness was not intended for “death, but for the glory of God, that the Son of God (Jesus) might be glorified thereby.” Lazarus was raised from the dead and went on to fulfill his life. Likewise, the man born blind from birth in John 9:1-3 was healed so that the works of God might be glorified in him. If that were not enough evidence, look what Jesus could do with five loaves of bread and two fish which were used to feed over 5,000 men in addition to women and children. So what can He do with your “brown bag gift”?

In Matthew 11:28, Jesus provided the right perspective on life’s happenings that we perceive to be hard to manage. He can handle anything and that’s why He said “come unto Me all you who labor and are heavy laden, and I will give you rest.” Approach the Lord in prayer and cast our burdens upon Him so that He can sustain us. Remember He can use the “gift” you have been given in a brown paper bag to bring glory to Himself and God the Father.

All of us who have received the “gift” of prostate cancer have an assignment. First, we have to make sure our relationship with God through faith in Jesus is intact. If it is, then we should remember to list God’s and Jesus’ characteristics and remember how they have helped us in the past. Finally, we must lay our situations down before the Lord. What’s your brown bag gift and how will you entrust it? Existing medical treatments are available and new ones are progressing through clinical trials. Two treatments have been approved by the FDA this past year alone. God also uses wise, compassionate and knowledgeable physicians to treat and support us. God will sustain you and more than likely, you will be able to outlive this disease with many productive years ahead. Whether our cancer is cured, in remission, under treatment or has recurred, God still loves us so unconditionally that He offered up His Son so that through faith in Jesus, we may have a deeply personal relationship with God, the Father. In addition, He still has a master plan for our earthly life and the promise of eternal life in perfect, cancer-free bodies. You may think you have seen better days, but the best is still to come to those who know God and His Son, Jesus. He can best transform us into men whose lives will be productive, fulfilling and glorifying to God. Don’t give up!!!

Leesburg, VA; bj gabrielsen photo