In a study published online on Oct. 20th in the Journal of the American Medical Association (JAMA) Oncology, more than 90 percent of men in Sweden who have very low-risk prostate cancer choose close monitoring rather than immediate treatment — and more American men should use that option, researchers say.
In a study of nearly 33,000 Swedish men with very low-risk (stage T1) prostate cancer diagnosed between 2009 and 2014, the number choosing what is called active surveillance increased from 57 percent to 91 percent during that time frame.
“For men who are diagnosed with low-risk prostate cancer, it is important to know that active surveillance is an accepted way to manage the cancer,” said lead researcher Dr. Stacy Loeb, an assistant professor in the departments of urology and population health at NYU Langone’s Perlmutter Cancer Center in New York City.
“There is no rush to get treatment — low-risk prostate cancer can be safely monitored,” she added. “Some men will eventually need treatment, but others will be able to preserve their quality of life for many years.”
In the United States, the majority of men with low-risk prostate cancer get treatment upfront, which can have side effects, such as urinary and erectile problems, Loeb said.
Active surveillance isn’t wait-and-see, she explained. It involves regular blood tests and regular biopsies to gauge the growth of the tumor. When the tumor grows to a point where treatment is needed, then it’s time for curative surgery or radiation.
A recent British trial showed that 10 years after diagnosis, the risk of dying from prostate cancer was the same whether men initially had surgery or radiation or opted for monitoring, Loeb added.
“We found that most men in Sweden with low-risk cancers are now opting for surveillance rather than upfront treatment,” Loeb said. “Hopefully, this study can increase awareness among patients in the U.S. and other countries that deferring treatment is an accepted option for low-risk prostate cancer.”
There is a lot of controversy about prostate cancer screening, Loeb noted. “Prostate cancer has no symptoms until it is advanced, so screening is actually very important to find life-threatening cancers in time for cure,” she said.
Patients with high-risk cancer do need treatment right away, and that treatment can be lifesaving, Loeb said. “However, many other men are diagnosed with low-risk cancers that have a very good prognosis without any treatment, and deferring upfront treatment can allow them to preserve their quality of life longer,” she said.
About 181,000 American men will be diagnosed with prostate cancer in 2016, and most of those will be in the earliest stages, according to the U.S. National Cancer Institute (NCI). Approximately 26,000 men will die from prostate cancer in 2016, the NCI estimates. The five-year survival rate for prostate cancer is nearly 99 percent, the NCI says.
“This [study] is more evidence of active surveillance becoming a standard of care,” said Dr. Matthew Cooperberg, an associate professor of urology, epidemiology and biostatistics at the University of California, San Francisco and author of an accompanying journal editorial.
Sweden has been far ahead of the United States in terms of active surveillance, but it is becoming more accepted here, Cooperberg said. About 40 percent to 50 percent of men with low-risk prostate cancer are choosing surveillance, “so we still have some catching up to do,” he said.
Adoption of active surveillance has been slow in the United States for several reasons, Cooperberg added. Among these are the financial and legal incentives to treat patients.
“In addition, culturally Americans have been uncomfortable with the idea of not treating cancer, because of the psychology that comes with the ‘C’ word,” he said. “But things are changing; it’s not such a foreign concept.”
Cooperberg said the future of active surveillance is refining it based on an individual’s cancer, so that tests and biopsies aren’t done on an arbitrary schedule, but on a schedule based on the characteristics of the patient’s tumor.
“Prostate cancer decision-making — from PSA testing on through treatment — really needs to be personalized,” he said.
As always, if this information pertains to your specific diagnosis, it should be discussed with your personal health care provider before taking any action. This report appeared in the October 20th issue of MedlinePlus, published online by the National Institutes of Health U.S. National Library of Medicine. This information also was posted on-line by Prostate Cancer News Today on October 31st (see link).
A large database analysis showed that the addition of external beam radiotherapy (RT) to androgen deprivation therapy (ADT) significantly improves overall survival (OS) in men with metastatic prostate cancer.
“As advances in systemic therapy for metastatic prostate cancer have improved OS and the control of metastatic disease, a greater interest has emerged in therapies to promote local control of the primary prostatic tumor,” wrote study authors led by Chad G. Rusthoven, MD, of the University of Colorado School of Medicine in Aurora. There is relatively limited data so far, though, on the use of external beam RT in these patients.
The study analyzed outcomes from 6,382 men diagnosed between 2004 and 2012 included in the National Cancer Data Base (NCDB), all of whom received ADT. Of these men, 538 (8.4%) also received prostate RT. The results of the analysis were published in the Journal of Clinical Oncology and linked herein.
Those who received RT were younger, had better comorbidity scores, lower prostate-specific antigen levels, and higher T stage, and were more likely to have n0 disease, to be treated at a community facility, and to have private insurance.
After a median follow-up of 5.1 years, the addition of RT was associated with a longer median OS of 53 months, compared with 29 months without RT. The 3-year OS rates were 62% with RT and 43% without RT; at 5 years, these rates were 49% and 25%, respectively, and at 8 years, the rates were 33% and 13%. A subgroup analysis showed that the biggest benefit of RT was gained in patients with Gleason scores of 8 or below, and for T1–3 tumors compared with T4 tumors. Higher RT dose was also associated with better OS compared with lower doses.
The analysis has limitations inherent to retrospective cohort studies, including the possibility of selection biases and imbalances. The authors noted that performance status and extent of metastatic disease burden could not be controlled for, and the sites of metastatic spread were unavailable.
Still, they concluded, “In this large contemporary analysis, men receiving prostate RT plus ADT lived substantially longer than men treated with ADT alone. Randomized trials to evaluate the impact of local therapy for men with metastatic prostate cancer appear warranted and several trials are ongoing.”
An excellent 3-minute video from Dr. H. Ballentine Carter, Professor of Urology and Oncology at Johns Hopkins, describes the use of MRI to view the prostate one day prior to performing a standard ultrasound-guided biopsy. The video speaks for itself and can be viewed at the following link.
This technique is also being used at the University of Texas Southwestern. See the following link for a complete description of how it is done and their positive results as compared with standard biopsy techniques.
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.
Three weeks ago, a good friend called me from his vacation to say his PSA had jumped from 4-5 to 8-9 within a few months. My friend was a Christian who definitely had a personal relationship with God through Jesus Christ. But he was very anxious as we probably all would be or have been at one time. He and I prayed and after a few days of consideration, my friend obtained an ultrasound-guided biopsy. Fortunately in his case, his 12 samples all came back negative for prostate cancer. But his experience reminded me again of the following devotional entitled “Anxiety” from Dr. Charles Stanley of In Touch Ministries which could apply at some time or other to anyone with health problems including cancer. The scripture text was Matthew 6:25, “do not worry about your life”.
“Has anxiety become a way of life for you? Are you living in a constant state of uncertainty and worry? Fear will arise whenever you respond to a problem or troubling situation on your own-without going to God first and seeking His help and power. The Lord gives you the gift of free will-you can choose what you do, how you feel, what you think about, and even how you’ll respond when faced with a problem.” Personally, anxiety is a signal that I must pray. Peace is a sign that I have given it all over to God. I am to pray until I have God’s peace according to Philippians 4:6-7 (‘let your requests be made known to God and the peace of God which passes all understanding shall keep your hearts and mind through Christ Jesus.’)
With this in mind, the Father may allow an overwhelming situation to arise in your life in order to develop and strengthen your faith, mature you spiritually, or to change a bad habit or negative attitude. Through your circumstances, He gives you the opportunity to seek Him, trust Him, obey Him and cast your care into His able hands. Therefore, understand your anxiety is an indication that you need God. Every time you sense fear rising up within you, go to your all-powerful, infinitely-wise Father. And give Him thanks that He is at work, teaching you to trust Him more, obey Him faithfully, and receive more of His blessings. A sample prayer could be ‘Father, I won’t be anxious for You are with me. Thank you for releasing me from this bondage of fear, amen.’ In His presence….find freedom from anxiety.”
If you are not sure of your relationship with God, see the following link.
Mutations in DNA-repair genes, including the breast cancer genes BRCA1 and BRCA2, are involved in an inherited high risk of prostate cancer and, potentially, the risk of an aggressive cancer, according to researchers at Fred Hutchinson Cancer Research Center and the University of Washington.
The study entitled, “Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer”, published in The New England Journal of Medicine, found the mutations in about 12 percent of men with the cancer — and found that men with metastatic prostate cancer were five times more likely than most people to have these DNA-repair gene mutations. Results suggest that screening for such mutations could help tailor their treatment and encourage family members to consider their own cancer risk.
Because BRCA1 and BRCA2 mutations have long been associated only with breast and ovarian cancers, it was thought that the mutations only affected women.
“I think these data really suggest that we need to engage men in discussions about genetics, where it has not been central before,” Dr. Heather Cheng, a Fred Hutchinson and University of Washington prostate cancer researcher.
The team analyzed 20 DNA-repair genes in metastatic prostate tumors and healthy tissues of 692 men. They found that 16 of the genes were mutated in both malignant and healthy cells in 12 percent of the metastatic cancer patients — much higher than researchers ever suspected, said first author Dr. Colin Pritchard.
“The implications are big in terms of intercepting and preventing a cancer because [carriers of these mutations] are at high risk,” said Dr. Pete Nelson, a Fred Hutch prostate cancer researcher and senior author on the study.
The findings are also important because men with advanced prostate cancer who have the mutations in DNA-repair genes could be treated with PARP inhibitors or platinum chemotherapy, which is commonly used in breast cancer patients. Although not yet approved for prostate cancer treatment, the treatments are on fast-track review by the U.S. Food and Drug Administration.
“For men with metastatic disease who are found to have these mutations, there are very clear treatment implications that would not otherwise be considered for prostate cancer. It would essentially expand [the patients’] toolbox of treatments,” Cheng said.
The authors concluded that it may be of interest to routinely examine all men with metastatic prostate cancer for the presence of germline mutations in DNA-repair genes. Future work by investigators will focus on determining which mutations predispose patients to the most aggressive type of prostate cancer.
The researchers hope the findings will land the screening in National Comprehensive Cancer Network guidelines — with future coverage by insurance companies.
Some of this information above also appeared in the blog dated July 28th, 2016. Information on PARP inhibitors under development can be found in the post dated November 30th, 2015.
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.
To understand better the benefits of vitamin D, watch this video shared by the Prostate Cancer Research Institute where Dr. Charles Myers, a medical oncologist and prostate cancer patient himself, talks about the use of vitamin D, how patients can benefit from it and how its deficiency can worsen patients’ health condition. In this 2-minute video, Dr. Myers always monitors the 25-hydroxy vitamin D levels of his patients and supplements them as needed with up to 5000-7000 units (IU) /day to achieve an optimum Vitamin D range of 40-80 nanograms/mL. It should be noted that vitamin D is a fat-soluble vitamin and can be problematic if taken in large excess. It is best absorbed when taken with the highest fat-containing meal of the day. Supplementation and dosage should be discussed with your health care provider.
In an accompanying study, researchers at the Medical University of South Carolina presented a clinical study entitled “Vitamin D in the prevention and treatment of cancer.” In this study, Dr. Bruce Hollis shows that supplementation with vitamin D (2,000-4,000 IU daily) can have a significant impact on disease progression, with the ability to alter molecular and biochemical pathways, slowing or even decreasing the development of less aggressive, or low-grade, prostate tumors without undergoing surgery or radiation. It was concluded that vitamin D seems to be specifically targeting tumor inflammation occurring mainly in the prostate gland, arresting lower-grade prostate cancers from becoming aggressive.
Previously on this Godandprostate website, posts discussing the relationship of vitamin D to prostate cancer have been posted on July 14, 2016, May 5th, 2016, Jan 21, 2015 and July 17th, 2014.
Please allow me to share lessons learned after my July 3rd post where I concluded that in the midst of unexpected results, I still believed wholeheartedly in God’s plan and faithfulness for my life especially as related to health issues. As a result of undergoing radiation treatment for my prostate cancer twelve years earlier, I am experiencing an undesirable but common side effect called radiation cystitis. Studies cited that it can be cured with up to sixty 2-hour sessions of hyperbaric therapy in a glass chamber wherein I am exposed to 100% oxygen under three atmospheres of pressure, equivalent to being under 50-60 feet of water. I had great hopes that since God made this therapy available to me, He would also cure me. The end result is that as of today, I am not totally relieved of all symptoms but there remains only an occasional trace which I can definitely live with. My Johns Hopkins urologist says that it will be a “constant issue”. So even though the treatments helped and I had hoped for a complete healing, God chose not to totally cure me. God has other plans. What have I learned?
The apostle Paul writes in 2 Corinthians 4:7-10, “But we have this treasure” (as Christians we have Christ in us) “in earthen vessels, that the surpassing greatness of the power may be of God and not from ourselves; we are afflicted in every way, but not crushed; perplexed” (note the word, I am at times!) “but not despairing; persecuted but not forsaken; struck down but not destroyed; always carrying about in the body the dying of Jesus” (just as He died, we have to die to ourselves); “that the life of Jesus may be manifested in our body”. I prayed many times that God would totally heal this condition but while it is inconvenient, He chose to leave me with a vestige. Like the oft-stated example of the apostle Paul who had a bothersome “thorn in the flesh”, God chose not to heal him totally even though Paul entreated the Lord three times for its complete removal. God’s answer was always the same, namely that “my grace is sufficient for you, for My strength is made perfect in (my) weakness.” ( 2 Corinthians 12:9). Recently in my quiet time, God told me the same thing and reminded me that He would take care of my body as I continued to minister about prostate cancer. I purposed in my heart to do just that.
As often happens, when I commit an issue to the Lord’s control, He tests me shortly thereafter to show myself whether or not I had truly committed it or not. It happened again recently. After a few days of positive symptom relief for which I was thankful, suddenly one day I regressed. After a few minutes of self-pity, I purposed in my heart and echoed the words of Job when he said “though He should slay me, yet I will trust Him.” The next day my condition improved significantly. I don’t always pass the “faith test” but this time I think I did.
God’s desire is for us to develop Christ-like character and grow in intimacy with Him. He wants us to experience the richness of His love and wholeheartedly show Him devotion. He will use trials and difficulties to accomplish His good purposes for us. Our inner man is being renewed in anticipation of eternal life in a new heaven and new earth with a new body. Life brings trouble to us from many sources, but the common thread in all trials is the Lord’s desire and ability to use them for our good and His glory. While I am forever grateful for the knowledge and care I receive from excellent physicians, I rest in a paraphrase of 1 Corinthians 1:25, “my faith doesn’t rest in the wisdom of man, it rests in the power of God.”
God’s blessings are not only for us but also for others. Our Father comforts us in our sufferings and asks that we share what we have received from Him with other people. Difficult times can even be ordained by God. Regardless of the source, our Father works in them to benefit us and to bless others. Hence I write this. Thank you for reading it.