General Patient Information – Page 10

Prostate Cancer “Calculator”

I recently came across an interesting article about a 72 year old man seeking advice on his prostate cancer diagnosis from his urologist at the University of Texas Health Center. His urologist showed him a unique way for men to evaluate their risk of developing prostate cancer by using a simple tool called the Prostate Cancer Risk Calculator. It involves entering data regarding age, race, PSA level, family history, digital rectal examination and prior prostate biopsy into a “calculator” which then gives a general risk percentage of high-grade or low-grade prostate cancer, and the chances that a biopsy would be negative. The web address for this calculator is deb.uthscsa.edu and can be accessed from the linked article. Please be advised that this is for information purposes only and should always be used in consultation with one’s personal physician.

Statin Drugs May Help Improve Prostate Cancer Survival

Cholesterol-lowering statin drugs may help slow prostate cancer in men who are taking drugs to reduce their hormone levels, i.e. androgen deprivation or hormonal therapy. In a study presented at the recent Orlando meeting of the American Association of Clinical Oncology (ASCO), researchers from Harvard Medical School and the Dana-Farber Cancer Center cited that taking a statin drug concurrent with hormone therapy slowed the progress of prostate cancer by about 10 months. Statin users were also less likely to be initially diagnosed with aggressive prostate cancer. It must be noted that the study did not show a direct cause and effect but merely an association between the two treatment regimens. The study involved 926 prostate cancer patients on hormonal therapy. For more information about the study and potential ways that statins might affect prostate cancer, see the linked article.

Bone Health, Osteoporosis and Prostate Cancer

Osteoporosis is a major side effect in the use of androgen deprivation therapy (ADT, hormone therapy) for prostate cancer. Men are urged to discuss any potential risks of osteoporosis and bone health in general with their physician. Primary risk factors include hormone therapy, lack of exercise, vitamin D deficiency, tobacco or alcohol use, thyroid problems, having a thin frame, previous fractures and bone metastases. Bone density measurements (not to be confused with bone scans for metastatic cancer) are generally obtained by either dual-energy X-ray absorptiometry (DEXA) scans or quantitative computed tomography (QCT) scans usually of the lumbar spine and hip. QCT is a technique that measures bone mineral density using a standard X-ray computed tomography scanner. QCT enables spine bone mineral density (BMD) measurements on patients with scoliosis, which cannot usually be measured using DXA scans. It is reported that for men, while the DEXA scan is the most commonly utilized, it seriously underestimates the degree of osteoporosis. QCT can avoid the artiﬁcially high BMD measurements that can confuse the results from DEXA scans in arthritic patients and patients who suffer from disc space narrowing or spinal degenerative diseases. Therefore, in the case of men with prostate cancer, some physicians recommend QCT over the more common DEXA scan. To enhance both muscle and bone density, weight-bearing exercise is essential. Several treatments are available for prostate cancer (pc) patients who have osteoporosis or bone metastases. These include: a) Zometa® (zolendronate), administered by i.v. drip monthly for pc patients with bone metastases; b) Xgeva® (denosumab), one injection monthly also for pc patients with bone metastases; c) Prolia® (denosumab), administered by injection every 6 months for men with osteoporosis or pc patients on hormonal therapy at high risk of fracture; and, d) Reclast® (zolendronate), administered by i.v. drip annually in men with osteoporosis. It is recommended that patients take calcium and vitamin D3 supplements and monitor them regularly by blood tests while taking any of the above-medications. Also a dental checkup is recommended before starting any of the above. It should also be noted that the greatest benefit from these agents is observed in the first year or two and it is possible to be on them too long when their risks begin to outweigh their benefits. As always, on-going thorough discussions with your oncologist or urologist regarding osteoporosis, bone health and prostate cancer is a necessity. Major portions of this article were summarized from the February issue of the Prostate Cancer Research Institute (PCRI) Insights as well as the following linked Wikipedia site.

Unsolicited Advice from Survivors for the Newly Diagnosed Men with Prostate Cancer

The following post comes from a site called Prostate Snatchers written by Ralph Blum and Dr. Mark Scholz. You are urged to subscribe to their periodic e mails by logging into prostatesnatchers.blogspot.com.

In 2014, approximately 233,000 men in the U.S. were told they had prostate cancer and to many of them it sounded at best, like the end of their sex life, and at worst like a death threat. In reality, the majority of them turned out to have an indolent form of the disease that was not life threatening and could safely be monitored without any immediate treatment. Having said that, a diagnosis of prostate cancer is not a walk in the park. Just when you are most vulnerable you are obliged to confront so much complex and conflicting information that to say it leaves you reeling would be an understatement. So your first and most important decision is not to make a pressured decision, not to rush the treatment selection process or allow anyone else—including any doctors you consult—to rush you into undergoing an irreversible treatment until the shock has worn off and you have had time to carefully analyze all the data that applies to your particular case. The first step after being diagnosed is to understand the concepts of staging and grading. The grade of your cancer will tell you how aggressive the cancer cells are. The stage tells you how extensive or advanced the cancer is. This information, together with your PSA level, will help determine your prostate cancer’s risk factor—whether you are in the low-risk, intermediate-risk, or high-risk category. If your cancer is low-risk it can be safely monitored with “active surveillance” and does not require any immediate treatment. If you are in the intermediate-risk category, you have many treatment choices, and in order to make the best decision you will need to get opinions from specialists with state-of-the-art knowledge. You will already have seen a urologist who, if you are a candidate for surgery, is likely to have recommended a prostatectomy. If this is the case, it is essential to ask him the tough questions: What are the risks? How many prostatectomies has he performed overall and how many has he done in the past twelve months? Does he perform nerve-sparing surgery, and if so what is his success rate with preservation of potency and continence? And if you are over seventy, please consider prioritizing almost any other treatment option ahead of going through a major surgical procedure. Before making a treatment decision you should consult a radiation oncologist about brachytherapy (radioactive seed implantation), and IMRT (Intensity Modulated Radiation Therapy), a precisely targeted type of radiation that delivers high doses to the prostate without damaging surrounding organs. In my opinion both these options are at least as effective as surgery at curing the disease and both are associated with significantly lower risk of long-term toxicity. You should also consult a medical oncologist about hormone therapy, a treatment that blocks the male hormone testosterone and significantly slows the spread of the cancer, often for years. Hormone therapy does not promise a cure, but it is a viable, non-invasive alternative to surgery, an effective delaying action. A medical oncologist is a good doctor to consult with as they have no vested interest in either surgery or radiation and can often be helpful in sorting out the conflicting opinions you likely have heard. If your cancer is in the high-risk category you will usually need two or more different kinds of treatment—probably hormone therapy plus radiation. Some centers even may mention chemotherapy such as commonly done for patients with colon cancer or for women with breast cancer. And there are many new treatment methods in the pipeline, so even if your cancer is aggressive, you are not looking at an imminent death threat. So do your research and take your choice. And always remember: Prostate cancer is about the best possible cancer to deal with.

Vitamin D May Prevent Prostate Tumor Growth

This website usually posts articles from the medical and scientific literature, however with so much discussion about the diverse role of vitamin D in many diseases, a recent video and article from Fox News is very pertinent. A University of Colorado Cancer Center study recently published in the journal Prostate presented new evidence that vitamin D may help reduce cancer-causing inflammation. Scientists found that a gene GDF-15 – known to be up-regulated (stimulated) by vitamin D – can help block a protein called NFkB, which drives inflammation and stimulates tumor growth. The accompanying video and article speak for themselves. It is suggested that men have their vitamin D3 blood levels checked routinely. Vitamin D3 blood levels of 30-80 ng/mL are optimum. The appropriate blood test for vitamin D3 is the 25-hydroxyvitamin D assay as opposed to the 1,25-dihydroxy assay.

Prostatesnatchers: A Must-Read Website.

Not long ago, I came across a website called Prostatesnatchers, written by a prominent West coast urologist, Dr. Mark Scholz and Ralph Blum. Recent posts addressed such topics as: a) radiation for PSA-relapsed prostate cancer; an alternative to lifelong Lupron (hormonal therapy), Dec. 10th; b) aspirin lowers cancer mortality rates (Nov. 12th); and, c) how to find a skilled specialist when prostate cancer is suspected (Nov. 5th). Pertinent e mail blogs are sent every 2-3 weeks or so. To subscribe to the site, go to prostatesnatchers. blogspot.com and provide your e mail information.

Current Clinical Trials in Immunotherapy for Prostate Cancer.

The Prostate Cancer Research Institute (PCRI) has listed four (4) Phase 2 or Phase 3 clinical trials which are currently recruiting patients. These trials all involve immunotherapeutic agents. The first is a Phase 3 trial of ProstAtak® coupled with standard radiation therapy for localized prostate cancer. Patients should be newly diagnosed with intermediate to high risk disease, having received less than 6 months of hormonal therapy, and with no metastases or no local treatment. The trial is recruiting in several states and at institutions such as Johns Hopkins and Walter Reed in Maryland and Memorial Sloan Kettering in New York. Second, a Phase 2 study involving Ipilimumab (Yervoy®) with abiraterone acetate (Zytiga®) plus prednisone in chemotherapy and immunotherapy-naïve patients with progressive metastatic hormone-resistant prostate cancer is recruiting patients at Memorial Sloan Kettering in New York. Ipilimumab is a human monoclonal antibody currently approved for the treatment of melanoma. Third, another Phase 2 study involving Provenge® (Sipuleucel-T) coupled with immediate or delayed CTLA-4 blockade is recruiting in San Francisco. CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) is a protein receptor found on the surface of T-cells that down-regulates the immune system. The CTLA-4 receptor acts as an “off” switch for the attack of cancer cells by T-cells. Hence blocking the CTLA-4 receptor would enhance T-cell anticancer activity. Finally, a Phase 3 trial (Prospect) involving Prostvac in men with few or no symptoms of metastatic, hormone-resistant prostate cancer is recruiting patients. This Prospect trial has been described in a previous blog posted on August 5th, 2014.

News from Johns Hopkins on Urinary Incontinence, Kegel Exercises and Familial Prostate Cancer.

Urinary incontinence is a major complication of radical prostatectomy. According to the November 9th Johns Hopkins Health Alerts (Prostate Disorders), incidence of serious incontinence from surgery at medical centers of excellence is low, around 3% whereas from overall national patient survey data, urinary incontinence is dramatically higher, around 50-60%. For a clear description of the physiology of urinary incontinence, see the full Hopkins Health Alert. An earlier issue of the Johns Hopkins Health Alerts (August 24th) described the Kegel exercises which strengthen pelvic floor muscles involved in urination. These exercises are often prescribed before prostate surgery.

Studies performed on hereditary forms of prostate cancer at Johns Hopkins and the National Cancer Institute have shown that men with one close relative, such as a father or brother, with prostate cancer have a two-fold increase in the risk of developing the disease. If two close relatives are affected, there may be as much as a five-fold increase. Although a great deal of research has been directed toward the roles of diet and dietary supplements in prostate cancer risk, the results have been inconclusive in terms of hard data. There is a general consensus that a reduction in the consumption of red meat is associated with lower prostate cancer rates, but the reason is not known. Cruciferous vegetables, such as broccoli, cabbage, and brussels sprouts, and leafy greens, such as kale and collards, contain compounds that seem to reduce prostate cancer risk. A compound called lycopene, found in tomatoes and best absorbed from cooked tomatoes (as in sauce), is also thought to be helpful. For a while, selenium and vitamin E were believed to have a significant effect on the risk of developing prostate cancer, but a large multi-institutional trial failed to show any benefit. Regardless of diet, prostate health should be monitored at least once a year with a PSA and digital rectal examination. And it is not just the absolute value of the PSA that is important, but also the rate of rise from one year to the next. If the PSA goes up more than 0.5 ng/mL/year, regardless of the absolute value, there is a greater risk that prostate cancer may be developing. Under those circumstances, biopsy should be considered, assuming that there are no other special considerations related to overall health or personal preferences.

Four Experts Recommend the Earlier Use of Provenge in Metastatic Prostate Cancer.

In the last few years, several new therapeutic agents have been approved for treating various aspects of prostate cancer. Now research also needs to focus on the timely utilization of these agents either individually or in combination and at which stages of disease should they best be applied. Provenge® (sipuleucel-T) was approved by the Food and Drug Administration in 2010 for metastatic prostate cancer patients who were hormone-resistant (refractory) and who had little or no pain. Provenge® is an immunotherapy uniquely administered over several weeks and generally acts by “kick starting” the immune system while not attacking cancer cells directly. This website has described Provenge® in several posts over the past years. The question of when in the course of prostate cancer treatment should Provenge® optimally be administered is currently under much discussion. A recent series of video and e mail comments from four prominent prostate cancer physicians propose that Provenge® should be used at an early stage in the treatment of metastatic cancer. The videos and comments are linked in this post. The physicians cited are Dr. Charles Myers (himself a prostate cancer survivor), Dr. Charles Drake from Johns Hopkins, Dr. David Crawford from the University of Colorado, and Dr. Leonard Gomella from the Jefferson Kimmel Cancer Center. The reader is urged to share this information with one’s physician as much of it is medical in nature. But it raises some interesting points for discussion and possible incorporation into a treatment regimen as directed by one’s individual physician.

1) A “Calculator” to Predict Biopsy Outcomes; 2) Understanding the TNM Staging System Upon Prostate Cancer Diagnosis.

1) Researchers at the University of Texas Health Sciences Center in San Antonio have developed a “calculator” to predict probabilities of biopsy results based upon data such as PSA, age, race, results of digital examination and family history. To access the “calculator” online, go to http://deb.uthscsa.edu/URORiskCalc/Pages/calcs/jsp. The “calculator” is based on data from the prostate cancer trial that involved more than 5,800 patients to determine the risk of developing prostate cancer based upon PSA and digital rectal examinations. This information was recently cited in the October 19th Johns Hopkins Prostate Disorder Health Alerts.

2) When prostate cancer is first detected, the urologist will describe the extent of the tumor and the course of the disease using a system called the Whitmore-Jewett method or more commonly the TNM (tumor, nodes, metastasis) staging system. The “T” value describes the extent of the tumor; the “N” value indicates whether the cancer has spread to any lymph nodes; and, the “M” value indicates the presence or absence of metastasis to distant sites. This description will help in the choice of the most appropriate treatment option. The Johns Hopkins Health Alerts (September 13th, 2014) describes the TNM stages in more detail.