A new study published in the Journal of Urology suggests that anxiety may prompt prostate cancer patients to opt for potentially unnecessary treatments.
The research included more than 1,500 men newly diagnosed with localized prostate cancer. They were more likely to choose surgery and radiation therapy than active surveillance. Active surveillance — also known as “watchful waiting” — is when the patient is monitored closely, but not treated.
“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” said the researchers from the University at Buffalo and Roswell Park Cancer Institute in Buffalo, N.Y.
“Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided,” they noted.
Though the study found an association between anxiety and more aggressive treatment, it didn’t prove cause and effect.
“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment,” said study author Heather Orom, an associate professor of community health and health behavior at the University at Buffalo.
“If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety. We hope this will help improve the treatment decision-making process and ultimately, the patient’s quality of life,” Orom said in a university news release.
Study co-author Dr. Willie Underwood III, an associate professor in Roswell Park’s department of urology, said that to help men and families through this difficult process, “it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret.” Overtreatment is a concern because surgery and radiation therapy can cause side effects such as erectile dysfunction and incontinence. These problems can be avoided in men with low-risk prostate cancer by choosing active surveillance, the researchers said.
This report appeared in the January 27th, 2017 Medline Plus, published by the U.S. National Library of Medicine.
The National Institutes of Health (NIH) of the Department of Health and Human Services (DHHS) sponsors clinical trials related to many diseases and conditions including prostate cancer. (The National Cancer Institute, NCI, is the largest of all the institutes comprising NIH). The director of the NIH, Dr. Francis Collins recently discussed accessing information about these trials on their website, clinicaltrials.gov. The new NIH rules makes it easier for the public to access purposes of the trials, enrollment requirements, location, and especially summary results. I encourage you to view the following link to the short video by Dr. Collins who was a pioneer in the sequencing of the total human genome a few years ago.
The Prostate Cancer Foundation (PCF) just published an e mail review entitled “When Treatment Stops Working, Blame Resistance.” It describes multiple ways of treating advanced prostate cancer including androgen receptor blockers such as enzalutamide and abiraterone, chemotherapy, targeted drugs such as PARP inhibitors (olaparib and rucaparib), immunotherapy including checkpoint inhibitors, bipolar hormonal therapy, SBRT radiation, liquid biopsy and radiopharmaceuticals. See this link.
There has been a lot written recently about positron emission tomography (PET) scans. The following is a link to an overview published in Medical News Today on December 16th.
Radical prostatectomy can be a very difficult operation. The very best urological surgeons specialize in the prostate gland. They do a lot of these procedures annually. How do you find the right surgeon? The Prostate Cancer Foundation has published a checklist of things to consider before choosing the right surgeon.
1) First, locate a high-volume center that performs a lot of these procedures. Often this is an academic center. Not only are surgeons involved but supporting teams e.g. nursing, specialize in caring for prostatectomy patients. Websites that can help locate such high-volume centers include the National Cancer Institute’s website namely http://www.cancer.gov/research/nci-role/cancer-centers/.
The National Comprehensive Cancer Network (NCCN) also has a useful website for all types of cancer including prostate. See the following web address, https://www.nccn.org/patients.
2) Look for a place where different specialties work together in multi-disciplinary teams such as urology, radiation oncology, medical oncology and pathology. Since prostate cancer is not a “one size fits all” condition, one can get opinions from a team of experts who may recommend treatment modes other than surgery.
3) Ask the surgeon about his patient results. Does he keep results of his many patients regarding their outcomes, side effects such as incontinence and/or impotence, cancer recurrences, etc? Come prepared with a list of questions to ask as well as a detailed description of your specific condition and hopes.
4) Ask the surgeon to provide you with names of his patients who have agreed to speak to other patients about their experiences. If possible, contact some of them. This is helpful in demonstrating that the surgeon has many “happy” patients who comprise a support network to help prospective patients decide what’s best for them. Also check the prostate cancer support groups in your area and ask these men about their experiences and specific surgeons.
5) How many radical prostatectomies has the surgeon performed? The answer should be in the hundreds. If it’s something like “quite a few”, seek elsewhere.
6) Ask more than one doctor to recommend the best prostate surgeon in your area. Some doctors are in practice groups and therefore recommend the specialist in that group. That’s why it is good to ask different doctors in different practices.
7) Beware of the reviews or ads on the internet. The internet is full of false accusations or glamorization of surgeons, and specific hospitals and departments. One urologist said that online reviews are totally unreliable. This is not “Angie’s List of plumbers.” Medical groups or individual physicians may have ulterior motives or “good urology friends” who may or may not be the best choice for you.
8) Don’t worry about offending the doctor with questions or by getting a second opinion. Don’t be rude or disrespectful but don’t feel intimidated either. Do your homework. It’s your prostate and your recovery and your life. You don’t want to be one of those men who say afterward “I wish I had listened to good advice; my surgical experience was not as good as I had hoped.”
An analysis by Canadian and Australian scientists of 27 previous studies led them to conclude that there is a significant association between alcohol use and prostate cancer risk. The more men drink, the greater the risk. Even low levels of drinking (up to two drinks a day) were associated with an 8 to 23 percent higher risk of prostate cancer when compared to no drinking, the researchers said. However, they did not prove that drinking caused the prostate cancer risk to increase. Alcohol is a known risk factor for breast cancer and at least seven types of digestive system cancers, and alcohol may also increase the risk of cancers of the skin and pancreas, the researchers said.
Additional details can be found on the following linked article published November 16th in the U.S. National Library of Medicine’s Medline Plus. See also the following item from Prostate Cancer News Today, Nov. 21.
When you’re diagnosed with prostate cancer, the doctor will determine how far the disease has progressed and tell you what stage the cancer is in. The staging shows how the tumor has grown and if the cancer has spread to other parts of the body. It’s important to know this information so that patients can start the correct course of treatment.
Here are the four recognized stages of prostate cancer:
Stage 1 refers to an early-stage diagnosis of prostate cancer and means that the tumor is in just one-half or less of one side of the prostate. At this stage, the tumor cannot be picked up on any imaging machines and cannot be felt in a digital rectum exam. The cancer is still confined to the prostate and hasn’t spread to any other parts of the body. Stage 1 prostate cancer will have a Gleason score below six and a PSA score below 10.
Stage 2 prostate cancer is split into stage 2A and 2B. In stage 2A, the cancer will still be confined to one-half of one side of the prostate and won’t have spread. The Gleason score will be 7 or under, and the PSA score will be 20 or under. At this stage, it still won’t be picked up via imaging or a digital rectum exam.
Stage 2B prostate cancer can be felt with a digital rectum exam and is now able to be picked up with imaging techniques. The cancer has now spread to the other side of the prostate, but not to the lymph nodes or other parts of the body. It will have a Gleason score of 8 or higher and a PSA score of 20 or higher.
Stage 3 is when the cancer has spread from the prostate and could now be in the seminal vesicles, but the lymph nodes and other parts of the body remain unaffected. Both the Gleason score and the PSA score can be of any value at this point.
Stage 4 prostate cancer is where the cancer has spread into other tissues surrounding the prostate including the rectum, bladder, pelvic wall or the urethral sphincter. It may also have spread to the lymph nodes and other parts of the body. At this stage, the Gleason and PSA scores can be of any level.
It isn’t often that a research finding appears in 4-5 e mail or other publications but such is the case herein. Researchers at Stanford University School of Medicine published a study entitled “Association Between Androgen Deprivation Therapy and the Risk of Dementia” in the journal Journal of the American Medical Association Oncology. They reported that men treated with testosterone-lowering drugs for their prostate cancer are more than twice as likely to develop dementia as those not receiving such treatment, according to a study that reviewed the medical records of nearly 10,000 patients. But, the study only found an association between ADT and dementia risk, not cause and effect. The researchers advised however that men undergoing androgen therapy shouldn’t stop the treatment based on these findings because more studies are needed to verify this potential link.
Last year, the research team at Stanford discovered that testosterone-lowering treatment was linked to a higher risk of developing Alzheimer’s disease. Since Alzheimer’s is commonly confused with vascular dementia, the team decided to explore if the association held true when including all types of dementia.
They identified medical records of 9,272 men with prostate cancer who had been treated between 1994 and 2003, of which 1,829 received testosterone-lowering treatment. To make sure results became as robust as possible, they first removed all patients who had dementia at prostate cancer diagnosis. Then, they matched treated and untreated patients with the same disease stages, to make sure the comparisons were valid.
The team discovered that within five years, 7.9 percent of those receiving testosterone-targeting treatment had developed dementia. Among patients not receiving such treatment, the number was 3.5 percent.
The risk is real and, depending on the prior dementia history of the patient alternative treatment treatment may be considered, particularly in light of a recent prospective study from the U.K., which showed that prostate cancer patients had the same chances of survival within a 10-year time frame, whether they received aggressive treatment or active monitoring. Only 1% of men died during the 10 years, suggesting that monitoring may be as good as treatment, without causing side effects.
According to an article in the Oct. 13th MedlinePlus published by the U.S. National Library of Medicine, one possible explanation is that androgens like testosterone are believed to be very important for neuron [brain cell] health. In the brain, the ability of neurons to repair themselves and not die off, those are at least partially regulated by androgens. A very reasonable theory would be if you don’t have those androgens around to have that protective effect, you would be more susceptible to developing dementia.
Based on the findings, researchers argue it makes sense to identify those at risk for dementia before considering testosterone-lowering treatment. Researchers, however, underscored that the data are derived from medical records, and that prospective clinical trials ultimately are needed to remove any doubts that testosterone-lowering treatments may trigger cognitive decline.
A slightly more extensive article for health professionals was published in the October 21st issue of Cancernetwork, home of the journal Oncology.
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).
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.