April 07 Newsletter Articles

Vitamin E Saves Lives

A new National Cancer Institute study of 20,000 older male smokers followed for 19 years finds that, contrary to recent headlines, vitamin E is a lifesaver.

Men with the highest blood levels of vitamin E (alphatocopherol) were 18% less apt to die from any cause than those with the lowest blood vitamin E. Specifically, high blood levels of E cut risk of dying from prostate cancer 32%, lung cancer 21%, ischemic (blood clot) stroke 37%, hemorraghic (bleeding) stroke 35% and respiratory disease 42%.

The "optimal" dose of vitamin E is unknown and would vary with individuals, says Oregon State University expert Maret Traber. Up to 1,500 IU of vitamin E a day is considered safe for adults.

From EATSmart by Jean Carper

Early-stage Prostate Cancer Tough to Treat

By LAURAN NEERGAARD – Associated Press

WASHINGTON – It took eight agonizing months for Charles Linzey to decide how to treat his early-stage prostate cancer. His wife, in contrast, had her early-stage breast cancer surgically removed just a month after diagnosis.

It's not that the Baltimore businessman was less decisive. Instead, Linzey ran into a distressing reality: Unlike with breast cancer and many other malignancies, doctors simply couldn't tell him which therapy was a better bet for the leading male cancer.

There is little good research directly comparing prostate treatment options to help the newly diagnosed choose between surgery, two types of radiation, or watching a small tumor to see if it needs treating at all.

"I never felt comfortable, even when I made my choice, with my choice. Because no one would say, Thats a good choice,'" said Linzey, 59, who ultimately went with implanted radioactive "seeds" and is faring well.

Two new studies suggest the advice gap has consequences: overtreating early-stage tumors, and therapy choices driven by fear and misperceptions.

"When we give people choices, it's sometimes more difficult," acknowledged Dr. John B. Fiveash, a radiation oncologist at the University of Alabama-Birmingham, who is at the forefront of a fledgling trend to try to change that – through specialized prostate clinics.

Key for patients to know: "Not all prostate cancer is the same," stressed Dr. John T. Wel, a University of Michigan urologist who recently reported that about 55 percent of men with low-risk tumors are overtreated, unnecessarily exposing them to such side effects as impotence and incontinence.

Certainly, aggressive prostate cancer can kill. But often, prostate cancer is so slow-growing, and discovered when it's so small, that men will die of something else before it ever causes symptoms, much less becomes life-threatening.

One man in every six will get prostate cancer, but only one in 34 will die of it, according to the American Cancer Society.

PROSTATE CANCER PATIENT SUPPORT 1 800 80Us TOO

CHEMOTHERAPY PLUS HORMONE THERAPY IS FEASIBLE FOR PROSTATE CANCER RELAPSE

Androgen-deprivation therapy, along with chemotherapy appears to be feasible for treating the early relapse of prostate cancer, when tumor bulk is still minimal, researchers report in the December 1st issue of the Journal of Clinical Oncology (J Clin Oncol 2006; 24:5408-13). As lead investigator, Dr. Mary-Ellen Taplin told Reuters Health: "Our study evaluated the concept of administering chemotherapy earlier in the natural history of relapsed disease than is currently the standard."

Dr. Taplin of Dana Farber Cancer Institute, Boston and colleagues studied 62 men who underwent prostatectomy, radiation or both, for localized disease with no metastases, but an increasing PSA level. Treatment consisted of four cycles of docetaxel (Taxotere®) every 21 days and estrarmustine (Emcyt®) 280 mg three times a day on days 1 through 5. After chemotherapy, androgen-deprivation therapy (ADT) consisting of goserelin acetate (Zoladex®) and bicalutamide (Casodex®) was prescribed for 15 months. The proportion of patients with a complete remission after chemotherapy was 53%; after ADT, it was 63%, and 1 year after completion of ADT, it was 36%.

In the 56 patients who were observed for at least 1 year after the end of ADT, 23 (41%) had recovered testosterone and had not progressed at their last follow-up. The median time to progression was 34 months from initiation of treatment.

Reuters Health, 19 December 2006

Chart

Unfortunately, doctors have no easy way to tell who will be in the lucky majority.

Adding to the confusion: Studies are contradictory about whether aggressive treatment really improves a low-risk man's long-term chances of survival – or if a better option might be to closely monitor the tumor and treat it only if it starts to grow, so that he doesn't endure side effects until he really has to.

And while some older studies do suggest that radiation and surgery recipients fare equally well for up to 10 years, Fiveash said there are no direct comparisons of more modem surgical and radiation techniques, including more precisely targeted, potentially safer ways to deliver radiation.

So doctors typically just present all the options and let men choose. Michigan's Wei and colleagues tracked more than 64,000 men deemed so low-risk that they were good candidates for what's dubbed "active waiting" instead of immediate treatment. Those older than 70 were most likely to be unnecessarily treated, he reports this month in the Journal of the National Cancer Institute.