January 2010 Newsletter Articles

Prostate-Surgery Questions

A new study suggests less-invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotence when compared with traditional surgery.

Laparoscopic, or keyhole, surgery is increasingly chosen by men having a cancerous prostate removed, and it often involves robotics.

For the study, appearing in Wednesday's Journal of the American Medical Association, researchers analyzed Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07.

Associated Press

PREDICTING THE RETURN OF PROSTATE CANCER: NEW STUDY BETTERS THE ODDS OF SUCCESS

Cancer experts at Johns Hopkins say a study that tracked prostate cancer patients for a median of 8 years shows that a three-way combination of measurements has the best chance yet of predicting disease metastasis. Findings from the study were presented at the 2009 ASCO meeting and investigators suggest this may help determine which patients may benefit from additional therapy when PSA levels rise after radical prostatectomy (RP).

After reviewing the records of 774 men whose PSA rose after RP, the researchers found that Gleason score and two measurements for PSA were the strongest risk factors for prostate cancer metastasis. Men with Gleason scores in the highest range, between 8 and 10, were twice as likely to develop metastatic cancer. In men whose PSA became detectable within 3 years after RP, cancer was more than three times more likely to metastasize. Finally, men whose PSA doubled within three months were more than 20 times more likely to develop metastatic cancer than men whose PSA look longer than 15 months to double.

An increase in PSA occurs in approximately 20 percent to 30 percent of men after surgery to remove the cancerous prostate, says Emmanuel Antonarakis, MD, Johns Hopkins Kimmel Cancer Center investigator. In these patients, the cancer is rarely detectable on imaging scans. When faced with the likelihood that their cancer has spread, many men opt to undergo androgen deprivation treatment (ADT), which can cause side effects mimicking those experienced by menopausal women.

"There is much debate on whether to prescribe immediate treatment for a man whose PSA begins to rise after he has had prostate cancer surgery, or to delay it," says Antonarakis. "Studies suggest that most men live the same length of time overall whether they receive therapy at the first sign of a rising PSA or wait until the cancer has spread to other sites."

Besides immediate ADT, men with a rising PSA can consider other options, such as intermittent ADT, expectant management or participation in clinical trials for experimental therapies.

ScienceDaily, 3 July 2009

GETTING CLOSER TO THE ORIGINS OF PROSTATE CANCER

In a study reported online ahead of print in the journal Nature, researchers describe a previously unknown form of prostate stem cell that can become cancerous if genetic controls go haywire. The prostate consists of several layers of cells, with the lowest, the basal layer, playing a supporting role and the luminal layer, just above it, doing the actual work of the gland.

The discovery was made in mice. The mouse work showed that the newly described stem cells can give rise to cancers if the action of a tumor suppressing gene is lost. That gene is frequently mutated in human prostate cancers. The next step is to show that the same kind of stem cells exist in humans. "But this work partially explains how you can have a prostate cancer that is luminal," explained study co-author Cory Abate-Shen, a professor of urology, pathology and cell biology at Columbia University's Herbert Irving Comprehensive Cancer Center, in New York City.

Prostate-Cancer Therapy Risk Cited

A new study links hormone therapy for prostate cancer with a higher risk of death in older men who have had serious heart problems.

Hormone therapy suppresses the amount of testosterone produced-in turn, causing prostate tumors to shrink or grow more slowly. The treatment, involving injections in a doctor's office, can help men with more advanced disease when used with surgery or radiation.

But the side effects are troubling: impotence, bone loss, hot flashes, memory problems, fatigue and an increased risk for diabetes and heart disease.

For the study, in Wednesday's Journal of the American Medical Association, researchers followed over 5,000 men with prostate cancer that hadn't spread. All the patients had radiation treatment at one Illinois treatment center. Thirty percent of them also took hormone therapy.

Five percent of the men in the study had a history of heart failure or heart attack and 43 of those men died. Among those with heart problems, the hormone treatment was linked to a 96% higher risk of death after adjusting for other risk factors.

In raw numbers, of the 95 men on hormone therapy who also had a history of serious heart problems, 25 died. Of the 161 men not on hormone therapy who also had a history of heart problems, 18 died.

Associated Press

MEN DIAGNOSED WITH PROSTATE CANCER IN RECENT YEARS HAVE BETTER SURVIVAL OUTCOMES

Research published online ahead of print in the Journal of the American Medical Association (JAMA), by a team at The Cancer Institute of New Jersey (CINJ), showed that men diagnosed with prostate cancer in the early 1990's had significantly improved survival outcomes compared with patients whose cancers were diagnosed in prior decades.

The study, Outcomes of Localized Prostate Cancer Following Conservative Management, examined 14,516 men aged 66 or older who were diagnosed with prostate cancer from 1992 through 2002 and did not receive surgery or radiation within six months of diagnosis. The researchers utilized information from the Surveillance, Epidemiology and End Results (SEER) cancer registries and healthcare encounter data collected by Medicare.

The study found that the risk of dying from prostate cancer over a ten-year period following diagnosis declined by more than 60 percent compared with patients diagnosed in the 1970s and 1980s. For example, among patients with intermediate-risk cancer, men aged 66 to 74 had between a two and six percent chance of dying from prostate cancer within ten years compared to 15 to 23 percent in the earlier period.

The JAMA research also showed that men aged 66 and older with low- to intermediate-risk cancer without initial surgery or radiation had a low risk of needing palliative therapy. Only four to eleven percent of men in this group used palliative surgery, radiation, or chemotherapy to alleviate pain or cancer symptoms over a ten-year period following diagnosis. It also was determined that between 56 and 60 percent of men in the study (depending on tumor grade) had a risk of dying of causes other than prostate cancer within ten years following diagnosis. The authors say improvement in survival rates since the 1990's could relate to such factors as earlier diagnosis due to the increased use of the PSA test, changes in how disease is classified, and advances in medical care. The improved survival reported in JAMA is in line with findings of another study published by some of the same authors online ahead of print in the Journal of the National Cancer Institute (JNCI), which documents significant changes in the contemporary risk profile of prostate cancer patients.

"Up until our paper, it was thought that all the stem cells in the prostate reside in the basal layer," Abate-Shen said. "We have found a second stem cell population that is luminal rather than basal." The research group already is looking for similar stem cells in human prostate glands. "If we can identify them in humans, we can analyze them molecularly," Abate-Shen said. "That would give us a tool to study where and how prostate cancer originates - we want to do battle with these stem cells" he added.

HealthDay News, 9 September 2009