March 2010 Newsletter Articles

STUDY BACKS PROSTATE CANCER SURGERY BEFORE AGE 65

A landmark study of one of the most agonizing decisions faced by men with early prostate cancer Should I have surgery? Or should I wait and see if it spreads? -- found that for those under 65, operating clearly saves lives, cutting the death rate by more than half.

For men over 65, however, the jury is still out. They account for the vast majority of prostate cancer patients.

Because of the findings, younger men "are much less likely to be encouraged to watch and wait," said Dr. Durado Brooks, director of prostate cancer at the American Cancer Society.

Often, doctors recommend "watchful waiting" (WW) because, in many men, the tumor grows so slowly that they die of something else before the cancer ever kills them. Surgery to remove the diseased prostate also carries its own risks: impotence and incontinence.

The latest study, published in the May 12, 2005 issue of the New England Journal of Medicine, followed Scandinavian men under age 75 for a decade after surgery, a long period for such research. It found that surgery reduces deaths from any cause -- not just prostate cancer -- by nearly half.

About 9.5% of those who got surgery and 15% of those in the WW group died within 10 years of diagnosis. But all the benefit appeared to be among men under 65, where the WW group had more than double the death rate of the surgery group.

The study's lead author, Dr. Anna Bill-Axelson of University Hospital in Uppsala, Sweden, said urologists who favor surgery over WW will now be able to say that, in younger men, "there is finally proof it saves lives."

About 60,000 Americans undergo prostate cancer surgery each year. A man's age, his overall health, how advanced the cancer is and how aggressive it appears under the microscope are among the factors that doctors use in deciding whether to recommend surgery.

But recent research has shown that even slow-growing tumors can become more lethal after 15 years.

The latest study began in 1989. Researchers at 14 hospitals in Sweden, Finland and Iceland studied 695 men, most with localized tumors and were considered moderately aggressive. Their age averaged just under 65 years. Half got surgery; the other half had WW.

Brooks said longer-term research is needed to determine how the results apply in this country.

The Associated Press

LIKELY ORIGINS OF PROSTATE CANCER DISCOVERED

Researchers have found a set of genes that may play a key role in prostate cancer - a discovery doctors hail as a major breakthrough that changes the way they think about genetic roots of the disease.

If further research confirms these findings, published Friday in the journal Science, the discovery eventually might lead to better tests for prostate cancer as well as targeted therapies, says one of the study's authors, Mark Rubin, chief of urologic pathology at Brigham and Women's Hospital in Boston.

"This is amazing," says Michael Heinrich, a professor at the Oregon Health & Science University Cancer Institute, who was not involved in the study. "This is the Rosetta Stone of prostate cancer. Cracking the code lets you read the whole library. The implications of this are huge in a lot of different ways."

Until now, doctors thought it was the result of lots of random genetic mutations, Heinrich says. This study, however, suggests for the first time that prostate cancer begins after specific genes fuse, forming a sort of two-headed monster.

Selected Men With Low Risk Prostate Cancer Have Good Clinical Outcomes Without Immediate Treatment

A multi-center study of prostate cancer patients, appearing in Journal of Urology on 16 March 2009 recommends that for some men diagnosed with low-risk prostate cancer, opting not to initially receive treatment can be safe if they are closely monitored. The study conducted between 1991 and 2007 involved 262 men from 4 US and Canadian hospitals who met the following criteria: under age 75; PSA below lOng/ml; clinical stage T1 -T2a; Gleason score 6 or below; and 3 or fewer positive cores at diagnostic biopsy. In addition, participants underwent a restaging biopsy and had no treatment for 6 months following the repeat biopsy. They subsequently underwent physical exams and PSA tests every 6 months with biopsies recommended every 1-2 years.

Forty-three patients eventually chose treatment or had evidence of cancer progression prompting a recommendation for treatment by their physician. Delayed treatment (radiation or surgery,) cured all but one of the cancers. The remaining 219 patients remained on active surveillance without evidence of metastases.

Study author Scott Eggener, MD, assistant professor of surgery at the University of Chicago Medical Center, notes there are no widely-accepted recommendations to select appropriate candidates for active surveillance or when to perform "restaging" biopsies.

Before electing active surveillance, it is important for patients to undergo a restaging biopsy following the initial diagnostic biopsy. An earlier study found that approximately 30 percent of patients were not appropriate candidates for active surveillance due to results from a restaging biopsy.

"Active surveillance"... identifies men unlikely to be affected by their cancer and encourages frequent monitoring, and then starting therapy at a later appropriate time if needed. Eggener adds that cure rates appear identical with immediate or delayed treatment

Science Daily, 22 March 2009

LIKELY ORIGINS OF PROSTATE CANCER DISCOVERED (continued from the left)

Doctors found these merged genes in nearly 80% of 29 prostate cancer samples, says Arul Chinnaiyan, a professor at the University of Michigan Medical School who directed the study. None of the 50 samples of non-cancerous tissue had the genes, he says.

This may allow doctors to begin to divide prostate cancer - which is now treated as a single disease into different types. Doctors have been treating breast cancer this way for years: They prescribe the drug Herceptin to women whose tumors make too much of certain protein, and they give the drug Tamoxifen to those whose tumors respond to hormones.

So far, Chinnaiyan and his colleagues have found fused genes only in prostate tissue. They are trying to see whether they can detect the genes in blood or urine, which could allow them to develop a more accurate diagnostic test for prostate cancer.

Chinnaiyan also hopes the genes will tell doctors which tumors are deadly and require aggressive treatment. That could allow men whose tumors are relatively harmless to avoid treatment and its side effects. Doctors now have few good ways to tell these men apart, leading about half to undergo unnecessary therapy, says Otis Brawley, medical director of Grady Health System's Georgia Cancer Center for Excellence.

Chinnaiyan says his discovery may allow doctors to develop new treatments. Chronic myeloid leukemia patients can live for years without serious side effects thanks to the drug Gleevec, which was developed after scientists discovered the cancer's genetic roots.

Brian Druker, the scientist who developed Gleevec, says it could take years or even decades to develop a targeted therapy for prostate cancer. But these genes at least give scientists a target – a critical first step. "This is incredibly important," Druker said in an e-mail. "Finding the cause gives us hope for finding a cure."

USA Today