Healthsifter by mary desmond pinkowish, since 2003

More on the Big Prostate Cancer Questions

Writing in today's Health Journal at the Wall Street Journal, Melinda Beck describes the conundrums facing men with elevated PSA levels. Should you undergo PSA screening at all? If you do have cancer, what's the next step.  Read her article "The Man, the Gland, the Dilemmas" here, or purchase the paper.

More on the Prostate Cancer Screening Mess

Read Tara Parker-Pope's article on the prostate cancer screening studies that appeared last week and are causing lots of confusion. This appeared in Tuesday's New York Times. I'm glad I don't have a prostate, actually.

Prostate Cancer Screening: Keep it Up!

If you were surprised/relieved/confused by the news from the prostate cancer screening trials that got wide press coverage over the weekend, read this article from Hugh Hewitt's blog at TownHall.com. The bottom line is that you need to continue testing. Avoid too-simple rationalizations for avoiding screening. Here's a portion of his post, which is the text of an email sent by Dr. Bruce Malkowicz, Co-Director of Urologic Oncology at the University of Pennsylvania, and the Thomas D. Stichter Memorial Professor of Urologic Research for the University of Pennsylvania Health System:

"The issue of screening for prostate cancer [CaP] is an important and controversial topic. What I was struck by in scanning the articles and what was confirmed in the editorial is the fact that while these are large trials, the reports are INTERIM ANALYSIS and not the final results of these studies. What is confirmed by the current data is our sense that prostate cancer is an over treated entity. It does not affirm or reject the role for screening. The European study actually suggests that the death rate from CaP may be reduced by 20% with the use of screening strategies although the statistical validity for this is marginal. Since this question is not answered there is definitely a role for active disease detection as part of overall male health. The key issue at this time is make a well informed decision on whether to pursue aggressive therapy or active observation.  Although one can not separate the all the aggressive lesions from the slower growing lesions, general parameters exist to help categorize this to some degree. The data from these reports suggest that low risk patients can feel more comfortable in following an ACTIVE, scheduled program of follow up instead of rushing to more aggressive treatments and their side effects. Those patients with intermediate and higher risk tumors would be taking their chances. Total ignorance of the situation is not appropriate. It is  true that some people can be made chronic patients with elevated PSA values that are false negatives and we have tried to deal with this by telling patients the basic statistics associated with PSA determinations. The prudent choice based on the available evidence is to first choose if you want to be ignorant of the entire situation or not, realizing that a positive lab test will probably lead to a biopsy and not  testing may miss a curable cancer. Once biopsied and diagnosed, an effort needs to be made by the patient and potentially treating physicians to choose observation or therapy based on the available data and the patient’s preferences.

Prostate Cancer Blog: One Man's Experience

Dana Jennings, a 51-year-old New York Times editor writes a blog about his current battle with prostate cancer. I recommend it if you or someone you love is being treated for this common malignancy. A cut above.

Obesity Linked to Prostate Cancer Deaths

Men with prostate cancer who are obese are two-and-a-half times more likely to die of the disease than their slimmer counterparts with this extremely common cancer. And if a prostate cancer victim is obese and also has very high insulin levels, the risk of death is four times greater. This according to an article in the current issue of Lancet Oncology. Read the story in Toronto's Globe and Mail. Here's an excerpt:

"The Harvard-McGill study, led by Harvard researcher Jing Ma, looked at 2,546 men diagnosed with prostate cancer. After controlling for factors such as age and whether they smoked, the researchers assessed blood samples taken from the men, who were all participants in the Physicians' Health Study, a larger, long-term study involving more than 22,000 doctors.

The researchers looked at each subject's body mass index (BMI), C-peptide concentrations – a marker of insulin secretion – and whether or not they died of prostate cancer.

Men who were overweight (a BMI of 25 to 29.9) or obese (a BMI of greater than 30) before diagnosis were significantly more likely to die from their prostate cancer than men of normal weight, the researchers found.

They also found that those with the highest C-peptide concentrations also had a significantly greater risk of prostate-cancer mortality compared with men with the lowest concentrations"

Prostate Cancer: Hormone Therapy May Help--or Hurt

One of the sad mysteries of prostate cancer is why hormone therapy works for a short period of months to a year or two, and then fails as the cancer returns. Research conducted in mice has some disturbing implications, as described today at ScienceDaily:

"When a man receives hormone therapy, initially the treatment works well, and his PSA (prostate specific antigen) level goes down," said Edward Messing, M.D., a urologist and an author of the paper. "But inevitably, the PSA will start climbing again, and that is usually the first sign that the treatment is beginning to fail. It's a sign that the cancer in the prostate is making a comeback."

In work funded by the National Cancer Institute, Chang's team found that blocking the receptor indeed prevents some cells in the prostate from growing, just as scientists expected. But Chang's team unexpectedly found that blocking the receptor actually spurs other prostate cells to grow.

"The androgen receptor acts differently in different cells in prostate tissue," said Chang. "It's always been assumed that blocking the androgen receptor will stop all prostate cells from growing, but we have found that that's not the case. Since current treatment acts non-specifically on all the cells having androgen receptors in the prostate, blocking the androgen receptor will give mixed results."

Future research may involve finding ways to focus hormonal therapy more precisely.

Prostate Cancer Screening

This utterance from the US Preventive Services Task Force is generating lots of interest. This influential group says that PSA testing should be discontinued in men older than 75. The Washington Post spoke to people on both sides of the debate, which is a heated one, and actually has been for some time. Quoting here from the Post:

"In the first update of its recommendations for prostate cancer screening in five years, the panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and that the potential harm clearly outweighs any benefits for men age 75 and older."

and on the other side of the fence:

"We have seen a dramatic drop in mortality," said J. Brantley Thrasher, chairman of the urology department at the University of Kansas and a spokesman for the American Urological Association. "They're not paying attention to that."

Others objected to setting an age cutoff, saying men should be evaluated individually.

"Men are living a lot longer and healthier these days. I play golf with 84-year-old guys who beat me all the time," said E. David Crawford, a professor of surgery and radiation at the University of Colorado at Denver. "You have to individualize treatment. If a 75-year-old man is found to have high-grade prostate cancer, it's going to kill him, and we can intervene and do something for him."

Finasteride (Proscar) Gets a Boost for Prostate Cancer Prevention

Doctors attending the American Urological Association meeting this month witnessed a 180-degree shift about using finasteride, also known by its trade name, Proscar, to prevent prostate cancer. A large study done several years ago, the Prostate Cancer Prevention Trial (PCPT), suggested that finasteride, which is used to treat noncancerous prostate gland enlargement, reduces the risk of low-grade prostate cancer but ups the risk of higher-grade, more dangerous disease.

But as reported in the NCI Cancer Bulletin this week, a re-analysis of prostate cancer samples from the PCPT suggests that the drug is linked to "modest" reductions in both lower- and higher-grade prostate cancer. It was not possible to make a statement about very-high-grade cancers, because so few men with that form of prostate cancer were enrolled in the study. You can see a web cast about these results at the AUA web site. It's the first presentation on the list. It's interesting that finasteride apparently increases the accuracy of both PSA testing and prostate biopsy, and I wonder if it's possible that this may have accounted for the apparent increase in risk that investigators noted several years ago. But they would have tried to account for that, right?

The scientists involved in the new analysis note that the difficulty of getting urologists to unlearn everything they thought they knew about finasteride and prostate cancer.

Lots of Saturated Fat = Bad Outcome for Prostate Cancer Treatment

A diet high in saturated fat gets in the way of effective treatment for prostate cancer, according to new findings published online at the International Journal of Cancer and reported at ScienceDaily. Compared to men on a low-saturated-fat diet, those on a high-saturated fat diet had evidence of cancer recurrence sooner. The effect of a high-saturated-fat diet was not cancelled by high levels of physical activity.

Using MRI to Predict Prostate Cancer Spread

Decision-making in prostate cancer is notoriously difficult. This study suggests that MRI scans made of the prostate before men undergo external beam radiation therapy may help with some treatment decisions. These investigators found that prostate tumors that extended 5 mm beyond the membrane the covers the prostate gland, as determined by the MRI, were more likely to spread than tumors that did not extend as far beyond the capsule. The researchers, based at the UCSF radiology department, suggest that men with these more extensive tumors may benefit from treatments that are more aggressive.