Older men with high-risk prostate cancer frequently are offered fewer – and less effective – choices of treatment than younger men, potentially resulting in earlier deaths, according to a new UCSF study.
The scientists found that men above age 75 with high-risk prostate cancer often are under-treated through hormone therapy or watchful waiting alone in lieu of more aggressive treatments such as surgery and radiation therapies. Instead, say the researchers, old age should not be viewed as a barrier to treatments that could lead to potential cures.
"There is a disconnect between risk and treatment decisions among older men," said senior investigator Matthew R. Cooperberg, MD, MPH. "Patient age is strongly influencing treatment decisions, so we sought to understand whether age plays a role in risk of the disease and survival. We found that under-treatment of older-men with high-risk disease might in part explain higher rates of cancer mortality in this group. There is also pervasive over-treatment of low-risk disease in this age group. Overall, treatment needs to be selected more based on disease risk and less based on chronologic age."
The study is published by the "Journal of Clinical Oncology," and is available online here.
Prostate cancer is the most common form of cancer in men and the second most common cause of cancer death after lung cancer. This year, an estimated 217,730 men will be diagnosed with the disease, and 32,050 men will die from it, reports the American Cancer Society. Moreover, prostate cancer is the most common malignancy among older men: 64 percent of new cases in the United States this year were diagnosed in men older than 65, and 23 percent in men above 75.
Yet most studies delving into optimal treatment options focus on men younger than 75. The new UCSF study is among the first to explore the relationship between age, disease risk and survival among prostate cancer patients.
The researchers studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a longitudinal, observational disease registry of men with prostate cancer who were recruited from urology practices throughout the United States. At the time of the study, the database contained information on 13,805 patients.
The scientists found that older patients are more likely to have high-risk prostate cancer at the point of diagnosis, and less likely to receive potentially curative local therapy. Yet when older, high-risk men received more aggressive treatment, they had a 46 percent lower death rate compared with patients treated more conservatively with hormonal therapy or watchful waiting.
The finding, the researchers say, suggests that underuse of aggressive therapy may in part explain the higher death rates of older men with the disease.
"Age does not independently predict prostate cancer survival," said Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and co-leader of the prostate program at the UCSF Helen Diller Family Comprehensive Cancer Center. He is a co-author of the paper. "Our findings support making treatment decisions on the basis of disease risk and life expectancy rather than on chronologic age."
The researchers note that the U.S. Preventive Services Task Force specifically recommends against screening men age 75 or older, but that position is based on studies on younger men, and furthermore does not account for health status or other diseases that the patients may have which would affect life expectancy.
"Older men with high-risk disease frequently die of prostate cancer and under-treatment might be a factor in their deaths," said Cooperberg, a prostate cancer specialist in the UCSF Department of Urology and the Helen Diller cancer center. "The notion of age as a primary determinant should be reconsidered. Patients with aggressive local disease should be offered a chance of aggressive therapy that might cure them regardless of their age."
Traditionally, Cooperberg said, physicians have feared the risks of surgery on their older patients. But for older patients with localized, high-risk disease – and a life expectancy of more than 10 years – the researchers recommend that surgical treatment and radiation be considered.
"Surgery and radiation risks do go up with age, but it may be that we are focusing too much on risk than on benefit," said Cooperberg. "We need a better balance between risk and benefit."
University of California - San Francisco
Showing posts with label Prostate Cancer Therapy. Show all posts
Showing posts with label Prostate Cancer Therapy. Show all posts
Tuesday, December 21, 2010
Wednesday, October 27, 2010
Review favors newer type of radiation for prostate cancer
A new British review of existing research suggests that while a newer type of radiation for the treatment of prostate cancer does not help patients live longer compared to an older type – at least when similar doses are given − it does appear to reduce gastrointestinal side effects.
The newer type of radiation, known as intensity-modulated radiotherapy, has become common in the United States. However, it costs more than the older type − three-dimensional conformal radiotherapy − and the review authors could not determine if it’s cost-effective.
The review is in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program, part of the National Institute for Health Research in the United Kingdom.
There is no question that the new technology offers an improvement and fewer side effects; the question is how much health insurers will be willing to pay for it, said radiation oncologist Dr. Anthony D’Amico, who is not affiliated with the review but is familiar with its findings.
An estimated 217,730 men will develop prostate cancer in the United States this year and 32,050 will die from it, according to the National Cancer Institute. Several treatments exist, including removal of the walnut-sized prostate − a treatment that often causes impotence and incontinence − and radiation delivered from within the prostate through pellets or from outside the body.
The challenge of sending in radiation from the outside is that the prostate is close to the rectum and bladder, which can be hit by the radiation too, said D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital in Boston.
Three-dimensional conformal radiation was developed several decades ago. Guided by the results of scans, radiologists aim to hit the prostate with radiation from several directions instead of just from front to back as in the past, D’Amico said.
Intensity-modulated radiation therapy appeared in the 1990s, he said. It allows radiologists to adjust the intensity of radiation beam as it goes through parts of the prostate with different contours, reducing damage to other parts of the body − especially the rectum − that would also get hit by radiation.
In the new review, researchers looked at data from 13 studies mostly done in the United States – eight full studies and five abstracts − comparing the two radiation approaches on 5,768 participants. None was a randomized controlled trial, considered the gold standard of medical research, in which researchers assign patients randomly to receive a certain treatment.
Why so few studies? “Lack of good quality research is not uncommon” when it comes to treatments that don’t involve drugs, said lead review author Silvia Hummel, a senior analyst at the University of Sheffield in the United Kingdom. Drug studies must go through “well-defined steps, including a randomized trial, in order to be approved for use in patients, whereas other technologies often evolve and are not tested in the same way,” she said.
Additionally, Hummel said, if clinicians believe that a new treatment is better, even if unproven, they might be reluctant to ask patients to participate in a trial.
Some studies looked at how long the patients survived after treatment and found no difference except in some cases when some patients lived longer after getting higher doses of intensity-modulated radiation therapy compared to those who got lower doses of three-dimensional conformal radiotherapy.
Most of the studies reported that patients who underwent intensity-modulated radiation therapy suffered from fewer gastrointestinal side effects such as rectal pain, bleeding and uncontrolled defecation. This appeared to be because the treatment does not cause radiation to hit as much of the rest of the body, especially the rectum.
A minority of the studies suggested that higher doses of intensity-modulated radiation therapy caused more side effects in the genitals and urinary system, such as incontinence and blood in the urine.
D’Amico, the U.S. radiation oncologist, said the review reflects the conclusions of not-yet-published research that supports intensity-modulated radiotherapy.
The British review did not come to any conclusions about whether the more-expensive therapy is cost-effective in terms of providing enough bang for the buck (or pound or euro).
The HTA programme, of the National Institute for Health Research (NIHR), produces high quality research information about the effectiveness, costs, and broader impact of health. It is the largest of the NIHR programmes, with more than 400 projects published since its inception in 1993. About 50 are published each year, all available for download free of charge from the Web site. It is coordinated by the National Coordinating Centre for Health Technology Assessment, based at the University of Southampton. Visit www.hta.ac.uk for more information.
Hummel S, et al. Intensity-modulated radiotherapy for the treatment of prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2010; 14(47).
Health Behavior News Service
The newer type of radiation, known as intensity-modulated radiotherapy, has become common in the United States. However, it costs more than the older type − three-dimensional conformal radiotherapy − and the review authors could not determine if it’s cost-effective.
The review is in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program, part of the National Institute for Health Research in the United Kingdom.
There is no question that the new technology offers an improvement and fewer side effects; the question is how much health insurers will be willing to pay for it, said radiation oncologist Dr. Anthony D’Amico, who is not affiliated with the review but is familiar with its findings.
An estimated 217,730 men will develop prostate cancer in the United States this year and 32,050 will die from it, according to the National Cancer Institute. Several treatments exist, including removal of the walnut-sized prostate − a treatment that often causes impotence and incontinence − and radiation delivered from within the prostate through pellets or from outside the body.
The challenge of sending in radiation from the outside is that the prostate is close to the rectum and bladder, which can be hit by the radiation too, said D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital in Boston.
Three-dimensional conformal radiation was developed several decades ago. Guided by the results of scans, radiologists aim to hit the prostate with radiation from several directions instead of just from front to back as in the past, D’Amico said.
Intensity-modulated radiation therapy appeared in the 1990s, he said. It allows radiologists to adjust the intensity of radiation beam as it goes through parts of the prostate with different contours, reducing damage to other parts of the body − especially the rectum − that would also get hit by radiation.
In the new review, researchers looked at data from 13 studies mostly done in the United States – eight full studies and five abstracts − comparing the two radiation approaches on 5,768 participants. None was a randomized controlled trial, considered the gold standard of medical research, in which researchers assign patients randomly to receive a certain treatment.
Why so few studies? “Lack of good quality research is not uncommon” when it comes to treatments that don’t involve drugs, said lead review author Silvia Hummel, a senior analyst at the University of Sheffield in the United Kingdom. Drug studies must go through “well-defined steps, including a randomized trial, in order to be approved for use in patients, whereas other technologies often evolve and are not tested in the same way,” she said.
Additionally, Hummel said, if clinicians believe that a new treatment is better, even if unproven, they might be reluctant to ask patients to participate in a trial.
Some studies looked at how long the patients survived after treatment and found no difference except in some cases when some patients lived longer after getting higher doses of intensity-modulated radiation therapy compared to those who got lower doses of three-dimensional conformal radiotherapy.
Most of the studies reported that patients who underwent intensity-modulated radiation therapy suffered from fewer gastrointestinal side effects such as rectal pain, bleeding and uncontrolled defecation. This appeared to be because the treatment does not cause radiation to hit as much of the rest of the body, especially the rectum.
A minority of the studies suggested that higher doses of intensity-modulated radiation therapy caused more side effects in the genitals and urinary system, such as incontinence and blood in the urine.
D’Amico, the U.S. radiation oncologist, said the review reflects the conclusions of not-yet-published research that supports intensity-modulated radiotherapy.
The British review did not come to any conclusions about whether the more-expensive therapy is cost-effective in terms of providing enough bang for the buck (or pound or euro).
The HTA programme, of the National Institute for Health Research (NIHR), produces high quality research information about the effectiveness, costs, and broader impact of health. It is the largest of the NIHR programmes, with more than 400 projects published since its inception in 1993. About 50 are published each year, all available for download free of charge from the Web site. It is coordinated by the National Coordinating Centre for Health Technology Assessment, based at the University of Southampton. Visit www.hta.ac.uk for more information.
Hummel S, et al. Intensity-modulated radiotherapy for the treatment of prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2010; 14(47).
Health Behavior News Service
Tuesday, October 19, 2010
Vitamin E in front line of prostate cancer fight
Survival rates of the world's most common cancer might soon be increased with a new vitamin E treatment which could significantly reduce tumour regrowth.
Queensland University of Technology (QUT) prostate cancer researchers are leading the fight against a disease which kills 3000 Australian men a year.
Dr Patrick Ling, whose research will be a centrepiece of the new $354 million Translational Research Institute (TRI) when it opens in Brisbane, is leading a team of researchers who have identified a particular constituent of vitamin E, known as tocotrienol (T3), which can inhibit the growth of prostate tumours.
Construction of TRI officially began today (October 19) at the Princess Alexandra Hospital. The world-class facility brings together some of Queensland's best medical researchers from four leading Australian research facilities to turn their work into accessible and potentially life-saving health treatments.
Dr Ling's research has been funded by Davos Life Science in Singapore, who recently awarded him a further $128,000 to undertake a one-year study of the long-term effectiveness of T3 to prevent the recurrence of treated prostate cancer tumours.
"Prostate cancer is the most common type of cancer in developed countries," Dr Ling said.
"It is responsible for more male deaths than any other cancer, except lung cancer."
Dr Ling said existing chemotherapy and hormonal therapy treatment of prostate cancer was insufficient because it failed to kill off the prostate cancer stem cells (CSCs) which were believed to be responsible for the regrowth of tumours.
However, the research team have discovered a particular form of T3, called gamma-tocotrienol (γ-T3), can successfully kill off the prostate cancer CSCs.
"Currently there is no effective treatment for metastatic prostate cancer, because it grows back after conventional therapies in more than 70 per cent of cases," he said.
"But with γ-T3, QUT researchers have found a better way to treat prostate cancer, which has the potential to inhibit recurrence of the disease."
Dr Ling said in animal trials, γ-T3 completely inhibited tumour formation in more than 70 per cent of the mice implanted with prostate cancer cells and fed the vitamin E constituent in water. In the remaining cases, tumour regrowth was considerably reduced, while tumours reformed in 100 per cent of the control group.
The findings were published recently in the International Journal of Cancer.
The next stage of Dr Ling's study has begun and will determine the long-term effectiveness of the γ-T3 treatment, with plans to progress to clinical trials in the future.
"Previous clinical trials using another vitamin E constituent to inhibit prostate cancer development were unsuccessful, but these trials did not use the vitamin E constituent γ-T3," he said.
"Other research has found γ-T3 is also effective in suppressing other types of cancer, including breast, colon, liver and gastric."
Dr Ling said while not all vitamin E preparations had the active constituent, natural vitamin E obtained from palm oil was rich in γ-T3.
Professor Ross Young, from QUT's Institute of Health and Biomedical Innovation (IHBI), said one of TRI's greatest strengths was to bring together leading researchers.
"Collaboration, which combines the expertise of researchers from different disciplines and institutions to achieve common goals, will lead to better solutions," Professor Young said.
QUT Vice-Chancellor Professor Peter Coaldrake said TRI would greatly benefit Queensland's and Australia's economy and ability to attract the world's best researchers to our shores.
"By having this world-class facility producing research of the highest quality, we will be increasing Queensland's international competitiveness in research," Professor Coaldrake said.
Queensland University of Technology
Queensland University of Technology (QUT) prostate cancer researchers are leading the fight against a disease which kills 3000 Australian men a year.
Dr Patrick Ling, whose research will be a centrepiece of the new $354 million Translational Research Institute (TRI) when it opens in Brisbane, is leading a team of researchers who have identified a particular constituent of vitamin E, known as tocotrienol (T3), which can inhibit the growth of prostate tumours.
Construction of TRI officially began today (October 19) at the Princess Alexandra Hospital. The world-class facility brings together some of Queensland's best medical researchers from four leading Australian research facilities to turn their work into accessible and potentially life-saving health treatments.
Dr Ling's research has been funded by Davos Life Science in Singapore, who recently awarded him a further $128,000 to undertake a one-year study of the long-term effectiveness of T3 to prevent the recurrence of treated prostate cancer tumours.
"Prostate cancer is the most common type of cancer in developed countries," Dr Ling said.
"It is responsible for more male deaths than any other cancer, except lung cancer."
Dr Ling said existing chemotherapy and hormonal therapy treatment of prostate cancer was insufficient because it failed to kill off the prostate cancer stem cells (CSCs) which were believed to be responsible for the regrowth of tumours.
However, the research team have discovered a particular form of T3, called gamma-tocotrienol (γ-T3), can successfully kill off the prostate cancer CSCs.
"Currently there is no effective treatment for metastatic prostate cancer, because it grows back after conventional therapies in more than 70 per cent of cases," he said.
"But with γ-T3, QUT researchers have found a better way to treat prostate cancer, which has the potential to inhibit recurrence of the disease."
Dr Ling said in animal trials, γ-T3 completely inhibited tumour formation in more than 70 per cent of the mice implanted with prostate cancer cells and fed the vitamin E constituent in water. In the remaining cases, tumour regrowth was considerably reduced, while tumours reformed in 100 per cent of the control group.
The findings were published recently in the International Journal of Cancer.
The next stage of Dr Ling's study has begun and will determine the long-term effectiveness of the γ-T3 treatment, with plans to progress to clinical trials in the future.
"Previous clinical trials using another vitamin E constituent to inhibit prostate cancer development were unsuccessful, but these trials did not use the vitamin E constituent γ-T3," he said.
"Other research has found γ-T3 is also effective in suppressing other types of cancer, including breast, colon, liver and gastric."
Dr Ling said while not all vitamin E preparations had the active constituent, natural vitamin E obtained from palm oil was rich in γ-T3.
Professor Ross Young, from QUT's Institute of Health and Biomedical Innovation (IHBI), said one of TRI's greatest strengths was to bring together leading researchers.
"Collaboration, which combines the expertise of researchers from different disciplines and institutions to achieve common goals, will lead to better solutions," Professor Young said.
QUT Vice-Chancellor Professor Peter Coaldrake said TRI would greatly benefit Queensland's and Australia's economy and ability to attract the world's best researchers to our shores.
"By having this world-class facility producing research of the highest quality, we will be increasing Queensland's international competitiveness in research," Professor Coaldrake said.
Queensland University of Technology
Monday, August 23, 2010
Cost of prostate cancer care varies with initial treatment choice
A new analysis has found that short-term and long-term costs of prostate cancer care vary considerably based on which treatment strategy a man initially receives. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the study finds that treatments that may be less expensive in the short-term may have higher long-term costs.
For men with early stage prostate cancer, various treatments are available, including surgery, radiation therapy, hormonal treatment, watchful waiting, or combinations of the above. A variety of factors determines which treatment is appropriate for a given man, and in some cases, a man may be able to choose among several options. Cost is one of many factors to consider when choosing among these options.
To determine how the initial treatment received by men with early stage prostate cancer affects costs of medical care both in the short-term (first year following diagnosis) and long-term (across five years of follow-up), Claire Snyder, PhD, of the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore led a team that reviewed early stage prostate-cancer cases from the Surveillance, Epidemiology and End Results (SEER)-Medicare database. (This database combines cancer incidence and survival data from US population-based cancer registries with Medicare administrative claims.) Patients included 13,769 men aged 66 years or older who were diagnosed in 2000 and were followed for 5 years. They were divided into groups based on the treatment they received during the first 9 months after diagnosis: watchful waiting, radiation, hormonal therapy, hormonal therapy plus radiation, and surgery (men in this latter group may have received hormones and/or radiation as well). Treatment costs were divided into initial (months -1 to 12), long-term (each 12 months thereafter), and total (months -1 to 60) costs. The incremental costs of care were calculated as the difference in medical costs for patients versus a group of similar men without cancer.
The investigators found that for most prostate cancer cases, costs were highest in the initial year and then dropped sharply and remained steady over the next several years; however, patterns of costs varied widely in the short-term and long-term based on initial treatment received. Watchful waiting had the lowest initial ($4270) and five-year total costs ($9130). Initial treatment costs were highest for patients who received hormonal therapy plus radiation ($17,474), followed by those undergoing surgery ($15,197). Hormonal therapy had the second lowest initial costs but the highest five-year total costs ($26,896). "This demonstrates that treatments that may be less expensive in the short-term may have higher long-term costs," said Dr. Snyder. Hormonal therapy plus radiation ($25,097) and surgery ($19,214) had the second and third highest five-year total costs. After excluding the last 12 months of life (because patterns of costs are quite different in the period prior to death), total costs were highest for hormonal therapy plus radiation ($23,488) and hormonal therapy only ($23,199).
These findings provide new information for patients, providers, and payers involved in prostate cancer care. Despite the high prevalence of early stage prostate cancer and the controversies associated with determining initial treatment, few other studies have examined both the short-term and long-term costs of available treatment options.
American Cancer Society
For men with early stage prostate cancer, various treatments are available, including surgery, radiation therapy, hormonal treatment, watchful waiting, or combinations of the above. A variety of factors determines which treatment is appropriate for a given man, and in some cases, a man may be able to choose among several options. Cost is one of many factors to consider when choosing among these options.
To determine how the initial treatment received by men with early stage prostate cancer affects costs of medical care both in the short-term (first year following diagnosis) and long-term (across five years of follow-up), Claire Snyder, PhD, of the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore led a team that reviewed early stage prostate-cancer cases from the Surveillance, Epidemiology and End Results (SEER)-Medicare database. (This database combines cancer incidence and survival data from US population-based cancer registries with Medicare administrative claims.) Patients included 13,769 men aged 66 years or older who were diagnosed in 2000 and were followed for 5 years. They were divided into groups based on the treatment they received during the first 9 months after diagnosis: watchful waiting, radiation, hormonal therapy, hormonal therapy plus radiation, and surgery (men in this latter group may have received hormones and/or radiation as well). Treatment costs were divided into initial (months -1 to 12), long-term (each 12 months thereafter), and total (months -1 to 60) costs. The incremental costs of care were calculated as the difference in medical costs for patients versus a group of similar men without cancer.
The investigators found that for most prostate cancer cases, costs were highest in the initial year and then dropped sharply and remained steady over the next several years; however, patterns of costs varied widely in the short-term and long-term based on initial treatment received. Watchful waiting had the lowest initial ($4270) and five-year total costs ($9130). Initial treatment costs were highest for patients who received hormonal therapy plus radiation ($17,474), followed by those undergoing surgery ($15,197). Hormonal therapy had the second lowest initial costs but the highest five-year total costs ($26,896). "This demonstrates that treatments that may be less expensive in the short-term may have higher long-term costs," said Dr. Snyder. Hormonal therapy plus radiation ($25,097) and surgery ($19,214) had the second and third highest five-year total costs. After excluding the last 12 months of life (because patterns of costs are quite different in the period prior to death), total costs were highest for hormonal therapy plus radiation ($23,488) and hormonal therapy only ($23,199).
These findings provide new information for patients, providers, and payers involved in prostate cancer care. Despite the high prevalence of early stage prostate cancer and the controversies associated with determining initial treatment, few other studies have examined both the short-term and long-term costs of available treatment options.
American Cancer Society
Friday, August 6, 2010
Surgery better than radiation, hormone treatments for some prostate cancer, study shows
Surgery for localized prostate cancer offers a significantly higher survival rate than either external-beam radiation or hormonal therapies, according to a new study led by researchers at UCSF.
The differences among therapies were more prominent at higher levels of cancer risk, and suggest, the researchers say, that in many cases surgery should play a greater role in treatment strategies for patients with prostate cancer that is likely to recur or spread.
The study is available online in the journal Cancer, the journal of the American Cancer Society, available here.
Most previous reports comparing treatment outcomes among different treatment options have looked only at PSA responses to treatment, rather than at the more important long-term survival outcomes, according to the researchers. Measuring levels of PSA, or prostate-specific antigen, in the blood, is intended to help determine whether prostate cancer has recurred or spread, although in many cases a rising PSA level does not necessarily mean the cancer will progress.
Roughly one man in six will be diagnosed with prostate cancer, which is the second leading cause of cancer death in American men, according to the American Cancer Society.
"Despite the high incidence of prostate cancer, there is relatively little high-quality evidence on which to base current treatments for localized disease," said Matthew R. Cooperberg, MD, MPH, lead investigator of the study and a prostate cancer specialist in the UCSF Department of Urology and the UCSF Helen Diller Family Comprehensive Cancer Center.
"These therapies can all have significant side effects, so it's important to understand which treatment alternatives are most effective. In current practice, likelihood of undergoing surgery falls progressively with increasing levels of risk, which may be exactly contrary to what the treatment pattern should be," he said.
Researchers found that the risk for cancer-specific mortality was more than three times higher in patients who received hormone therapy versus radical prostatectomy (surgical removal of the prostate) and more than twice as high in patients who received external-beam radiation therapy versus prostatectomy.
For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk.
The American Urological Association's clinical practice guidelines for localized prostate cancer treatments include active surveillance, radical prostatectomy, external-beam radiation therapy, and brachytherapy (radiotherapy delivered via radioactive seeds), but draw no conclusions about the relative efficacy of each.
Androgen-deprivation therapy, which suppresses the production of male sex hormones, is not endorsed by the American Urological Association clinical practice guidelines for localized prostate cancer, due to inadequate evidence regarding outcomes, yet it is commonly used in practice, the researchers state.
"This is a clear signal to the physician community that prostatectomy should be considered for men with higher-risk prostate cancer. In many cases, surgery would be part of a multimodal treatment approach, including adjuvant radiation or systemic treatments based on the pathology and early PSA response," added Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and leader of the Prostate Program at the UCSF Helen Diller Family Comprehensive Cancer Center. Carroll is senior author on the paper.
Because no adequate randomized trials have compared active treatments for localized prostate cancer, the authors analyzed risk-adjusted, cancer-specific mortality outcomes among men who underwent radical prostatectomy, external-beam radiation therapy, or primary androgen deprivation.
The research team analyzed data from 7,538 men with localized disease from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, a national disease registry comprising men from 40 urologic practice sites from across the country. The team then compared outcomes across treatments after adjusting for risk and age. In total, 266 men died of prostate cancer during follow-up.
University of California - San Francisco
The differences among therapies were more prominent at higher levels of cancer risk, and suggest, the researchers say, that in many cases surgery should play a greater role in treatment strategies for patients with prostate cancer that is likely to recur or spread.
The study is available online in the journal Cancer, the journal of the American Cancer Society, available here.
Most previous reports comparing treatment outcomes among different treatment options have looked only at PSA responses to treatment, rather than at the more important long-term survival outcomes, according to the researchers. Measuring levels of PSA, or prostate-specific antigen, in the blood, is intended to help determine whether prostate cancer has recurred or spread, although in many cases a rising PSA level does not necessarily mean the cancer will progress.
Roughly one man in six will be diagnosed with prostate cancer, which is the second leading cause of cancer death in American men, according to the American Cancer Society.
"Despite the high incidence of prostate cancer, there is relatively little high-quality evidence on which to base current treatments for localized disease," said Matthew R. Cooperberg, MD, MPH, lead investigator of the study and a prostate cancer specialist in the UCSF Department of Urology and the UCSF Helen Diller Family Comprehensive Cancer Center.
"These therapies can all have significant side effects, so it's important to understand which treatment alternatives are most effective. In current practice, likelihood of undergoing surgery falls progressively with increasing levels of risk, which may be exactly contrary to what the treatment pattern should be," he said.
Researchers found that the risk for cancer-specific mortality was more than three times higher in patients who received hormone therapy versus radical prostatectomy (surgical removal of the prostate) and more than twice as high in patients who received external-beam radiation therapy versus prostatectomy.
For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk.
The American Urological Association's clinical practice guidelines for localized prostate cancer treatments include active surveillance, radical prostatectomy, external-beam radiation therapy, and brachytherapy (radiotherapy delivered via radioactive seeds), but draw no conclusions about the relative efficacy of each.
Androgen-deprivation therapy, which suppresses the production of male sex hormones, is not endorsed by the American Urological Association clinical practice guidelines for localized prostate cancer, due to inadequate evidence regarding outcomes, yet it is commonly used in practice, the researchers state.
"This is a clear signal to the physician community that prostatectomy should be considered for men with higher-risk prostate cancer. In many cases, surgery would be part of a multimodal treatment approach, including adjuvant radiation or systemic treatments based on the pathology and early PSA response," added Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and leader of the Prostate Program at the UCSF Helen Diller Family Comprehensive Cancer Center. Carroll is senior author on the paper.
Because no adequate randomized trials have compared active treatments for localized prostate cancer, the authors analyzed risk-adjusted, cancer-specific mortality outcomes among men who underwent radical prostatectomy, external-beam radiation therapy, or primary androgen deprivation.
The research team analyzed data from 7,538 men with localized disease from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, a national disease registry comprising men from 40 urologic practice sites from across the country. The team then compared outcomes across treatments after adjusting for risk and age. In total, 266 men died of prostate cancer during follow-up.
University of California - San Francisco
Thursday, June 24, 2010
Optimizing Brachytherapy Dose On The Same Day As The Implant Can Control Prostate Cancer
Ensuring the optimum radiation dose on the same day as the brachytherapy implant in prostate cancer treatment manages to control the illness in about 95% of the cases. This is the result of research undertaken at the University Hospital of Navarre and published in the latest issue of Brachytherapy, journal of the American Society of Brachytherapy.
As is known, brachytherapy is a radiotherapy treatment involving the insertion of radioactive sources within or near the tumour.
Read more at Medical News Today.
As is known, brachytherapy is a radiotherapy treatment involving the insertion of radioactive sources within or near the tumour.
Read more at Medical News Today.
Tuesday, June 8, 2010
Drug that restricts blood supply to prostate tumors delays disease progression
A blood vessel-blocking drug called tasquinimod slowed the rate of disease progression in a clinical trial of 200 prostate cancer patients, according to experts at Johns Hopkins, Roswell Park Cancer Institute and Duke University.
Tasquinimod is a so-called "anti-angiogenesis" drug that squeezes off blood supply to prostate tumors by blocking new blood vessel development. Tumors require these vast networks of blood vessels to supply nutrients.
The multicenter trial at seven institutions, including Johns Hopkins, enrolled prostate cancer patients whose disease had spread to take a once-daily pill for four weeks. At six months, 57 percent of men taking tasquinimod had no disease progression as compared with 33 percent taking a placebo. Overall, the drug added approximately 12 weeks of time that the disease did not worsen (progression-free survival).
The most common side effects included gastrointestinal problems, fatigue and bone pain, and some rare occurrences of heart attack, stroke and deep vein thrombosis.
"Given these results, we feel it is reasonable to move forward with Phase III studies," says Michael Carducci, M.D., professor at the Johns Hopkins Kimmel Cancer Center, who will lead the next phase of an international study of the drug. "After exploring the drug as a single agent, we may study it in combination approaches with other prostate cancer drugs."
Research leading to tasquinimod began in the early 1990s when John Isaacs, Ph.D., professor at the Johns Hopkins Kimmel Cancer Center, found that a drug called linomide, which had been tested in multiple sclerosis, restricted blood supply to prostate tumors. However, the drug's cardiac side effects were too toxic for humans, so Isaacs in collaboration with the pharmaceutical company Active Biotech identified tasquinimod for clinical testing after searching for drugs similar to linomide with the same blood vessel action but with less toxicity.
Isaacs says that tasquinimod works by stopping new blood vessel development around the tumor, but does not make existing vasculature disappear. "The idea for anti-angiogenesis drugs is not to prevent tumors from developing; rather, it is to stabilize disease," says Isaacs, who is conducting additional laboratory studies to identify the drug's precise cellular target.
Funding for the study was provided by Active Biotech, manufacturer of tasquinimod, and the U.S. Department of Defense.
Carducci is a paid consultant to Active Biotech and the terms of this arrangement are being managed in accordance with policies set by the Johns Hopkins University.
Johns Hopkins Medical Institutions
Tasquinimod is a so-called "anti-angiogenesis" drug that squeezes off blood supply to prostate tumors by blocking new blood vessel development. Tumors require these vast networks of blood vessels to supply nutrients.
The multicenter trial at seven institutions, including Johns Hopkins, enrolled prostate cancer patients whose disease had spread to take a once-daily pill for four weeks. At six months, 57 percent of men taking tasquinimod had no disease progression as compared with 33 percent taking a placebo. Overall, the drug added approximately 12 weeks of time that the disease did not worsen (progression-free survival).
The most common side effects included gastrointestinal problems, fatigue and bone pain, and some rare occurrences of heart attack, stroke and deep vein thrombosis.
"Given these results, we feel it is reasonable to move forward with Phase III studies," says Michael Carducci, M.D., professor at the Johns Hopkins Kimmel Cancer Center, who will lead the next phase of an international study of the drug. "After exploring the drug as a single agent, we may study it in combination approaches with other prostate cancer drugs."
Research leading to tasquinimod began in the early 1990s when John Isaacs, Ph.D., professor at the Johns Hopkins Kimmel Cancer Center, found that a drug called linomide, which had been tested in multiple sclerosis, restricted blood supply to prostate tumors. However, the drug's cardiac side effects were too toxic for humans, so Isaacs in collaboration with the pharmaceutical company Active Biotech identified tasquinimod for clinical testing after searching for drugs similar to linomide with the same blood vessel action but with less toxicity.
Isaacs says that tasquinimod works by stopping new blood vessel development around the tumor, but does not make existing vasculature disappear. "The idea for anti-angiogenesis drugs is not to prevent tumors from developing; rather, it is to stabilize disease," says Isaacs, who is conducting additional laboratory studies to identify the drug's precise cellular target.
Funding for the study was provided by Active Biotech, manufacturer of tasquinimod, and the U.S. Department of Defense.
Carducci is a paid consultant to Active Biotech and the terms of this arrangement are being managed in accordance with policies set by the Johns Hopkins University.
Johns Hopkins Medical Institutions
Saturday, May 22, 2010
Advanced Prostate Cancer Patients Finally Have Another Option
Today is an exciting day for men with advanced prostate cancer and the millions of families and loved ones who are profoundly affected. Today a new prostate cancer treatment option, Provenge, was approved by the Food and Drug Administration (FDA).
Read more at Medical News Today.
Read more at Medical News Today.
Tuesday, May 18, 2010
What is the role of focal therapy in low-risk prostate cancer?
In the July issue of European Urology, the scientific journal of the European Association of Urology (EAU), S. Eggener et al. discussed in a recent study the significance and impact of focal therapy for low-risk cancer patients.
Since the introduction of prostate cancer screening based on prostate-specific antigen (PSA), over-treatment has increased. A significant proportion of patients diagnosed with prostate cancer have well differentiated, low-volume tumours at minimal risk of impacting their quality of life or longevity. The selection of a treatment strategy, among the multitude of options, has enormous implications for individuals and health care systems.
A conceptually appealing option to patients uncomfortable with observational strategies yet highly concerned about the risks of whole-gland treatment is to bridge elements of active surveillance with whole-gland therapy. This hybrid approach, termed focal therapy, aims to eradicate known cancer foci with the highest likelihood of progressing or metastasizing while attempting to diminish collateral damage to the vital structures essential for maintaining normal urinary and sexual function.
Limitations of focal therapy include the inability to stage or grade the cancer(s) accurately, suboptimal imaging capabilities, uncertainty regarding the natural history of untreated cancer foci, challenges with post-treatment monitoring, and the lack of quality-of-life data compared with alternative treatment strategies.
The aim of the present study was to review the rationale, patient selection criteria, diagnostic imaging, biopsy schemes, and treatment modalities available for the focal therapy of localized prostate cancer.
A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was performed from 1995 to 2009 using medical subject headings ''focal therapy'' or ''ablative'' and ''prostate cancer'.' Additional articles were extracted based on recommendations from an expert panel of authors.
One of the conclusions of the study is that focal therapy for prostate cancer is a promising and emerging treatment strategy for men with a low risk of cancer progression or metastasis. Evaluation in formal prospective clinical trials is essential before this new strategy is accepted in clinical practice.
European Association of Urology
Since the introduction of prostate cancer screening based on prostate-specific antigen (PSA), over-treatment has increased. A significant proportion of patients diagnosed with prostate cancer have well differentiated, low-volume tumours at minimal risk of impacting their quality of life or longevity. The selection of a treatment strategy, among the multitude of options, has enormous implications for individuals and health care systems.
A conceptually appealing option to patients uncomfortable with observational strategies yet highly concerned about the risks of whole-gland treatment is to bridge elements of active surveillance with whole-gland therapy. This hybrid approach, termed focal therapy, aims to eradicate known cancer foci with the highest likelihood of progressing or metastasizing while attempting to diminish collateral damage to the vital structures essential for maintaining normal urinary and sexual function.
Limitations of focal therapy include the inability to stage or grade the cancer(s) accurately, suboptimal imaging capabilities, uncertainty regarding the natural history of untreated cancer foci, challenges with post-treatment monitoring, and the lack of quality-of-life data compared with alternative treatment strategies.
The aim of the present study was to review the rationale, patient selection criteria, diagnostic imaging, biopsy schemes, and treatment modalities available for the focal therapy of localized prostate cancer.
A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was performed from 1995 to 2009 using medical subject headings ''focal therapy'' or ''ablative'' and ''prostate cancer'.' Additional articles were extracted based on recommendations from an expert panel of authors.
One of the conclusions of the study is that focal therapy for prostate cancer is a promising and emerging treatment strategy for men with a low risk of cancer progression or metastasis. Evaluation in formal prospective clinical trials is essential before this new strategy is accepted in clinical practice.
European Association of Urology
Thursday, April 29, 2010
A new era of cancer treatments
Today’s announcement that the U.S. Food and Drug Administration has approved Provengeâ, a new form of therapy for some prostate cancer patients, marks the beginning of an era in which patients’ own immune systems become part of the standard therapeutic arsenal against cancer, say Dana-Farber Cancer Institute investigators who led a study of the treatment’s effectiveness in patients.
Read more at Machines Like Us.
Read more at Machines Like Us.
Thursday, April 22, 2010
ASTRO president speaks on prostate cancer at MEDCAC meeting
ASTRO President Anthony Zietman, M.D., spoke before the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting today on radiation therapy for treatment of localized prostate cancer. MEDCAC provides advice and recommendations to the Centers for Medicare and Medicaid Services for what is covered by Medicare and Medicaid, based on scientific evidence. Today's meeting focused on the risks, benefits and outcomes of radiation therapy treatments for localized prostate cancer as compared with watchful waiting.
In his remarks, Dr. Zietman, an expert in radiation therapy treatments for prostate cancer from Massachusetts General Hospital and Harvard University in Boston, provided data on how successful radiation therapy techniques, including external beam radiation therapy and brachytherapy, are at treating prostate cancer without significant side effects. He acknowledged that it is possible some men are receiving treatments for prostate cancer that would have done well without treatment through watchful waiting or active surveillance. However, doctors currently have little way to tell if a man's prostate cancer will progress to be life-threatening or if it will remain somewhat asymptomatic.
With respect to stereotactic body radiation therapy (SBRT), Dr. Zietman said that the treatment, which pinpoints high doses of radiation to the prostate over a few days instead of several weeks, shows promise as a non-invasive way to cure prostate cancer. However, he cautioned that SBRT needed further study in clinical trials to fully capture survival and quality of life measures.
"Prostate cancer is the number one cancer diagnosed in men. I applaud MEDCAC for studying this important issue and appreciate the opportunity to participate in the forum," Dr. Zietman said.
American Society for Radiation Oncology
In his remarks, Dr. Zietman, an expert in radiation therapy treatments for prostate cancer from Massachusetts General Hospital and Harvard University in Boston, provided data on how successful radiation therapy techniques, including external beam radiation therapy and brachytherapy, are at treating prostate cancer without significant side effects. He acknowledged that it is possible some men are receiving treatments for prostate cancer that would have done well without treatment through watchful waiting or active surveillance. However, doctors currently have little way to tell if a man's prostate cancer will progress to be life-threatening or if it will remain somewhat asymptomatic.
With respect to stereotactic body radiation therapy (SBRT), Dr. Zietman said that the treatment, which pinpoints high doses of radiation to the prostate over a few days instead of several weeks, shows promise as a non-invasive way to cure prostate cancer. However, he cautioned that SBRT needed further study in clinical trials to fully capture survival and quality of life measures.
"Prostate cancer is the number one cancer diagnosed in men. I applaud MEDCAC for studying this important issue and appreciate the opportunity to participate in the forum," Dr. Zietman said.
American Society for Radiation Oncology
Thursday, April 1, 2010
VARI study could improve treatments for prostate cancer
Van Andel Research Institute (VARI) scientists have determined how two proteins required for the initiation and development of prostate cancer interact at the molecular level, which could lead to improved treatments for the disease.
One of the proteins, androgen receptor, is already an important drug target for prostate cancer. The other, steroid receptor coactivator-3 (SRC3), was originally identified for its role in the development of breast cancer. SCR3 has also been characterized as a key factor in the development of prostate cancer, but, until now, the exact relationship between androgen receptor and SCR3 has been unclear.
Understanding the relationship between these two proteins, and targeting this interaction, could lead to new, more effective treatments for prostate cancer, the most common form of cancer in men, with more than 192,000 new cases and more than 27,000 deaths reported in the United States in 2009 (Source: National Cancer Institute).
"Anti-androgen therapies become less effective over time," said VARI Distinguished Scientific Investigator H. Eric Xu, Ph.D., whose laboratory published the findings recently in the Journal of Biological Chemistry, where it was named Paper of the Week by the journal. "To develop the next generation of prostate cancer treatments, we need to find ways to disrupt the interaction between androgen receptor and the molecules it depends on to work, such as SRC3."
Androgen receptor activity is required for the initiation and development of prostate cancer. When activated by hormones, androgen receptor binds to DNA in the cell nucleus and regulates gene expression with the help of molecules called coactivators, including SRC3. As a result, genes create more or less of specific proteins in the cell, which can affect cell behavior. Although androgen receptor needs coactivators such as SRC3 to have an effect, little has been known about precisely how androgen receptor interacts with its coactivators.
VARI researchers used peptide profiling and other techniques of molecular biology to discover that SRC3 is a preferred coactivator for androgen receptor. They went on to determine the crystal structures that reveal how androgen receptor and SRC3 interact at the molecular level. This detailed information could be used to develop new, more effective treatments that disrupt interaction between the two proteins.
Van Andel Research Institute
One of the proteins, androgen receptor, is already an important drug target for prostate cancer. The other, steroid receptor coactivator-3 (SRC3), was originally identified for its role in the development of breast cancer. SCR3 has also been characterized as a key factor in the development of prostate cancer, but, until now, the exact relationship between androgen receptor and SCR3 has been unclear.
Understanding the relationship between these two proteins, and targeting this interaction, could lead to new, more effective treatments for prostate cancer, the most common form of cancer in men, with more than 192,000 new cases and more than 27,000 deaths reported in the United States in 2009 (Source: National Cancer Institute).
"Anti-androgen therapies become less effective over time," said VARI Distinguished Scientific Investigator H. Eric Xu, Ph.D., whose laboratory published the findings recently in the Journal of Biological Chemistry, where it was named Paper of the Week by the journal. "To develop the next generation of prostate cancer treatments, we need to find ways to disrupt the interaction between androgen receptor and the molecules it depends on to work, such as SRC3."
Androgen receptor activity is required for the initiation and development of prostate cancer. When activated by hormones, androgen receptor binds to DNA in the cell nucleus and regulates gene expression with the help of molecules called coactivators, including SRC3. As a result, genes create more or less of specific proteins in the cell, which can affect cell behavior. Although androgen receptor needs coactivators such as SRC3 to have an effect, little has been known about precisely how androgen receptor interacts with its coactivators.
VARI researchers used peptide profiling and other techniques of molecular biology to discover that SRC3 is a preferred coactivator for androgen receptor. They went on to determine the crystal structures that reveal how androgen receptor and SRC3 interact at the molecular level. This detailed information could be used to develop new, more effective treatments that disrupt interaction between the two proteins.
Van Andel Research Institute
Saturday, March 27, 2010
Prostate Cancer Treatment Database Hits Milestone Of 12,500
Radiotherapy Centers of Georgia (RCOG), a division of RC Cancer Centers announced that they have reached a new milestone and recently treated their 12,500th patient for prostate cancer with their ProstRcision® treatment therapy. The milestone means their treatment database is one of the most comprehensive in the nation. Available exclusively from RC Cancer Centers, ProstRcision® has the industry's highest documented cure rate of 83 percent.
Read more at Medical News Today.
Read more at Medical News Today.
Saturday, March 20, 2010
Nuclear Commission fines VA over botched prostate cancer radiation therapies
The U.S. Department of Veterans Affairs (VA) is being fined for botching 97 of 116 procedures to treat prostate cancer among men seeking care at the agency's medical center in Philadelphia. Although the punishment, which adds up to a mere $227,500, might not sound like more than a slap on the wrist, it is coming from the Nuclear Regulatory Commission (NRC) and is one of the largest the commission has ever given out for medical mistakes.
Read more at Scientific American.
Read more at Scientific American.
Friday, March 19, 2010
Study shows further benefits of noscapine for prostate cancer
New research has revealed a major breakthrough in the use of cough medicine ingredient noscapine as a prophylactic treatment for prostate cancer.
The study shows that noscapine inhibited tumor growth in mice and also limited the spread of tumors without causing any side effects.
The collaborative pre-clinical laboratory research was conducted by Dr. Israel Barken, of the Prostate Cancer Research and Education Foundation (PCREF), Moshe Rogosnitzky, of the MedInsight Research Institute and Dr. Jack Geller, of the University of California San Diego.
They concluded that noscapine administered as a preventive measure may offer significant benefits in the management of prostate cancer, a disease that kills more than 28,000 men in the U.S. each year.
Their findings said: "Pre-treatment with noscapine confers a significant benefit compared with control in both primary tumor growth and primary tumor growth- inhibition rate and exhibits an extremely favorable tolerability profile."
The research team is now keen to take their work further by examining the effects of noscapine – a non-addictive derivative of opium – as a prophylactic agent given to patients following prostate cancer surgery or radiation.
Dr. Barken, Founder and Medical Director of the PCREF in San Diego, California, said: "PCREF is now seeking sponsorship for clinical data collection in post-surgery patients who are at high-risk of recurrence for their prostate cancer.
"Based on our research so far, we believe that noscapine could be a very promising treatment to prevent recurrence in such cases due to its excellent safety record and oral bioavailability."
The latest research focused on pre-treating mice with noscapine before injecting them with prostate cancer cells. This resulted in the tumor growth rate being two-thirds smaller in the noscapine group compared with a non-noscapine group.
The study also found that lung metastasis rates were 80% less in the mice pre-treated with noscapine, while the experts noted that the noscapine group suffered no cancer-related weight loss – compared with significant weight loss in the non-noscapine group.
Noscapine has been used worldwide since the 1950s as an ingredient in over-the-counter cough medicines and was originally suggested as an anti-cancer agent in the early 1960s. But major studies of its anti-cancer properties have only taken place in recent years.
The latest research is the result of ongoing collaborative work between the Prostate Cancer Research and Educational Foundation (PC-REF) and Baltimore-based MedInsight Research Institute. Their previous work has shown that noscapine has properties that limit the growth of prostate cancer.
The latest study was based on the theory that prostate cancer could be a suitable target for a risk-reduction approach because of its high prevalence and significant morbidity and mortality.
Moshe Rogosnitzky, co-founder and Director of Research at the MedInsight Research Institute, said: "There is an ever-growing need for effective ways to prevent recurrence of cancer after curative surgery.
"It is MedInsight's belief that many effective treatments for this and other diseases can be selected from the vast armory of existing off-patent and unpromoted drugs. The results of this study, once confirmed in a clinical trial, are an example where we may yet again have an agent that not only has an envious safety record, but is already available for use today."
MedInsight Research Institute
The study shows that noscapine inhibited tumor growth in mice and also limited the spread of tumors without causing any side effects.
The collaborative pre-clinical laboratory research was conducted by Dr. Israel Barken, of the Prostate Cancer Research and Education Foundation (PCREF), Moshe Rogosnitzky, of the MedInsight Research Institute and Dr. Jack Geller, of the University of California San Diego.
They concluded that noscapine administered as a preventive measure may offer significant benefits in the management of prostate cancer, a disease that kills more than 28,000 men in the U.S. each year.
Their findings said: "Pre-treatment with noscapine confers a significant benefit compared with control in both primary tumor growth and primary tumor growth- inhibition rate and exhibits an extremely favorable tolerability profile."
The research team is now keen to take their work further by examining the effects of noscapine – a non-addictive derivative of opium – as a prophylactic agent given to patients following prostate cancer surgery or radiation.
Dr. Barken, Founder and Medical Director of the PCREF in San Diego, California, said: "PCREF is now seeking sponsorship for clinical data collection in post-surgery patients who are at high-risk of recurrence for their prostate cancer.
"Based on our research so far, we believe that noscapine could be a very promising treatment to prevent recurrence in such cases due to its excellent safety record and oral bioavailability."
The latest research focused on pre-treating mice with noscapine before injecting them with prostate cancer cells. This resulted in the tumor growth rate being two-thirds smaller in the noscapine group compared with a non-noscapine group.
The study also found that lung metastasis rates were 80% less in the mice pre-treated with noscapine, while the experts noted that the noscapine group suffered no cancer-related weight loss – compared with significant weight loss in the non-noscapine group.
Noscapine has been used worldwide since the 1950s as an ingredient in over-the-counter cough medicines and was originally suggested as an anti-cancer agent in the early 1960s. But major studies of its anti-cancer properties have only taken place in recent years.
The latest research is the result of ongoing collaborative work between the Prostate Cancer Research and Educational Foundation (PC-REF) and Baltimore-based MedInsight Research Institute. Their previous work has shown that noscapine has properties that limit the growth of prostate cancer.
The latest study was based on the theory that prostate cancer could be a suitable target for a risk-reduction approach because of its high prevalence and significant morbidity and mortality.
Moshe Rogosnitzky, co-founder and Director of Research at the MedInsight Research Institute, said: "There is an ever-growing need for effective ways to prevent recurrence of cancer after curative surgery.
"It is MedInsight's belief that many effective treatments for this and other diseases can be selected from the vast armory of existing off-patent and unpromoted drugs. The results of this study, once confirmed in a clinical trial, are an example where we may yet again have an agent that not only has an envious safety record, but is already available for use today."
MedInsight Research Institute
Thursday, February 25, 2010
Effective prostate cancer treatment discovery
Monash University biomedical scientists have identified a new way to treat castrate resistant cells in prostate cancer sufferers – the most common cancer in Australian men.
For more than 60 years the main way to treat men with prostate cancer has involved removing the hormones that fuel growth of the cancer cells. Although initially effective this treatment inevitably fails and when the tumour growth resumes, the disease is incurable. The team, from the Prostate & Breast Cancer Research Program, has discovered a way to treat these potentially fatal diseased cells, which remain in a patient after they have undergone hormone treatment.
The findings have been published in the prestigious medical journal PNAS.
Associate Dean, Research Centres & Institutes and co-author Professor Gail Risbridger said the studies provided proof of the controversial concept that estrogens (hormones mainly thought as being important for women) could be good for men and used therapeutically to treat prostate cancer.
"The research showed that drugs that activate one of the two estrogen receptors, causes cell death. Most commonly cell death in patients with prostate cancer is achieved by withdrawing androgens (male hormones) which results in castration," Professor Risbridger said.
"Although the bulk of the tumour is removed by castration, some cells remain and these castrate-resistant cells are the ones that give rise to recurrent incurable disease."
The team used a drug developed to selectively and specifically activate the beta estrogen receptor in the prostate.
"It not only inhibits the growth of prostate cancer but also kills off cancer cells that are resistant to conventional treatment such as androgen deprivation therapy, more commonly known as castration therapy and does so using a mechanism that is different to castration." Professor Risbridger said.
The team made the discovery in animal models, and then successfully replicated laboratory results using human cells and tissues from patients with prostate cancer.
"The team at Monash University has discovered how this compound working through the beta receptors targets a small, but very important, population of cells in the tumour. It is a significant piece of the puzzle that will help medical research in this field – an achievement that could eventually enhance treatment options for patients around the world with advanced prostate cancer." Professor Risbridger said.
Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men. Each year in Australia, close to 3,300 men die of prostate cancer - equal to the number of women who die from breast cancer annually. About 20,000 new cases are diagnosed in Australia every year and one in nine men will develop prostate cancer in their lifetime. Current treatments of prostate cancer include hormone therapy however patient side effects can be devastating.
"This research also has personal meaning and provides me with the imperative to conduct basic biomedical research where the fundamental outcomes such as those we describe, may ultimately translate into more effective ways to treat prostate cancer" Professor Risbridger said.
Monash University
For more than 60 years the main way to treat men with prostate cancer has involved removing the hormones that fuel growth of the cancer cells. Although initially effective this treatment inevitably fails and when the tumour growth resumes, the disease is incurable. The team, from the Prostate & Breast Cancer Research Program, has discovered a way to treat these potentially fatal diseased cells, which remain in a patient after they have undergone hormone treatment.
The findings have been published in the prestigious medical journal PNAS.
Associate Dean, Research Centres & Institutes and co-author Professor Gail Risbridger said the studies provided proof of the controversial concept that estrogens (hormones mainly thought as being important for women) could be good for men and used therapeutically to treat prostate cancer.
"The research showed that drugs that activate one of the two estrogen receptors, causes cell death. Most commonly cell death in patients with prostate cancer is achieved by withdrawing androgens (male hormones) which results in castration," Professor Risbridger said.
"Although the bulk of the tumour is removed by castration, some cells remain and these castrate-resistant cells are the ones that give rise to recurrent incurable disease."
The team used a drug developed to selectively and specifically activate the beta estrogen receptor in the prostate.
"It not only inhibits the growth of prostate cancer but also kills off cancer cells that are resistant to conventional treatment such as androgen deprivation therapy, more commonly known as castration therapy and does so using a mechanism that is different to castration." Professor Risbridger said.
The team made the discovery in animal models, and then successfully replicated laboratory results using human cells and tissues from patients with prostate cancer.
"The team at Monash University has discovered how this compound working through the beta receptors targets a small, but very important, population of cells in the tumour. It is a significant piece of the puzzle that will help medical research in this field – an achievement that could eventually enhance treatment options for patients around the world with advanced prostate cancer." Professor Risbridger said.
Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men. Each year in Australia, close to 3,300 men die of prostate cancer - equal to the number of women who die from breast cancer annually. About 20,000 new cases are diagnosed in Australia every year and one in nine men will develop prostate cancer in their lifetime. Current treatments of prostate cancer include hormone therapy however patient side effects can be devastating.
"This research also has personal meaning and provides me with the imperative to conduct basic biomedical research where the fundamental outcomes such as those we describe, may ultimately translate into more effective ways to treat prostate cancer" Professor Risbridger said.
Monash University
Tuesday, January 5, 2010
Sexual function does not continuously decline after radiation therapy treatments for prostate cancer
Sexual function in prostate cancer patients receiving external beam radiation therapy (EBRT) decreases within the first two years after treatment but then stabilizes and does not continuously decline as was previously thought, according to a study in the January 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).
Prostate cancer is the most common male cancer other than skin cancer. It can be effectively treated using multiple methods, including prostatectomy, brachytherapy and EBRT, so the long-term side effects are often used by patients and doctors as deciding factors when choosing a treatment.
Changes in sexual function are some of the more common side effects from prostate cancer treatments, but the degree to which EBRT affects function varies widely, depending on the study.
In a first of its kind study, researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital Department of Radiation Oncology in Philadelphia and the University of California, Davis, School of Medicine Department of Radiation Oncology in Sacramento, Calif., evaluated 143 prostate cancer patients receiving EBRT who completed baseline data on sexual function before treatment and at follow-up visits.
Patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years. The study authors found that the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment and then stabilized with no significant changes thereafter.
"Treatment-related side effects, especially sexual function, have a significant effect on a patient's quality of life and satisfaction with their overall outcome," Richard Valicenti, M.D., M.A., senior author on the study and professor and chair of radiation oncology at the University of California, Davis, School of Medicine. "The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT and what they can expect after treatment, which should aid in deciding on a treatment course."
American Society for Radiation Oncology
Prostate cancer is the most common male cancer other than skin cancer. It can be effectively treated using multiple methods, including prostatectomy, brachytherapy and EBRT, so the long-term side effects are often used by patients and doctors as deciding factors when choosing a treatment.
Changes in sexual function are some of the more common side effects from prostate cancer treatments, but the degree to which EBRT affects function varies widely, depending on the study.
In a first of its kind study, researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital Department of Radiation Oncology in Philadelphia and the University of California, Davis, School of Medicine Department of Radiation Oncology in Sacramento, Calif., evaluated 143 prostate cancer patients receiving EBRT who completed baseline data on sexual function before treatment and at follow-up visits.
Patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years. The study authors found that the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment and then stabilized with no significant changes thereafter.
"Treatment-related side effects, especially sexual function, have a significant effect on a patient's quality of life and satisfaction with their overall outcome," Richard Valicenti, M.D., M.A., senior author on the study and professor and chair of radiation oncology at the University of California, Davis, School of Medicine. "The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT and what they can expect after treatment, which should aid in deciding on a treatment course."
American Society for Radiation Oncology
Sunday, January 3, 2010
Experimental drug shows promise against brain and prostate cancers
An experimental drug currently being tested against breast and lung cancer shows promise in fighting the brain cancer glioblastoma and prostate cancer, researchers at UT Southwestern Medical Center have found in two preclinical studies.
Read more at Machines Like Us.
Read more at Machines Like Us.
Tuesday, December 8, 2009
Exercise reduces death rate in prostate cancer patients
As little as 15 minutes of exercise a day can reduce overall mortality rates in patients with prostate cancer, according to findings presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, held here, Dec. 6-9, 2009. "We saw benefits at very attainable levels of activity," said Stacey A. Kenfield, Sc.D., epidemiology research associate at the Harvard School of Public Health and lead author of the study. "The results suggest that men with prostate cancer should do some physical activity for their overall health."
Researchers assessed physical activity levels for 2,686 patients enrolled in the Health Professionals Follow-up Study, both before and after diagnosis (men with metastases at diagnosis were excluded).
Men who engaged in three or more hours of Metabolic Equivalent Tasks (MET) a week — equivalent to jogging, biking, swimming or playing tennis for about a half-hour per week — had a 35 percent lower risk of overall mortality.
Specific to walking, the researchers found that men who walked four or more hours a week had a 23 percent lower risk of all-cause mortality compared to men who walked less than 20 minutes per week. Men who walked 90 or more minutes at a normal to brisk pace had a 51 percent lower risk of death from any cause than men who walked less than 90 minutes at an easy walking pace.
Walking didn't show any effect on prostate cancer specific mortality, but more strenuous exercising did. Men who engaged in five or more hours of vigorous physical activity a week were at a decreased risk of dying from their prostate cancer.
"This is the first large population study to examine exercise in relation to mortality in prostate cancer survivors," said Kenfield. Previous studies focused on how exercise affects risk of developing prostate cancer. Kenfield said that researchers aren't sure of the exact molecular effects exercise has on prostate cancer, but exercise is known to influence a number of hormones hypothesized to stimulate prostate cancer, boost immune function and reduce inflammation.
"How these factors may work together to affect prostate cancer biologically is still being studied," she said. "For now, our data indicate that for prostate cancer survivors, a moderate amount of regular exercise may improve overall survival, while five or more hours per week of vigorous exercise may decrease the death rate due to prostate cancer specifically."
American Association for Cancer Research
Researchers assessed physical activity levels for 2,686 patients enrolled in the Health Professionals Follow-up Study, both before and after diagnosis (men with metastases at diagnosis were excluded).
Men who engaged in three or more hours of Metabolic Equivalent Tasks (MET) a week — equivalent to jogging, biking, swimming or playing tennis for about a half-hour per week — had a 35 percent lower risk of overall mortality.
Specific to walking, the researchers found that men who walked four or more hours a week had a 23 percent lower risk of all-cause mortality compared to men who walked less than 20 minutes per week. Men who walked 90 or more minutes at a normal to brisk pace had a 51 percent lower risk of death from any cause than men who walked less than 90 minutes at an easy walking pace.
Walking didn't show any effect on prostate cancer specific mortality, but more strenuous exercising did. Men who engaged in five or more hours of vigorous physical activity a week were at a decreased risk of dying from their prostate cancer.
"This is the first large population study to examine exercise in relation to mortality in prostate cancer survivors," said Kenfield. Previous studies focused on how exercise affects risk of developing prostate cancer. Kenfield said that researchers aren't sure of the exact molecular effects exercise has on prostate cancer, but exercise is known to influence a number of hormones hypothesized to stimulate prostate cancer, boost immune function and reduce inflammation.
"How these factors may work together to affect prostate cancer biologically is still being studied," she said. "For now, our data indicate that for prostate cancer survivors, a moderate amount of regular exercise may improve overall survival, while five or more hours per week of vigorous exercise may decrease the death rate due to prostate cancer specifically."
American Association for Cancer Research
Wednesday, November 4, 2009
Chemo-radiation before prostate removal may prevent cancer recurrence
Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
Their findings were presented this week at the 51st annual meeting of the American Society of Therapeutic Radiology and Oncology in Chicago.
"In men with aggressive prostate cancer, standard therapies such as radiation or surgery often fail to eliminate the cancer completely at the site of treatment. When these cancers recur, they are often fatal," said Mark Garzotto, M.D., principal investigator and Associate Professor of Urology and Radiation Medicine in the OHSU Knight Cancer Institute; and Chief of Urologic Oncology in the Portland Veterans Affairs Medical Center.
Previous clinical trials examining the effect of either hormonal therapy or chemotherapy prior to surgery have shown little if any benefit over prostate removal alone. "Novel approaches are needed if we are to make advances in this disease," added Dr. Garzotto.
The use of multimodality therapy — combined radiation, chemotherapy and surgery — has resulted in improved outcomes in a number of cancers, but has not yet been studied in prostate cancer.
This study looked at whether radiation therapy and chemotherapy (docetaxel) administered before surgery is possible, safe, and, ultimately, capable of preventing cancer recurrences. To answer these questions, Garzotto and colleagues developed a treatment regimen in which radiation and docetaxel were administered together before prostatectomy.
Twelve eligible participants were enrolled in the study between April 2006 and March 2008. The men were given intensity-modulated radiation therapy and increasing doses of docetaxel for five consecutive weeks, which was followed by surgical removal of the prostate gland.
The participants tolerated the treatment well and were able to undergo surgery without any major complications, which was a potential concern in this trial. Specifically there were no rectal or ureteral injuries or blood clots in the legs. Examination of the tumor tissue after surgery showed the cancer margins, evidence of complete removal of all of the cancer, to be clean in 75 percent of patients, which is higher than was expected. Also, the PSA, or prostate-specific antigen levels, a predictor of prostate cancer recurrence, were undetectable after treatment in all patients.
"Our study is the first-ever clinical trial in prostate cancer to combine radiation, chemotherapy and surgery given as a combination treatment before prostate surgery to potentially provide higher cure rates than traditional approaches with fewer side effects," said Arthur Hung, M.D., co-investigator and Assistant Professor of Radiation Medicine in the OHSU Knight Cancer Institute.
The researchers concluded this chemo-radiation combination is feasible and safe and potentially may reduce cancer recurrence rates in this high-risk population. Further, they say the development of this approach now opens the door to the study other drugs in combination with radiation.
Oregon Health & Science University
Their findings were presented this week at the 51st annual meeting of the American Society of Therapeutic Radiology and Oncology in Chicago.
"In men with aggressive prostate cancer, standard therapies such as radiation or surgery often fail to eliminate the cancer completely at the site of treatment. When these cancers recur, they are often fatal," said Mark Garzotto, M.D., principal investigator and Associate Professor of Urology and Radiation Medicine in the OHSU Knight Cancer Institute; and Chief of Urologic Oncology in the Portland Veterans Affairs Medical Center.
Previous clinical trials examining the effect of either hormonal therapy or chemotherapy prior to surgery have shown little if any benefit over prostate removal alone. "Novel approaches are needed if we are to make advances in this disease," added Dr. Garzotto.
The use of multimodality therapy — combined radiation, chemotherapy and surgery — has resulted in improved outcomes in a number of cancers, but has not yet been studied in prostate cancer.
This study looked at whether radiation therapy and chemotherapy (docetaxel) administered before surgery is possible, safe, and, ultimately, capable of preventing cancer recurrences. To answer these questions, Garzotto and colleagues developed a treatment regimen in which radiation and docetaxel were administered together before prostatectomy.
Twelve eligible participants were enrolled in the study between April 2006 and March 2008. The men were given intensity-modulated radiation therapy and increasing doses of docetaxel for five consecutive weeks, which was followed by surgical removal of the prostate gland.
The participants tolerated the treatment well and were able to undergo surgery without any major complications, which was a potential concern in this trial. Specifically there were no rectal or ureteral injuries or blood clots in the legs. Examination of the tumor tissue after surgery showed the cancer margins, evidence of complete removal of all of the cancer, to be clean in 75 percent of patients, which is higher than was expected. Also, the PSA, or prostate-specific antigen levels, a predictor of prostate cancer recurrence, were undetectable after treatment in all patients.
"Our study is the first-ever clinical trial in prostate cancer to combine radiation, chemotherapy and surgery given as a combination treatment before prostate surgery to potentially provide higher cure rates than traditional approaches with fewer side effects," said Arthur Hung, M.D., co-investigator and Assistant Professor of Radiation Medicine in the OHSU Knight Cancer Institute.
The researchers concluded this chemo-radiation combination is feasible and safe and potentially may reduce cancer recurrence rates in this high-risk population. Further, they say the development of this approach now opens the door to the study other drugs in combination with radiation.
Oregon Health & Science University
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