Home runs in cancer treatment are the goal, but often-times the incremental increases are the treatments that add together to make a difference.
The latest data from England show that a Radium injection can provide substantial improvements in patients with far-advanced prostate cancer. I have had patients receive this treatment and have seen successes. This treatment, along with the new information on ZYTEGA, are giving more hope to prostate cancer survivors.
NY Times Article
Supplementation with Omega 3 fatty acids, the healthy fats that come naturally from fish sources and also are used as supplements like Mega Red, has shown an association with prostate cancer.
Journal of the National Cancer Institute report shows a statistical increase in men with high levels of Omega 3’s, having more ‘low grade’ and ‘high grade’ prostate cancer statistically.
Although this should not be reason to shun such supplements, it does raise the specter of unintended consequences of vitamins and supplements, something I have mentioned previously in my comments on the use of Vitamin in THE GUIDE (Page 14)
THE GUIDE by Doctor Doug
Zytega is a new medication for prostate cancer that works by blocking testosterone. It is superior to other medications for this purpose and I have personally seen strong results in patients who have used this after failing chemotherapy.
Now, a new report on the New England Journal of Medicine, shows that Zytega is effective at earlier points in treatment and can be used prior to resorting to chemotherapy.
This safe and effective medication will prove a boon to treatment at this point and is a welcome addition. The only issue with the medication is cost, but getting supportive research to prove effectiveness earlier in treatment will provide the incentive for insurance coverage for this medication
It is great to have new treatments for patients with advanced cancer, and XTANDI has just been approved for patients with progressive disease who have failed Taxotere (an IV chemotherapy medication).
XTANDI (Enzalutamide) is very much like Zytiga…..a previously approved medications for advanced prostate cancer. The medication is a pill that maximally suppressed all testosterone in the body and thereby deprives the prostate cancer cells of any testosterone, a hormone which assists in prostate tissue growth. The advantage of XTANDI is that is does not require prednisone, like Zytiga dose, and this may be a benefit.
There is hope that XTANDI and ZYTIGA will be used prior to trying IV chemotherapy, but they have not yet been approved for these purposes, so they remain a ‘last line’ therapy. That, and the cost (approx $7,000 per month) are among the limiters for this new medication, but it is great to have more weapons at our disposal.
A recent study of 6000 men with localized prostate cancer demonstrated a marked reduction in cancer recurrence with the use of aspirin. A 57% reduction in recurrence was noted.
This simple measure is worth employing in anyone with a history of prostate cancer, so tell someone you know who has had either surgery or xray treatment for their disease.
A recent study of 1000 men with milder forms prostate cancer has questioned the benefits of aggressive treatment (read surgery) in patients with milder stages of disease. The conclusion of the study is that surgical treatment (removal of the prostate) does not prevent cancer deaths in this low risk group.
Despite the claims of this study, the conclusions are considered more uncertain than perhaps the headlines would suggest. The reasons for this uncertainty include a variety of factors:
This study has been ongoing since 1994 and so it emcompasses a variety of different treatment approaches during that timeframe, as patterns of treatment have changed over the past 18 years.
The study was meant to enroll 2000 patients, but stopped at 940 due to a slowness in recruitment for study. This affects the statistical validity of the findings.
The study was meant to determine if there was ‘at least’ a 25% difference in treatment result between the two approaches, but may miss differences that are less than 25%.
For many reasons, I think this study is important, but of uncertain significance. Primarily, it suggests that the differences between various approaches (aggressive vs. non-aggressive) may be less than we assume. Although it does not prove that ‘watch and wait’ is as good as surgery, it shows that the differences may not be as vast as one would presume, and this can give heart to those who would rather pursue a conservative approach.
What with elevated PSA’s that do not show prostate cancer, the increased risk of infection from the prostate biopsies, and the question of ‘overdiagnosis’ of mild disease that does not require treatment…the entire PSA issue has become increasingly unclear.
Into that mix, steps the latest study from the NCI (National Cancer Institute).
This study of 77,000 men for 13 years demonstrated no survival benefit for the patients who had PSA screening.
This data is very solid and the practice of ‘routine’ PSA testing has to come into question.
Now, I’ve had abundant experience with this issue, having trained at Hopkins during the “Pat Walsh” era when radical prostetectomy was perfected, while at the same time the PSA was just coming into broad use. Certainly, 20 years ago, virtually all of my patients with PSA elevations had prostate cancer, but over the ensuing years, with ongoing screening, it has become increasingly evident that elevated PSA’s generally do not have prostate cancer and that many patients have undergone invasive testing to prove they are ‘clean.’
At this point, I am going to have a more complete discussion with patients about the pro’s and con’s of PSA testing and would recommend a PSA in patients with:
Family history of prostate cancer
Questionable findings on prostate exam
This is a fluid situation, but I think the time is coming to rethink what we’ve been doing and to change course with a more measured approach.
Good news for patients treated with hormone deprivation therapy for their prostate cancer…..There is no increase risk in heart disease rate from this treatment.
This is an important finding and is documented in a 10-year follow-up study out of Sweden.
There has been concern that removing male hormone effects, might have a negative effect on heart disease risk, as manipulating hormone levels later in life, has been called into question in women, thus the aversion to starting hormone therapy ‘later’ in the menopause.
This information gives comfort to those who require this treatment approach for their advancing prostate cancer.
Still, keeping an eye on the heart, monitoring cholesterol, etc….is appropriate as it would be for any man over the age of 50, but no special considerations needs to be given.
A recent study from shows that prostate biopsy, a test done to confirm the diagnosis of prostate cancer and the PSA is elevated, has an increasing risk of serious infection and complications.
Since 1996, the risk of significant problems from the procedure has doubled to 7%.
This is something I’ve definitely observed over time and it is another reasons that we are being more sanguine about prostate biopsy when PSA is elevated.
Still….we will do the PSA testing for monitoring, but this gives even more fodder for those who want to maintain a strong respect for ‘watching and waiting’ when PSA’s vary and are inconclusive.