February 9, 2010, 9:05 AM CT

Lower detection of prostate cancer with PSA screening in US

Fewer prostate cancers were detected by prostate-specific antigen (PSA) screening in the U.S. than in a European randomized trial because of lower screening sensitivity, as per a new brief communication published online February 8 in the Journal of the National Cancer Institute

To compare the PSA screening performance in a clinical trial with that in a population setting, Elisabeth M. Wever, MSc, Department of Public Health, Erasmus Medical Center, the Netherlands, and his colleagues applied a microsimulation model developed for prostate cancer and screening to the European Randomized Study of Screening for Prostate Cancer (ERSPC)Rotterdam. The model was adapted by replacing the trial's demography parameters with U.S.-specific ones and the screening protocol with the frequency of PSA tests in the population. The natural progression of prostate cancer and the sensitivity (percentage of men correctly identified as having prostate cancer of those who have preclinical prostate cancer) of a PSA test followed by a biopsy were assumed to be the same in the US as in the trial.

The prostate cancer incidence predicted by the model in the U.S. was substantially higher than the actual prostate cancer incidence. However, the actual incidence was reproduced by assuming a substantially lower PSA test sensitivity in the U.S. than in ERSPCRotterdam......... Posted by: Mark      Read more         Source

February 3, 2010, 8:08 AM CT

How some prostate cancer cells become more aggressive?

Prostate cancer cells are more likely to spread to other parts of the body if a specific gene quits functioning normally, as per new data from scientists at UT Southwestern Medical Center.

Certain prostate cancer cells can be held in check by the DAB2IP gene. The gene's product, the DABIP protein, acts as scaffolding that prevents a number of other proteins involved in the progression of prostate cancer cells from over-activation. When those cells lose the DAB2IP protein, however, they break free and are able to metastasize, or spread, drastically increasing the risk of cancer progression in other organs as the cells travel through the bloodstream or lymph system.

The study in mice, reported in the Jan. 11 issue of the Proceedings of the National Academy of Sciences, observed that eliminating the DAB2IP scaffolding in human carcinoma cells caused them to change from epithelial cells to mesenchymal cells - a hallmark of metastatic cancer.

Cells undergoing an epithelial to mesenchymal transition (EMT) experience biological changes that enable them to move freely and spontaneously throughout the body," said Dr. Jer-Tsong Hsieh, director of the Jean H. & John T. Walker Jr. Center for Research in Urologic Oncology at.

UT Southwestern and the study's senior author. "By restoring DAB2IP function in cancer cells in mice, we reversed their ability to change and metastasize"......... Posted by: Mark      Read more         Source

January 25, 2010, 7:57 AM CT

Prostate cancer is treated differently

Scientists at Moores Cancer Center at the University of California, San Diego and his colleagues have observed that prostate cancer therapys varied significantly between county hospitals and private providers. Patients treated in county hospitals are more likely to undergo surgery while patients treated in private facilities tend to receive radiation or hormone treatment. These findings were published online by the journal Cancer on January 25.

"The study examined the factors that drive therapy choices for prostate cancer patients" said J. Kellogg Parsons, MD, MHS, principal investigator and urologic oncologist at Moores UCSD Cancer Center. "We observed that decisions are significantly influenced by the type of health care facility where they receive care".

Surgery, radiation and hormone treatment are the most common therapys for localized prostate cancer. Each is linked to different risks and benefits with no consensus as to the most effective form of therapy, though life expectancy, other illnesses, cancer severity and patient preferences may account in part for therapy choices. Parsons and his colleagues at UCLA compared the types of therapys patients with prostate cancer received from public and private hospitals as part of a California public assistance program. The scientists analyzed the care provided to 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT)......... Posted by: Mark      Read more         Source

November 9, 2009, 8:22 AM CT

Prostate biopsy is not always necessary

Scientists at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men appears to be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.

Elevated levels of PSA have traditionally been seen as a potential sign of prostate cancer, leading to the widespread use of PSA testing. However, the scientists observed that parathyroid hormone, a substance the body produces to regulate calcium in the blood, can elevate prostate-specific antigen (PSA) levels in healthy men who do not have prostate cancer. These "non-cancer" elevations in PSA could cause a number of men to be biopsied unnecessarily, which often leads to unnecessary therapy.

"PSA picks up any prostate activity, not just cancer," said lead investigator Gary G. Schwartz, Ph.D., M.P.H., an associate professor of cancer biology and epidemiology and prevention at the School of Medicine. "Inflammation and other factors can elevate PSA levels. If the levels are elevated, the man is commonly sent for a biopsy. The problem is that, as men age, they often develop microscopic cancers in the prostate that are clinically insignificant. If it weren't for the biopsy, these clinically insignificant cancers, which would never develop into fatal prostate cancer, would never be seen"......... Posted by: Mark      Read more         Source

November 4, 2009, 8:13 AM CT

Size and shape of the blood vessels predict prostate cancer behavior

A diagnosis of prostate cancer raises the question for patients and their physicians as to how the tumor will behave. Will it grow quickly and aggressively and require continuous therapy, or slowly, allowing treatment and its risks to be safely delayed?

The answer may lie in the size and shape of the blood vessels that are visible within the cancer, as per research led by researchers at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in collaboration with the Harvard School of Public Health.

The study of 572 men with localized prostate cancer indicates that aggressive or lethal prostate cancers tend to have blood vessels that are small, irregular and primitive in cross-section, while slow-growing or indolent tumors have blood vessels that look more normal.

The findings were published Oct. 26 in the Journal of Clinical Oncology

"It's as if aggressive prostate cancers are growing faster and their blood vessels never fully mature," says study leader Dr. Steven Clinton, professor of medicine and a medical oncologist and prostate cancer specialist at Ohio State's Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute.

"Prostate cancer is very heterogeneous, and we need better tools to predict whether a patient has a prostate cancer that is aggressive, fairly average or indolent in its behavior so that we can better define a course of therapy surgery, chemotherapy, radiotherapy, hormonal treatment, or potentially new drugs that target blood vessels that is specific for each person's type of cancer," Clinton says......... Posted by: Mark      Read more         Source

October 20, 2009, 10:01 PM CT

Call to reconsider screening for breast cancer and prostate cancer

Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece reported in the "Journal of the American Medical Association".

Instead, overall cancer rates are higher, a number of more patients are being treated, and the occurence rate of aggressive or later-stage disease has not been significantly decreased, the authors conclude. Current screening programs are leading to "potential tumor over-detection and over-treatment," they write in the Oct. 21, 2009 issue of JAMA.

"Screening does provide some benefit, but the problem is that the benefit is not nearly as much as we hoped and comes at the cost of over-diagnosis and over-treatment," said Laura Esserman, MD, MBA, professor of surgery and radiology, director of the UCSF Carol Franc Buck Breast Care Center, and co-leader of the breast oncology program at the UCSF Helen Diller Family Comprehensive Cancer Center.

"We need to focus on developing new tools to identify men and women at risk for the most aggressive cancers, to identify at the time of diagnosis those who have indolent or 'idle' tumors that are not life-threatening," she added. "If we can identify groups of patients that don't need much therapy, or don't need to be screened, wouldn't that be great? Screening is by no means perfect. We should want to make it better. For both breast and prostate cancer we need to invest in changing our focus from the cancers that won't kill people to the ones that do"......... Posted by: Janet      Read more         Source

September 29, 2009, 8:10 AM CT

Tools for prostate cancer screening

Eventhough screening for prostate cancer with the Prostate Specific Antigen (PSA) test in men ages 50-70 can detect the cancer before it becomes symptomatic, knowing whether screening is beneficial for these men is uncertain.

Recent trials have shown small or no reductions in prostate cancer mortality among those screened. The small potential for benefit must be balanced against the more common and immediate downsides of increasing the chance of prostate cancer diagnosis and therapy-related complications.

Developing more effective decision support tools may help men and their physicians discuss whether or not to undertake PSA screening.

Michael Pignone, M.D., M.P.H., authored an editorial in the Sept. 28 Archives of Internal Medicine about this issue. He evaluated two studies: one from the National Survey of Medical Decisions and a second study from Australia that modeled the potential effects of screening for use in discussions about screening.

Pignone is associate professor of medicine and chief of the division of general internal medicine in the UNC School of Medicine and a member of UNC Lineberger Comprehensive Cancer Center.

He explained, "To make a good decision about whether or not to be screened, patients need to know their chances of being helped by screening and their chances of being harmed"......... Posted by: Mark      Read more         Source

July 20, 2009, 10:58 PM CT

Heavy alcohol consumption and risk of prostate cancer

Consumption of 50 g or more of alcohol per day or four or more drinks per day for at least five days per week was linked to an elevated risk for prostate cancer. Furthermore, drinking 50 g or more of alcohol per day rendered therapy with finasteride ineffective.

Scientists analyzed data from 2,129 participants with cancer and 8,791 participants without disease from the Prostate Cancer Prevention Trial. They examined the relationships between risk for low- and high-grade prostate cancer and total alcohol consumption, types of alcoholic beverages and consumption pattern. Scientists also analyzed the effect of alcohol consumption on the effectiveness of finasteride based on the arms that patients were randomly assigned to in the original trial.

Consumption of 50 g or more of alcohol per day increased risk for high-grade prostate cancer yielding an RR of 2.01 (95% CI, 1.33-3.05). Consumption of four or more drinks per day for at least five days per week also increased this risk with an RR of 2.17 (95% CI, 1.42-3.30).

Compared with no alcohol intake, heavy drinking for at least five days per week was linked to risk for high-grade cancer (RR=2.17; 95% CI, 1.42-3.30).

Patients in the finasteride group who consumed <50 g of alcohol per day had a 29% lower risk for low- and high-grade cancer, but patients in this group who consumed >50 g of alcohol per day had a 17% increased risk (P=.03)......... Posted by: Mark      Read more         Source

July 4, 2009, 10:56 PM CT

Prostate cancer patients who are disease free after 5 years

Patients with prostate cancer who receive brachytherapy and remain free of disease for five years or greater are unlikely to have a recurrence at 10 years, as per a research studyin the July 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).

Brachytherapy is the placement of radioactive sources in or just next to a tumor either permanently or temporarily, depending upon the cancer.

In the study, scientists at The Mount Sinai Medical Center Departments of Radiation Oncology and Urology in New York followed 742 patients with prostate cancer who were treated with brachytherapy alone, brachytherapy and hormonal treatment, or combined brachytherapy and external beam radiotherapy (EBRT) between 1991 and 2002. None of these patients had recurred during their first five years post-treatment. They observed that the PSA level taken at five years was an indicator of how well a patient would do in the future and the overall chance of being cancer free at 10 years was 97 percent.

Also, none of the study participants developed metastatic disease or died from prostate cancer.

"Our data have indicated that improvements in therapy are continuing and that these will continue to have an effect on prostate brachytherapy data for years to come," Richard Stock, M.D., main author of the study and chairman of radiation oncology at The Mount Sinai Medical Center, said. "Late failure rates will continue to decrease, making prostate brachytherapy alone and combined with hormonal treatment and/or EBRT an increasingly attractive therapy option"......... Posted by: Mark      Read more         Source

June 25, 2009, 6:06 PM CT

Selenium intake may worsen prostate cancer

Higher selenium levels in the blood may worsen prostate cancer in some men who already have the disease, as per a research studyby scientists at Dana-Farber Cancer Institute the University of California, San Francisco.

A higher risk of more-aggressive prostate cancer was seen in men with a certain genetic variant found in about 75 percent of the patients with prostate cancer in the study. In those subjects, having a high level of selenium in the blood was linked to a two hundred percent greater risk of poorer outcomes than men with the lowest amounts of selenium. By contrast, the 25 percent of men with a different variant of the same gene and who had high selenium levels were at 40 percent lower risk of aggressive disease. The variants are slightly different forms of a gene that instructs cells to make manganese superoxide dismutase (SOD2), an enzyme that protects the body against harmful oxygen compounds.

The research findings suggest that "if you already have prostate cancer, it appears to be a bad thing to take selenium," says Philip Kantoff, MD, director of Dana-Farber's Lank Center for Genitourinary Oncology and senior author of the study that is published by the Journal of Clinical Oncology on its website now and later will be in a print journal. The main author is June Chan, ScD, of the University of California, San Francisco......... Posted by: Mark      Read more         Source

June 10, 2009, 9:02 PM CT

Now you can buy a kit to test for prostate cancer

An over-the-counter prostate cancer test kit could be coming to a pharmacy near you, thanks to the collaborative work of a University of Central Florida chemist and M.D. Anderson Cancer Center Orlando researchers.

UCF's Qun "Treen" Huo and M.D. Anderson-Orlando's Dr. Cheryl Baker and Jimmie Colon teamed up about 18 months ago with a very ambitious plan. Huo wanted to develop an effective, inexpensive test to screen for prostate cancer that would be easy enough to use at home or a local pharmacy.

"Now cancer tests are so inconvenient and expensive, and a lot of people don't have insurance, so they are not likely to test if they have no symptoms," Huo said. "Cancer is really scary because there aren't a lot of symptoms in the early stages. So I said, 'Why not create a test that is easy and inexpensive? Then more people can test and catch cancer early so it can be treated early.'".

Prostate cancer affects one of every six men and is the second-most common cancer among men in the United States, as per the American Cancer Society. It is estimated that more than 2 million American men are currently living with prostate cancer and that one new case occurs every 2.7 minutes. More than 27,000 men die from the disease each year, as per the American Cancer Society......... Posted by: Mark      Read more         Source

May 22, 2009, 5:06 AM CT

Younger men with advanced prostate cancer

While young men with prostate cancer have a low risk of dying early, those with advanced forms of cancer do not live as long as older men with similar forms of the disease. That is the conclusion of a newly released study reported in the July 1, 2009 issue of CANCER, a peer-evaluated journal of the American Cancer Society. The paradoxical findings indicate that there appears to be biological differences between prostate cancers that develop in younger men and those that develop in older men, and that uncovering these differences may help tailor screening and therapy strategies for patients based on age.

In general, a younger cancer patient has a better prognosis than an older patient with the same type of cancer. Few studies have analyzed the health of younger vs. older men after diagnosis and therapy for prostate cancer, though.

To investigate the impact of age on prostate cancer prognosis, Daniel Lin, M.D., of the University of Washington and his colleagues designed a study to examine the association between age at diagnosis and health outcomes in men diagnosed with prostate cancer in the United States. Mining the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, the researchers identified 318,774 men diagnosed with prostate cancer between 1988 and 2003. Men aged 35 to 74 years were stratified by age at the time of diagnosis, and the scientists examined differences in tumor characteristics, therapy, and survival within each age group......... Posted by: Mark      Read more         Source

April 27, 2009, 5:31 AM CT

Diet soda may reduce kidney stones

Patients with stone disease could benefit from drinking diet soda. New research from the University of California, San Francisco suggests that the citrate and malate content in usually consumed sodas appears to be sufficient to inhibit the development of calcium stones. The study was presented at the 104th Annual Scientific Meeting of the American Urological Association (AUA).

Increased alkalinity is proven to augment citraturia, a known factor for calcium stones. Malate increases the amount of alkali delivered. Scientists measured the citrate and malate content of 15 popular diet sodas. The scientists observed that Diet Sunkist Orange contained the greatest amount of total alkali and Diet 7-Up had the greatest amount of citrate as alkali.

"This study by no means suggests that patients with recurrent kidney stones should trade in their water bottles for soda cans," said Anthony Y. Smith, MD, an AUA spokesman. "However, this study suggests instead that patients with stone disease who do not drink soda appears to benefit from moderate consumption"......... Posted by: Mark      Read more         Source

April 27, 2009, 5:27 AM CT

Statins may reduce the risk of prostate cancer

Cholesterol-lowering drugs called statins may reduce inflammation in prostate tumors, possibly hindering cancer growth, as per a research studyled by researchers in the Duke Prostate Center.

"Prior studies have shown that men taking statins seem to have a lower occurence rate of advanced prostate cancer, but the mechanisms by which statins might be affecting the prostate remained largely unknown," said Lionel Baez, M.D., a researcher in the Duke Prostate Center and lead investigator on this study. "We looked at tumor samples and observed that men who were on statins had a 72 percent reduction in risk for tumor inflammation, and we believe this might play a role in the correlation between prostate cancer and statin use".

The scientists presented their finding at the American Urological Association's annual meeting on April 26, 2009, and the study was selected to be part of the meeting's press program on April 27, 2009. The study was funded by the United States Department of Defense and the American Urological Association Foundation.

The scientists looked at pathological information from the tumors of 254 men who underwent radical prostatectomy or surgery to remove the entire prostate as a therapy for prostate cancer at the Durham Veterans Affairs Medical Center between 1993 and 2004. The tissue was graded by a pathologist for inflammation on a scale of 0 to 2: 0 for no inflammation, 1 for mild inflammation (less than 10 percent of the tumor) and 2 for marked inflammation (greater than 10 percent of the tumor)......... Posted by: Mark      Read more         Source

April 27, 2009, 5:00 AM CT

Who should get PSA testing?

LINTHICUM, MD, April 27, 2009The American Urological Association (AUA) today issued new clinical guidance which directly contrasts recent recommendations issued by other major groups about prostate cancer screening, asserting that the prostate-specific antigen (PSA) test should be offered to well-informed, men aged 40 years or older who have a life expectancy of at least 10 years. The PSA test, as well as how it is used to guide patient care (e.g., at what age men should begin regular testing, intervals at which the test should be repeated, at what point a biopsy is necessary) is highly controversial; however, the AUA believes that, when offered and interpreted appropriately the PSA test may provide essential information for the diagnosis, pre-treatment staging or risk evaluation and post-treatment monitoring of prostate cancer.

The new Best Practice Statement updates the AUA's prior guidance, which was issued in 2000. Major changes to the AUA statement include new recommendations about who should be considered for PSA testing, as well as when a biopsy is indicated following an abnormal PSA reading. As per the AUA, early detection and risk evaluation of prostate cancer should be offered to well-informed men 40 years of age or older who have a life expectancy of at least 10 years. The future risk of prostate cancer is closely correlation to a man's PSA score; a baseline PSA level above the median for age 40 is a strong predictor of prostate cancer. Such testing may not only allow for earlier detection of more curable cancers, but may also allow for more efficient, less frequent testing. Men who wish to be screened for prostate cancer should have both a PSA test and a digital rectal exam (DRE). The Statement also notes that other factors such as family history, age, overall health and ethnicity should be combined with the results of PSA testing and physical examination in order to better determine the risk of prostate cancer. The Statement recommends that the benefits and risks of screening of prostate cancer should be discussed including the risk of over-detection, detecting some cancers which may not need immediate therapy......... Posted by: Mark      Read more         Source

March 16, 2009, 5:14 AM CT

Some men with prostate cancer doesn't require immediate treatment

A multi-center study of patients with prostate cancer appearing in today's Journal of Urology recommends that for some men diagnosed with low-risk prostate cancer, opting not to initially receive therapy can be safe if they are closely monitored.

The study addresses an important question for men newly diagnosed with prostate cancer and at minimal risk of cancer progression or metastases: when to actively treat versus when to observe and closely monitor. Radiation treatment and surgery are effective therapys but can be linked to serious long-term side effects such as incontinence and erectile dysfunction. Investigators in the study show that two separate biopsies are needed to determine optimal selection of patients for active surveillance, also known as "watchful waiting" when patients decide not to undergo immediate therapy.

Study author Scott Eggener, MD, assistant professor of surgery at the University of Chicago Medical Center, notes there are no widely-accepted recommendations on which patients are appropriate candidates for active surveillance or when to perform second or "restaging" biopsies. The authors show that a restaging biopsy provides doctors with additional information regarding the cancer and is the best way to ensure the short-term success of active surveillance......... Posted by: Mark      Read more         Source