Prostrate Cancer

Breast and prostate cancer family link found: Men from families where the women have high rates of breast cancer could face a heightened risk of prostate cancer. (SYDNEY (AFP) researchers- 19/05/08)

A mutated gene seen as a factor in breast cancer can also expose men to a four times higher risk of prostate cancer, the scientists said, describing confirmation of the link as a world first. The research was funded by Australia's National Breast Cancer Foundation and carried out by researchers at kConFab, an Australian and New Zealand consortium for research into familial breast cancer. The consortium has been investigating families with multiple cases of breast and ovarian cancer for 10 years and noticed that prostate cancer was also common in some of the families, said kConFab national manager Heather Thorne. Those families carried a mutation in the BRCA2 gene, which is passed from one generation to the next, and "this led us to explore whether these prostate cancers were caused by the genetic fault running in the family," she said.

"We discovered that a man with a genetic fault in BRCA2 has almost four times the risk of developing prostate cancer than men in the general population. "The BRCA2-prostate cancers that arise in these men also tend to be more aggressive". It was hoped the discovery would lead men to assess their personal risk in the same way women already do with breast and ovarian cancer, Thorne said in a statement. "If a man comes from a family with multiple cases of breast or ovarian cancer, or knows there is a BRCA2 gene mutation running in their family, they may be at increased risk of developing prostate cancer. "These men can go to a Family Cancer Clinic and discuss genetic testing, and be given appropriate advice if they are found to be at increased risk."

Breast cancer survivors who find they have a mutation in the BRCA2 gene will also now know that their brothers or sons could be at increased risk of prostate cancer, she said. The results of the research were published this week in the US journal Clinical Cancer Research and trials were now being undertaken to try to find early detection biomarkers for men who carry the faulty genes, Thorne said. Prostate cancer is the commonest cancer afflicting men in developed countries.

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Which Best Predicts Prostate Cancer Risk? Race, Family History Or Baseline PSA(Yahoo News-18/05/2008)

African-American men with family histories of prostate cancer could benefit from a baseline prostate-specific antigen (PSA) reading to determine their probability of developing the disease. Researchers from Northwestern University in Chicago say this new perspective on testing could lead to highly individualized screening protocols based on a man's baseline level and how it relates to established age-specific medians. 

According to new data presented during the Annual Scientific Meeting of the American Urological Association (AUA) in Orlando, African-American men with known prostate cancer risk factors with baseline levels higher than the age-specific median are more likely to develop the disease in their lifetimes than the general population. However, African-American men with a family history were unlikely to develop prostate cancer if their baseline PSA level was below the age-specific median. The effect of the baseline PSA level on future prostate cancer risk was so robust that the correlation held true even for men with other significant risk factors. The study will be presented to the media during a special press conference on May 18, 2008 at 12:00 p.m. 

Using a study cohort drawn from a longitudinal screening study enrolling more than 26,000 volunteers between 1991 and 2001, researchers analyzed a group of 329 African-American men with a family history of prostate cancer. The volunteers were divided into three groups by ages: 40s, 50s and 60+ with a mean follow-up time of 19.5, 71 and 81 months, respectively. None of the men in their 40s or 50s with both risk factors and a baseline PSA below the median were diagnosed with prostate cancer. Eight percent of men in their 40s with both risk factors and a PSA above the median were diagnosed, as were 16 percent of men in their 50s. Twice as many men in their 60s with both risk factors and a baseline PSA above the median were diagnosed with prostate cancer.

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When To Wait And When To Treat? New Program Will Search For Biomarkers In Men With Prostate Cancer To Help Find An Answer (Yahoo News-03/05/2008)

Researchers at Fred Hutchinson Cancer Research Center have a lead role in a new public/private partnership to create the first systematic surveillance program of men with prostate cancer to look for biological clues to help determine when to wait and when to treat the disease. The project was announced by the Canary Foundation and the National Cancer Institute. Peter Nelson, M.D., of the Hutchinson Center's Clinical Research and Human Biology divisions, will lead the Canary Prostate Consortium. This group of six institutions nationwide will enroll men in a cancer-surveillance study to look for biomarkers -- proteins in the blood that could predict prostate-tumor aggressiveness. The new study is meant to help answer a key question that has vexed physicians and researchers: When is it best to treat prostate cancer versus observation or "watchful waiting." For most men with prostate cancer, the disease never progresses to become a serious health problem, yet most receive some sort of treatment, such as radiation or surgery. Such treatments can have side effects, such as impotence and incontinence, which can be worse than the low-grade cancer. Currently it is challenging to accurately predict when inactive or slow-growing prostate tumors will become aggressive.

"There's an emerging consensus that we dramatically over treat prostate cancer in general," said Nelson. "The overall prevalence of the disease in the population far exceeds the number of men whose disease progresses to cause serious problems. Yet, there are clearly many prostate cancers that behave aggressively and patients benefit from treatment. It is a challenging problem." In the study, men diagnosed with early-stage prostate cancer will not be treated right away but will be closely followed in an active surveillance program involving regular collection of blood and urine samples as well as prostate biopsies. A new repository for blood and DNA samples will be located at the Hutchinson Center. The repository will be funded by the Canary Foundation. NCI's Early Detection Research Network (EDRN), the federal agency that is partnering with the Canary Foundation, will establish disease-specific Common Data Elements, a biospecimen management system and a protocol oversight program. The EDRN data management and coordinating center is based at the Hutchinson Center under the direction of Zideng Feng, Ph.D., a member of the Hutchinson Center's Public Health Sciences Division. The samples will be tested for candidate biomarkers -- proteins in the blood -- that can signal when indolent disease has progressed to more aggressive illness. Such biomarkers could help physicians better determine when to initiate treatment versus watchful waiting.

Each of the study institutions also has a "retrospective" tissue collection of samples taken from unrelated studies. These will also be examined to ascertain the accuracy of predictive biomarkers. "We are proud to launch this new study with EDRN and with the participation of leading research institutes," said Nelson, who is also a professor of oncology at the University of Washington School of Medicine. "Through collaboration we can make bigger strides in providing better, more individualized treatment for prostate-cancer patients." The Canary Foundation is providing initial funding for the Prostate Active Surveillance Study. The five institutions that will enroll patients are University of Washington, Stanford University, University of California at San Francisco, University of British Columbia and University of Texas Health Science Center in San Antonio.

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Cancer Risk Lingers for Long-Banned DDT
Study Shows Link Between the Pesticide and Testicular Cancer(WebMD Medical News-29/04/2008)

By Kelli Miller Stacy
 Men exposed to the lingering remnants of the once widely used pesticide DDT have an increased risk for the most common form of testicular cancer.Scientists reporting in the April 29 issue of the Journal of the National Cancer Institute have found that men with the highest blood levels of DDE (dichlorodiphenyldichloroethylene), a DDT byproduct, were 1.7 times more likely to develop testicular germ cell tumors than those who had the lowest levels. DDT (dichlorodiphenyltrichloroethane) is a synthetic bug killer known as an organochlorine pesticide. It was developed during the 1940s to kill mosquitos and prevent insect-borne diseases such as malaria. Farmers later sprayed it on crops to control insects. The U.S. banned DDT in 1972 because of potential health risks. However, the chemical and its breakdown products, or metabolites, can persist in the environment for many years. Studies have linked persistent exposure to DDT and similar pesticides to various health risks, including reproductive damage and cancer. But the findings regarding testicular cancer have not been replicated in an independent data set.

For the current study, Katherine McGlynn, PhD, of the National Cancer Institute, and colleagues evaluated the relationship between organochlorine pesticide exposure and a man's risk of testicular germ cell tumors (TGCTs). Germs cells are the cells that produce sperm. The majority of testicular cancers arise from these cells. The rate of TGCTs in the U.S. has been increasing for at least 30 years, since about the time DDT was banned. McGlynn's team measured the amount of pesticides or their breakdown products in blood samples from healthy men and those who were later diagnosed with TGCTs. The men donated the blood about 14 years earlier as part of the U.S. Servicemen's Testicular Tumor Environmental and Endocrine Determinants study. The researchers divided the men into groups based on the level of a particular pesticide in their blood and found that the highest levels of DDE were associated with an increased chance of developing testicular cancer compared with those with the lowest levels. "If the relative risks calculated in this study are accurate ... the proportion of disease in the study population that is attributable to DDE exposure ... would be approximately 15 percent for all [testicular germ cell tumors]," the authors write. McGlynn notes that it is impossible to determine when the men were exposed to the pesticide, but she adds that it may date back to the mother's pregnancy or shortly thereafter. "Because evidence suggests that TGCT is initiated in very early life, it is possible that exposure to these persistent organic pesticides during fetal life or via breast feeding may increase the risk of TGCT in young men," she writes. Although DDT is banned in the U.S., developing countries continue to use the product and more widespread use is being considered. The study authors encourage further studies to examine the link between the pesticides and testicular cancer in other populations.

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Prostate cancer deaths down after PSAs(UPI-25/04/2008)

Deaths from prostate cancer more than halved in a region in Austria after a program was carried out to improve early detection and treatment, a study said. Prostate specific antigen, or PSA testing, was introduced to the Tyrol in 1988 and since 1993 it has been freely available to all men ages 45 to 75, and to men under 40 with a family history of the prostate disease, said lead author Georg Bartsch of the University of Innsbruck. Bartsch -- part of the international team of medical experts that makes up the Tyrol Prostate Cancer Screening Group -- said nearly 87 percent of eligible men in Tyrol have been tested at least once since the program was introduced in 1988.The study, published in the urology journal BJU International, found that by 2005, cancer deaths had fallen by 54 percent, compared with 29 percent for the rest of Austria, which hadn't benefited from the program. "Our findings suggest that the combination of free PSA testing and free treatment for any resulting prostate cancer can lead to significant reductions in death rates," Bartsch said in a statement. "This free treatment normally involved surgical removal of the prostate."

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Celebrex Plus Lipitor Could Fight Prostate Cancer (HealthDay News -14/04/2008) 

Two widely used drugs -- one lowers cholesterol and one is an anti-inflammatory -- may be useful in controlling prostate cancer. New research being presented at the American Association for Cancer Research annual meeting in San Diego finds that the painkiller Celebrex and the statin Lipitor, when used together or alone, can stop early prostate cancer before it becomes deadly. The study was conducted in mice so the idea isn't yet ready for clinical use, but experts said these preliminary results did look promising. "They need to come up with the molecular mechanics and then take it back to clinical trials," said Dr. K. Scott Coffield, a professor of surgery at Texas A&M Health Science Center College of Medicine and a urologist-oncologist at Scott & White. "It's early but it's interesting and that's wonderful." "It's very intriguing and it gives some clinical data, but it's not enough to start recommending these medications for people who don't need them for other reasons," added Dr. Ronald D. Ennis, director of radiation oncology at St. Luke's Roosevelt Hospital, Continuum Cancer Centers, in New York City.

Prostate cancer is the second-leading cancer killer in men in the United States. In the early stages, prostate tumors depend on androgen (male) hormones such as testosterone to grow. As such, early treatment typically involves interfering with these hormones but these therapies eventually lose their effectiveness. Tumors that are dependent on androgen are typically less aggressive than later tumors that don't rely on androgen. Epidemiological studies have suggested that statins (such as Lipitor) and nonsteroidal anti-inflammatory drugs (such as Celebrex) may be able to stop the progression from an early cancer to a later, more aggressive malignancy. This study aimed to delay the progression of androgen-dependent tumors to 
androgen-independent tumors, thus allowing doctors more time to administer anti-hormone therapy. Anti-androgen therapy is less toxic than many other cancer therapies, as are Lipitor and Celebrex. "Comparing complications for many anti-cancer treatments, these drugs generally would be very safe," Ennis said. (Celebrex, a cox-2 inhibitor, is the only drug in this class still on the market in the United States; two others, Vioxx and Bextra, were withdrawn because of safety 
issues). In the study, the investigators first cultured prostate tumors in mice, then added in either Lipitor or Celebrex, and then the combination of the two drugs.

All three approaches inhibited cancer growth. Interestingly, however, the combination of Lipitor and Celebrex at lower doses than when given individually resulted in a greater effect, the team found. "It had a pretty substantial effect with this combination," said study senior author Allan Conney, director of the Susan Lehman Komen Laboratory for Cancer Research at the Ernest Mario School of Pharmacy of Rutgers University, in New Brunswick, N.J. "We're hoping that this can be extrapolated to humans," Conney added. "There's a need to do a clinical trial on this combination of Lipitor and Celebrex to see if it can prolong the time that it takes to convert the androgen-dependent tumors to androgen-independent tumors, which are the more severe kind." As of now, it's unclear why Lipitor and Celebrex are having this effect on prostate tumors. Ennis doubted it was a cholesterol issue. "Statins as a group must have another effect beyond lowering cholesterol," he said. "They're known to have some anti-inflammatory effects but what they're doing to cancer isn't known yet. Once we figure that out, we may be able to develop better drugs that do the same thing." "That's very exciting but not yet enough to start prescribing this for prostate cancer," Ennis added. 

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Soy Compound May Halt Spread of Prostate Cancer (Yahoo News)

A compound found in soybeans almost completely prevented the spread of human prostate cancer in mice, according to a study published in the March 15 issue of Cancer Research, a journal of the American Association for Cancer Research. Researchers say that the amount of the chemical, an antioxidant known as genistein, used in the experiments was no higher than what a human would eat in a soybean-rich diet. Investigators from Northwestern University found that genistein decreased metastasis of prostate cancer to the lungs by 96 percent compared with mice that did not eat the compound in their chow - making the study the first to demonstrate genistein can stop prostate cancer metastasis in a living organism. 

“These impressive results give us hope that genistein might show some effect in preventing the spread of prostate cancer in patients,” said the study’s senior investigator, Raymond C. Bergan, MD, director of experimental therapeutics for the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. 
“Diet can affect cancer and it doesn’t do it by magic,” Bergan said. “Certain chemicals have beneficial effects and now we have all the preclinical studies we need to suggest genistein might be a very promising chemopreventive drug.” Bergan and his team have previously demonstrated in prostate cancer cell cultures that genistein inhibits detachment of cancer cells from a primary prostate tumor and represses cell 
invasion. It does this by blocking activation of p38 MAP kinases, molecules which regulate pathways that activate proteins that loosen cancer cells from their tight hold within a tumor, pushing them to migrate. “In culture, you can actually see that when genistein is introduced, cells flatten themselves in order to spread out and stick strongly to nearby cells,” he said.

In this study, investigators fed genistein to several groups of mice before implanting them with an aggressive form of prostate cancer .The amount of genistein in the blood of the animals was comparable to human blood concentrations after consumption of soy foods, Bergan said. The researchers found that while genistein didn’t reduce the size of tumors that developed within the prostate, it stopped lung metastasis almost completely. They repeated the experiment and found the same result. They then examined tissue in the animals, measuring the size of tumor cells’ nuclei to determine if the cells had flattened out in order to spread. “Within a tumor, it is hard to tell where the borders of cells stop, so one way to measure adherence is to look at the size of the nuclei in cells and see if they are wider due to cell spread,” Bergan said. “And that is what we found, demonstrating that the drug is having a primary effect on metastasis.” He said that the study also found that mice fed genistein expressed higher levels of genes that are involved in cancer cell migration which, Bergan says, at first might not make sense in light of the study’s conclusion that genistein almost completely blocked metastasis.  “What we think is happening here is that the cells we put in the mice normally like to move. When genistein restricted their ability to do so, they tried to compensate by producing more 
protein involved in migration. But genistein prevented those proteins from being activated,” he said. “This is really a lesson for researchers who depend on biomarker studies to test whether a treatment is working. They need to be aware that those biomarkers might be telling only half of the story.”

Bergan cautioned that much is unknown about use of genistein in preventing cancer spread. For example, it may be that the effects of the compound in people who have eaten soy all their lives is stronger than benefit seen in patients who have only started to use genistein. “The problem we have faced is that epidemiology studies that found men who eat soy are at reduced risk of prostate cancer death are all associative. They don’t prove anything,” he said. “The only way we will find out how promising genistein is will be from conducting clinical trials.” Human observational studies have found that while the spread of prostate cancer is reduced in men who eat soy-rich foods, findings have been mixed as to whether prostate cancer incidence is markedly different. Results of some laboratory studies of genistein have also been 
mixed, but most have shown favorable results, Bergan said, demonstrating that genistein can inhibit a variety of cell molecules including tyrosine kinases, which activate proteins by attaching them to phosphate chemicals. 

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New blood marker may predict prostate cancer spread ( Yahoo news -27/2/2008)

Information could lead to more accurate prediction of cancer metastasis thereby improving patient management. Researchers report finding a new blood biomarker that enables close to 98 percent accuracy in predicting the spread of prostate cancer to regional lymph nodes. Their study is published in the March 1 issue of Clinical Cancer Research, a journal of the American Association for Cancer Research. 
When cancer spreads beyond a solid tumor, it often does so at a microscopic level that typically cannot be identified by conventional imaging methods such as CT scans. The new blood test measures levels of endoglin, a plasma biomarker that has been previously shown to predict the spread of colon and breast cancer. In this study, researchers concluded for the first time that endoglin could help predict whether a patient’s prostate cancer would spread 
beyond the solid tumor site into their lymph nodes. 

“For prostate cancer, we have hit the limit of our ability to classify risk in these patients before initial surgery. We currently use prostate specific antigen, Gleason grade and a rectal exam, but the predictive value of those three tests is inadequate for predicting what cancers will spread. Conventional imaging modalities used for clinical staging in prostate cancer are inadequate to detect small but clinically significant lymph node metastases.” said study author Shahrokh F. Shariat, MD, chief urology resident at the University of Texas Southwestern Medical Center. “Although it is recognized that pelvic lymphadenectomy can provide important staging and prognostic information, it is still not clear in whom this procedure should be done. Doing pelvic lymphadenectomy on all patients is not universally practiced, as this procedure could be time consuming and is not without morbidity. As such, it would be of tremendous benefit to have an accurate blood marker that identifies patients in whom pelvic lymphadenectomy should be done,” said co-author Claus G. Roehrborn, MD, professor and chairman of Urology at the University of Texas Southwestern Medical Center. Shariat and his colleagues observed 425 patients who had undergone surgery to remove both their prostates and associated pelvic lymph nodes. Researchers measured the levels of plasma endoglin using a commercially available blood test. Higher plasma endoglin levels were associated with an increased risk of cancer spread to the lymph nodes. Each 1 ng/mL 
increase of plasma endoglin increased the risk for cancer spread into the lymph nodes by 17 percent. 

When researchers added endoglin levels to their usual methods of prediction, the accuracy improved from 89.4 percent without endoglin to 97.8 percent. Blood levels of endoglin may allow doctors to predict the risk of cancer spread at an earlier stage and with higher accuracy than currently available methods. “Despite strides in the management of prostate cancer, approximately 25 percent to 30 percent fail primary curative treatment such as radical prostatectomy and radiotherapy. This is often due to spread of cancer cells beyond the original tumor site. Use of plasma endoglin 
could help identify patients at risk for lymph nodes metastasis who should undergo pelvic lymphadenectomy. In addition, it may spare patients at low risk of lymph node metastasis the potential morbidity of an unnecessary lymphadenectomy,” Shariat said. 

The authors stressed that some limitations of this study should be noted. The retrospective study, the standard lymph node sampling, and the small number of events support the need for multicenter prospective studies before the clinical use of endoglin as a marker for predicting lymph node metastasis in patients with clinically localized prostate cancer. “Ultimately endoglin will need to be combined with three of four other markers to predict risk with greater certainty. The problem with biomarkers is that there is a tremendous variability among patients, but this moves us forward from what we were able to do with imaging and with our other commonly used methods,” Shariat said. The study was funded through a grant from the National Institutes of Health.

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Conventional prognostic factors fail to explain better prostate cancer survival in most Asian men- (Yahoo News- 13/08/2007)

Prognostic factors commonly used by clinicians to assess men with prostate cancer do not adequately predict survival outcomes in Asian men living in America, according to the first comprehensive ethnic analysis of Asian-American men with prostate cancer. Published in the September 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study showed that compared to white men, most Asian ethnic groups except South Asians paradoxically have better outcomes despite having worse prognostic profiles at the time of diagnosis. The study is the first to report prostate cancer survival data for Korean, South Asian and Vietnamese men living in the U.S. In the U.S. in 2007, over 218,000 men are expected to be diagnosed with prostate cancer and over 27,000 will die. Established prognostic factors include age, summary stage, primary treatment, histologic grade, socioeconomic status, and year of diagnosis. Epidemiologic studies have identified racial differences in incidence and mortality, with African-American men being at greater risk than other races. Asian-American men as a single, ethnic group have the lowest incidence of disease and the lowest mortality rate. The reasons for these racial differences remain poorly studied.

In particular, the risk among different Asian ethnicities is poorly understood, in part, because most studies have aggregated all Asians into a single racial category, ignoring the diverse ethnicities that make up Asia. The few that have tried to analyze by Asian ethnicity have typically analyzed only a few ethnicities, missing significant Asian-American ethnic populations in the process. Interestingly, the data to date show that compared to non-Hispanic white Americans, some Asian ethnicities, such as Japanese-Americans, have higher survival rates, despite worse clinical disease, whereas others, such as Filipino-Americans, have worse survival rates. However, South Asians – e.g., Indians, Pakistanis Bangladesh, etc. – who represent the third largest Asian subgroup in America, have never been studied for prostate cancer. Dr. Anthony Robbins of the California Cancer Registry in Sacramento, and co-investigators compared prognostic factors and survival rates of 116,916 men (108,076 whites and 8,840 Asians from the six largest represented Asian ethnicities - Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese) diagnosed with prostate cancer.

Dr. Robbins and his coauthors found that for each Asian ethnic subgroup, prognostic risk profiles were worse compared to whites. For example, all Asian ethnicities were more likely to have more advanced disease and use non-curative therapies. However, for all Asian ethnicities except South Asians, survival rates were equal to or better than whites. Japanese-Americans, for example, had significantly lower hazard ratio compared to non-Hispanic white Americans (34% lower). In contrast, South Asian-Americans had significantly higher hazard ratio compared to non-Hispanic white Americans (40% higher). The study should help physicians more accurately apply prognostic factors to their prostate cancer patients. The authors conclude, “these results argue that traditional prognostic factors for survival from prostate cancer (stage, grade, treatment, age, year of diagnosis, and socioeconomic status), do not explain why most Asian men have better survival compared to whites, but they do explain the poorer survival of South Asian men compared to whites.”

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After Prostate Cancer Diagnosis, Weigh the Options- (Yahoo News- 17/08/2007)

For men, a diagnosis of prostate cancer prompts a thicket of difficult decisions. Aggressive action against these tumors extends life span for some patients, but side effects such as impotence and incontinence can take a heavy toll on their quality of life. Other men do best with no invasive treatment at all. In choosing from among myriad treatments, doctors and patients typically work collaboratively to weigh a man's age, his medical history, the tumor's severity, and other personal factors. The list continues to grow. This month, for example, research published in the online version of Cancer suggests it may behoove people to take their ethnicity into account as well. The most common treatments include surgery to remove the tumor, radiation to kill it, or "watchful waiting." The watchful approach, also called active surveillance, involves frequent monitoring of the tumor, using blood tests and rectal exams, in lieu of aggressive efforts to eradicate it. In America, the majority of patients—some 72 percent—pass over active surveillance for more aggressive therapy. Mark Litwin, a urologist at UCLA, says this speaks to an American penchant for quick, definitive fixes. But there's also evidence that suggests an aggressive approach pays off. A study published last year, for example, found that men undergoing aggressive treatment were 30 percent less likely to die during the following year than men who did not. 

However, there are side effects of treatment to consider. Surgery can slice the nerves and muscles that control erections and urination, while radiation therapy can damage the same tissues. The National Cancer Institute's Prostate Cancer Outcomes Study, an ongoing nationwide study initiated in 1994, found that five years after surgery, 15 percent of surgery patients and 4 percent of radiotherapy patients were incontinent and 79 percent and 63 percent, respectively, reported impotence. (Some of those problems, presumably, were due to the men's advancing age and not their treatment.) While better on both those counts, radiotherapy caused bowel urgency or painful hemorrhoids 9 percent more often than did surgery. And some studies suggest that surgery is particularly effective at clearing cancer. Refinements to surgical techniques and the advent of new forms of radiation therapy may have improved complications rates since the 1,187 men in the NCI study received their treatments. But treatment complications remain a major disincentive to aggressive therapy. Prostate cancer is usually a slow-growing disease, which means that many men who have a tumor will nevertheless die from something else, before the tumor spreads and becomes dangerous. Selecting the right treatment, therefore, requires considering both how quickly a particular tumor might kill and how much longer the patient, if cancer free, could expect to live.

Predicting the cancer's move is not easy. "People say, 'The cancer will do this. The cancer will do that.' Cancer does whatever it wants," says Cy Stein of Montefiore-Einstein Cancer Center in New York City. Stein, a medical oncologist, thinks that even a small risk that a tumor will spread can make aggressive treatment worth it for many patients. Litwin, in contrast, argues that doctors need to treat discerningly, rather than simply treating most men aggressively. "The risk of dying of prostate cancer is low, no matter what age you are," he says. Age is nevertheless important. The average age at diagnosis is about 73, according to a study published this year in the American Journal of Men's Health. Most doctors say robust younger men who are uncomfortable living with cancer should consider aggressive treatment, while older men or men with other health problems may be better off with active surveillance.  Characteristics of the tumor, including its size and apparent aggressiveness, are also key. "It's important for patients to realize that not all cases of prostate cancer are created equal, and that the debate over the role of watchful waiting versus treatment centers around patients with low- and intermediate-risk disease," stresses Yu-Ning Wong, a medical oncologist at Fox Chase Cancer Center in Philadelphia. "Patients with more aggressive [tumors] are at a higher risk of developing metastatic disease and really should strongly consider treatment."

But even in a case where some doctors would favor aggressive treatment to prevent possible metastasis, others might counsel watchful waiting to preserve quality of life. These differing schools of thought reflect a fundamental uncertainty among prostate cancer experts: whether aggressive treatment of early-stage prostate cancer actually extends patients' lives. It's an unnerving state of affairs for patients, and much of the decision comes down to how comfortable a man and his doctor are relying on clinical measurements and interpretative calculations, such as the so-called Gleason score that estimates the likelihood that a given tumor will spread and kill. Given the uncertainty, how should a patient approach his decision? With patience, suggests Litwin, who urges men to take plenty of time before choosing a treatment. If you want the best care, he says, it's worth it to become familiar with the pros and cons of the various treatments, to get multiple medical opinions, and to be prepared to travel to a first-rate medical center in an urban area. But be wary of agonizing over the wrong details. "Men get so burnt out trying to pick one treatment over another they forget to put the same effort into choosing their provider," he says. "The quality of the provider trumps the type of treatment."

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Obesity Linked to Prostate Cancer Death Rates- (HealthDay- 12/11/2007)

 In another sign that too much weight spells health problems, new research suggests that fat men are twice as likely to die after being diagnosed with prostate cancer than men of normal weight. The research doesn't confirm a cause-and-effect link between obesity and a higher risk of death from prostate cancer, and it's not clear if losing weight would help patients after they're diagnosed with the disease.

Still, "if you look down the list of factors that are most predictive of a bad outcome, this [excess weight] ranks up there pretty high," said study co-author Dr. Matthew R. Smith, an oncologist at Massachusetts General Hospital in Boston. According to the Prostate Cancer Foundation, the disease strikes one in six American men and is the most prevalent form of non-skin cancer in the United States. Risk rises with age, with more than 65 percent of all cases diagnosed in men over the age of 65. However, prostate cancer can successfully be treated in many cases, particularly if it's caught early.

In the new study, Smith and his colleagues examined the results of men with advanced prostate cancer who were enrolled in a drug study between 1987 and 1992. The researchers looked at 788 men whose weights were recorded at the time of diagnosis to see if their body mass index -- BMI, a ratio of weight to height -- affected their risk of dying. The researchers found that 6.5 percent of men with normal or low weight -- a BMI of less than 25 -- died from prostate cancer within five years. But the death rate for overweight men (a BMI of 25 to 30) was 13.1 percent, and it was 12.2 percent for obese men (a BMI of 30 or higher).

The higher rate of death remained constant even when the researchers adjusted their findings for other possible factors. The study results are published in the Nov. 12 online issue of the journal Cancer. It remains unclear why there might be a link between obesity and death rates from prostate cancer. It's possible that metabolism rates in heavy men might make the cancer more aggressive, Smith said, or obesity could render treatments less effective.

Dr. Martha K. Terris, a professor of urology at the Medical College of Georgia, who's familiar with the study findings, said hormone balance could be another factor. "Obesity changes the proportion of estrogen and testosterone in the blood, and this change may impact on the cancer behavior," she said. Terris added that "obese individuals generally eat more high-fat diets with less fruits and vegetables that could contain key vitamins that help control cancer growth."

For now, Smith said, "the part we can't know is whether improvements in lifestyle intervention after prostate cancer diagnosis would improve outcomes." Still, it would be wise for doctors to tell their patients about the apparent link between weight and prostate cancer death rates, Smith said. "This may be a teachable moment that prompts a discussion about general health considerations," he said.

In a related study published in Cancer, University of Michigan researchers found that families coping with prostate cancer reported improved quality of life from a structured support program integrated into the patients cancer management. The study, led by Dr. Laurel Northouse, found that patients and their spouses who participated in a five-session home counseling program reported significant improvement in such areas as symptom management, hope, uncertainty and the couples' communication.

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Radiation Seed Treatment Helps Younger Men Fight Prostate Cancer- (HealthDay- 2/11/2007)

Radiation seed implants, known as brachytherapy, are just as effective for treating prostate cancer in men 60 and younger as they are for older men, a new study finds.Brachytherapy is a minimally invasive procedure in which small radioactive seeds are placed in the prostate to kill cancer cells. Recovery time after seed implantation is much shorter than surgery, and studies have found brachytherapy to be as effective as surgery. However, men 60 and younger are often advised to have surgery to remove part or all of the prostate, because many surgeons believe it's more effective long-term, according to background information in a news release about the study.

In this study, researchers analyzed the outcomes of more than 1,700 men with localized prostate cancer treated with brachytherapy at Mount Sinai Medical Center in New York between 1990 and 2005. They found that men 60 and younger had the same outcomes as older men."These results suggest that brachytherapy is extremely effective in curing localized prostate cancer for men aged 60 and younger," lead author Dr. Alice Ho, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York, said in a prepared statement.

"When younger men are diagnosed with localized prostate cancer, they should be presented with all viable treatment options, including brachytherapy. Every man with prostate cancer, regardless of his age, should have access to the treatment that is best for his cancer and lifestyle," Ho said. The findings were expected to be presented Wednesday at the American Society for Therapeutic Radiology and Oncology annual meeting, in Los Angeles.

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Prostate Cancer Survival Varies- (HealthDay- 7/10/2007)

Men diagnosed with prostate cancer in the summer and fall have a better chance of survival than those diagnosed in the spring and winter, a new study of Norwegian men suggests. "Summer and autumn months correspond to times when vitamin D is highest (in Norway). Although the study does not prove vitamin D is the determining factor, it does suggest that this possibility should be studied further," study co-author Dr. Tomasz Beer, director of the prostate cancer program at the Oregon Health & Science University Cancer Institute, said in a prepared statement.

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In the study, a team of American and Norwegian researchers analyzed data for more than 46,000 Norwegian men diagnosed with prostate cancer from 1964 to 1992. Compared with men diagnosed in the summer and fall, those diagnosed in the winter and spring were 20 percent more likely to die within three years after diagnosis. The study was published in the journalThe Prostate. The researchers also examined whether survivability was affected by factors such as eating foods high in vitamin D (such as fatty fish), taking vacations in sunny southern locations, and where the men lived in Norway.

Only age seemed to have a influence -- younger men had a slightly better rate of survival. The researchers noted that the capacity of skin to produce vitamin D when exposed to sunshine is about 40 percent lower in men 75 and older than in men 60 and younger. Vitamin D, which has been shown to inhibit cancer growth, may also help maintain immune system health and help regulate cell growth and differentiation, Beer said.

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Study Supports Change to Prostate Cancer Biopsy-(HealthDay- 2/10/2006) 

Adding an extra step to the standard test for prostate cancer might improve treatment for some men, a new study finds. Doctors now use what's known as the Gleason test -- named for the physician who developed it -- as a major tool in judging how aggressively a prostate cancer should be treated, explained lead researcher Dr. Abhijit A. Patel, a radiation oncologist at Brigham and Women's Hospital in Boston. His team published its findings in the Oct. 3 issue of the Journal of the American Medical Association.In the Gleason test, doctors take a biopsy of the cancer and look at the level of disorder displayed by cells in the two largest sections of the sample -- scoring them from 1 (less disorderly) to 5 (more disorderly).

"The less it looks like normal tissue, the more aggressive [the cancer] is," Patel explained. They then add up the two numbers to arrive at a Gleason score. A score of 7 calls for treatment such as radiation therapy, Patel said, while higher scores indicate an even more dangerous tumor.In the new study, the Brigham and Women's team looked for a third pattern of disorder from another part of the samples. Such disorderly patterns are found in about 5 percent of cases but usually are ignored. The new report included that third pattern in the diagnostic process.

Tests on 2,370 men with prostate cancer showed that men with Gleason score 7 plus this disorderly third pattern had a more rapid increase in prostate-specific antigen (PSA) levels in the blood. PSA indicates prostate tumor growth of the tumor and is the basis of the common PSA diagnostic blood test.These men should probably receive more aggressive treatment to fight their disease, Patel said, compared to men without this combination of factors.

The time to what physicians call "PSA failure" averaged five years in these men, compared to 6.7 years in men with a Gleason score of 7 but no disorderly third pattern. In fact, the failure time for men with a Gleason score of 7 and the third pattern of disorderly cells was the same as for men whose cancers had a Gleason score of 8 or greater. "We think these patients should get more therapy," Patel said. "In addition to surgery, they might need hormonal therapy to suppress the activity of testosterone." Testosterone, the male sex hormone, spurs the growth of prostate cancer.It's not known yet whether more aggressive treatment for men with the disorderly third pattern will improve their outcomes, since no such study has been done, Patel said.

But the idea does make sense, said Dr. David Berman, an assistant professor of pathology, urology and oncology at the Johns Hopkins University School of Medicine in Baltimore. "In prostate cancer it's difficult to go with things like survival to measure outcome. Biochemical recurrence is the easiest thing you can measure."The revised Gleason score tested by Patel's group was first proposed several years ago, and has already been adopted by some specialists, Berman noted.

The Hopkins expert is also the lead author of a new report, published in the October issue of Cancer Research, that indicates that the addition of hormone suppression therapy to prostate cancer treatment might bring dangers of its own.Laboratory studies indicate that hormone suppression therapy could boost the activity of a protein called nestin, which promotes the movement of prostate cancer cells to other parts of the body.That danger is far from proven, however. "These are early days to make a whole lot of therapeutic recommendations based on it," Berman said.

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Asian men more likely to survive prostate cancer-(ET- 4/9/2006) 

In a study of prostate cancer patients living in California, most Asian men with the disease survived longer than their white counterparts. The exception was men from South Asia; their survival was worse than that of white men. In an interview with Reuters Health, Dr. Anthony S. Robbins, from the California Cancer Registry in Sacramento, said that few studies have compared prostate cancer risk factors and survival between Asians and whites. He added that "there are zero that looked at Koreans, Vietnamese, and South Asians." He said that his group was surprised at "how much better nearly all the Asian groups fared compared to whites."

The study involved an analysis of data for 108,076 whites and 8840 Asians who were diagnosed with prostate cancer from 1995 to 2004. The cohort included six of the largest ethnic subgroups of Asians: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. South Asians included men from southern India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Sikkim. The overall 10-year prostate cancer-specific death rate was 11.9 percent, according to the report in the medical journal Cancer. The researchers were surprised by "how much variation there was across the Asian groups, all the way from an 8 percent risk of death over 10 years in Japanese men to a 16 percent risk in South Asian men."

All of the Asian groups had worse risk factor profiles than whites, yet only in South Asian men did the profile correspond with poorer survival. "For the groups with better survival, it was paradoxical," said Robbins, "because their risk factor profiles were all going in the wrong direction ... you would have thought they would do worse than whites." Nonetheless, "The take-home message is that for five out of six Asian groups, 'being Asian' was a favorable prognostic factor for prostate cancer survival," Robbins noted. "Obviously, the main question we are still trying to explain is why these five Asian groups had better survival. What is behind the 'Asian edge' in prostate cancer? Diet? Lower comorbidity? Less overweight/obesity?"

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Protein may aid prostate cancer victims- (Cambridge- 20/7/2006)

CAMBRIDGE, Mass., July 20 (UPI) -- Researchers at the Massachusetts Institute of Technology have learned a specific protein may hold the key to restricting the spread of prostate cancer.

A university cancer research team has found that Protein 4.1B can play an integral role in not only suppressing prostate cancer, but also predicting where forms of the disease may spread. The research team gathered its findings by injecting mice with prostate cancer tumors and compared the varied metastatic properties of its cells, a release said Friday.

That research prompted them to suppress Protein 4.1B in several poorly metastatic cells and those cells' ability to spread quickly grew. MIT professor Richard O. Hynes said those findings are likely similar in humans as low levels of that protein have been found in patients with metastatic prostate cancers. "Our findings show that Protein 4.1B loss is causally related to the progression of prostate cancer," Hynes said. "Although such a causal link has not yet been shown in other cancers, we also believe that Protein 4.1B is a more widely significant factor in metastasis in other cancers than has been realized."

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Common gene link seen between prostate and colorectal cancer- (ET- 8/7/2006)

A combination of genetic variants that boosts the risk of prostate cancer also increases the risk of colorectal cancer, according to papers published on Sunday in the journal Nature Genetics. The mutations lie on Chromosome 8, say three groups of scientists who compared the DNA of thousands of healthy individuals with that of other people who had one or both kinds of the cancer.

Colorectal cancer is the fourth deadliest form of cancer, according to the World Health Organisation (WHO). Cancer of the bowel and rectum inflicts 655,000 deaths per year, after cancer of lung (1.3 million deaths), the stomach (one million), and liver (662,000), the WHO website says. Colorectal cancer has been previously linked to a small number of relatively rare genetic mutations, as well as to lifestyle habits, such as smoking, a diet high in fat and low in fruit and vegetables. This is the first evidence for a common genetic risk factor with another cancer type. Genetic "signatures" of susceptibility to cancer can be used to help doctors advise people at risk, counselling them for instance to get frequent screenings and avoid risky activities. They also open up potential paths for drugs to block or reverse the workings of the flawed gene.

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Diet could be life or death for prostate cancer patients-(ET- 21/6/2006) 

Switching to a healthy diet rich in fish and nuts could be the difference between living or dying for men prone to to prostate cancer, new US research indicates. A study published in the online edition of the Journal of Clinical Investigation found that omega-3 fatty acids found in the foods may improve the prognosis for men with a genetic predisposition to the condition.

Working with mice genetically engineered to develop prostate tumors, scientists fed some of the mice a diet high in omega-3 fatty acids from birth. These mice had fewer tumors and a longer life span than those not fed the diet. Survival was 60 percent in mice fed a high omega-3 diet, 10 percent in mice on a low omega-3 diet and zero percent in mice fed a diet high in omega-6, a different type of polyunsaturated fatty acid found in vegetable oils.

In normal mice not engineered for prostate cancer, all survived regardless of diet, according to the study funded by the National Institutes of Health. Dietary sources of omega-3 fatty acids include cold water fish such as salmon, halibut, tuna, sardines and mackerel, and fish oil such as cod liver oil. English walnuts and flaxseeds also contain omega-3s. "This study clearly shows that diet can tip the balance toward a good or bad outcome," said Yong Q. Chen, senior researcher at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

"It's possible that a change in diet could mean the difference between dying from the disease and surviving with it." Taking a recommended daily dose of omega-3s can reduce risk of cardiovascular disease and lower blood pressure slightly, previous studies have shown. High doses may have a harmful effect, such as excess bleeding, according to the National Institutes of Health.

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Prostate cancer is among the leading causes of cancer death in men- (Yahoo News- 11/6/2006)
 
Prostate Cancer is the most frequently diagnosed cancer in men. More than 218,000 men will be diagnosed with prostate cancer this year alone, and more than 27,000 will die. June is Prostate Cancer Awareness Month, and with Father's Day approaching, it's a great time think about the ways men can keep their prostates healthy and be proactive about cancer prevention. "Prostate cancer and problems urinating caused by benign prostatic enlargement affect the vast majority of men as they age," said Dr. Christopher Saigal, an assistant professor of urology and a researcher at UCLA's Jonsson Cancer Center. "It makes sense to do what you can to avoid a foreseeable problem with your health".

-- Maintain a healthy weight and exercise regularly.

-- Eat five or more servings of fruits and vegetables every day. Tomatoes, watermelons, pink grapefruits, guava and papaya contain lycopene, a powerful antioxidant, and have been touted as prostate healthy. Cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale also are good choices.

-- Limit your intake of red meat, especially high-fat or processed meats, and limit your intake of high-fat dairy products.

-- Tell your doctor if you have a family history of prostate cancer. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease.

-- Include more soy in your diet from sources such as tofu, soy nuts or soy flour or powders.

-- Avoid tobacco and alcohol.

-- Include in your diet selenium-rich foods such as wheat germ, tuna, herring and other seafood and shellfish, beef liver, kidney, eggs, sunflower and sesame seeds, cashews, mushrooms, garlic and onions. Selenium reduces risk of prostate cancer.

-- Get screened. PSA blood test and digital rectal exams are recommended annually, beginning at age 50. Men at high risk, such as African American men or men with a strong family history of prostate cancer should begin testing at age 45.

UCLA's Jonsson Comprehensive Cancer Center comprises more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2006, the Jonsson Cancer Center was named the best cancer center in California by U.S. News & World Report, a ranking it has held for seven consecutive years.

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Vitamins May Not Prevent Prostate Cancer (ET- 15/2/2006)

WASHINGTON - Taking the vitamins E and C or the nutrient beta-carotene doesn't protect against prostate cancer, says the latest study in the continuing, confusing quest to determine when supplements really help health. The government research, published Tuesday in the Journal of the National Cancer Institute, is among many large studies examining whether these antioxidants play a role in prostate cancer when taken as pills — instead of when they're consumed as part of an overall healthy diet.

Previous research has yielded conflicting results, and even this new study of almost 30,000 men doesn't settle the issue. Indeed, while vitamin E showed no effect on men overall, the study leaves open the possibility that it might help smokers. The men were enrolled in an NCI study whose primary aim is to test the value of screening tests for prostate cancer. They also were surveyed about their diet and what supplements they took — relying on memory, not nearly as precise as other research now under way that controls supplement doses.

Some 1,338 men were diagnosed with prostate cancer within eight years of entering the study. Supplement users were just as likely to be diagnosed as nonusers. Smokers were 71 percent less likely to be diagnosed with advanced disease if they had taken high doses of vitamin E for many years. But, perplexingly, the risk of earlier-stage cancer increased among vitamin E-using smokers. Smoking itself raises the risk of prostate cancer, and even if further research concludes that vitamin E somehow tempers that risk, kicking the habit would be far more protective, Harvard University scientists caution in an accompanying editorial.

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Prostate cancer hormone therapy triggers bone loss- (ET-21/12/2005) 

NEW YORK (Reuters Health) - Men with advanced prostate cancer may be given therapy to stop their production of testosterone, which may drive tumor growth. However, androgen deprivation therapy, or ADT, appears to trigger a rapid loss of bone mineral density (BMD), researchers report. Dr. Susan L. Greenspan of the University of Pittsburgh and colleagues note in the Journal of Clinical Endocrinology and Metabolism that although bone loss is associated with ADT, little is known about when this may occur. To investigate further, the researchers studied 152 men with prostate cancer and healthy "controls." In all, 30 of the cancer patients had had ADT for less than 6 months, 50 had received it for 6 months or more, and the remaining 72 were not receiving ADT.

At 12 months, depending on the site of measurement, BMD loss ranged from 1 to 4 percent in men recently started on ADT. In particular, the loss in BMD at the wrist was 3.3 percent in these patients compared to just 2 percent in those patients had been on therapy for longer. No significant reduction in BMD was seen in patients not undergoing ADT or controls.Because the rate of bone loss "is maximal in the first year after androgen suppression is initiated," the researchers suggest that drug therapy aimed at stopping the resorption of bone "may be most effective if prescribed during this period."

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Lean body mass may protect against prostate cancer-(ET- 14/12/2005)

A high lean body mass - calculated using an equation to determine body mass minus the fat -- may lower the risk of prostate cancer, a new study indicates. Prostate cancer is a hormone-related disease affected by a variety of other factors including genetics, age, ethnicity and family history. In the last few years, researchers started to suspect that body size might also affect the risk of prostate cancer, but research has provided conflicting results. Most studies investigated body mass index, but this index includes lean and fat tissue, which may have different influences on the risk of cancer.

In an attempt to settle things, Dr. John S. Witte from the University of California, San Francisco, and his colleagues conducted a study of 439 men with prostate cancer and 479 of their siblings without prostate cancer. They examined the effects of weight, height, body mass index, and lean body mass, which they thought might be more relevant than body mass index to the risk of prostate cancer and aggressiveness of the disease.

The researchers found that the higher the lean body mass, the lower the risk of prostate cancer, especially in men with more aggressive disease or who were older when their cancer was diagnosed. They also observed a similar, though weaker, inverse pattern for weight, but found no associations between risk of prostate cancer and body mass index or height. The investigators suspect that the inverse associations between higher lean body mass and prostate cancer risk may reflect the potentially protective effect of high levels of the male hormone androgen in patients with high lean body mass on the development and progression of prostate cancer.

Obesity increases risk of prostate cancer return extra pounds in midlife linked to recurrence of disease after surgery. Men who gain weight rapidly between the ages of 25 and 40 are twice as likely to experience a recurrence of prostate cancer after surgery as men who keep the pounds off, research suggests. Men who are obese at age 40 and at the time of prostate cancer diagnosis also have a higher risk of recurrence.“At any age, but especially in the adult population, keeping a healthy weight and diet will not only help prostate cancer patients to potentially reduce the chance of the cancer to recur, but will also reduce their risk of cardiovascular disease and diabetes,” Dr. Sara S. Strom from The University of Texas M.D. Anderson Cancer Center, Houston, told Reuters Health.

Strom and colleagues evaluated self-reported measures of obesity at different ages in a group of 526 prostate cancer patients treated with radical prostatectomy (removal of the prostate) in an effort to predict biochemical failure, which is the increase in PSA levels in the blood after removal of the prostate, the primary source of this protein. After removal of the prostate gland, the PSA level should be undetectable. Strom and colleagues report that men who were obese at the time of diagnosis had marginally higher rates of biochemical failure, but those who were obese at age 40 had significantly lower biochemical failure-free survival than did those who were not obese at age 40.

Obesity between age 25 and 40 was associated with more than a doubling of the biochemical failure risk, according to a report in the October 1st issue of Clinical Cancer Research, as was an annual weight gain in excess of about three and a half pounds per year between age 25 and the diagnosis of prostate cancer. Men who gained more weight since age 25 also experienced progression significantly sooner than those who gained weight more slowly or not at all, the researchers note. Strom said physicians need “to pay attention to the level of obesity of the patients and to reinforce the need for strict follow-ups to monitor the disease. In addition, (they need) to take weight gain and obesity into consideration when discussing the possibility/need of additional treatments.”

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'Robots helped treat my prostate cancer'-(CNN- 4/12/2005)

John Fox was diagnosed with prostate cancer two years ago. After researching different treatments on the Internet, he elected to have laproscopic radical prostatectomy surgery -- a procedure less intrusive than traditional treatments. Here is his story: In September 2003, I was diagnosed with prostate cancer at 50 years of age. All my life I'd been relatively healthy. After turning 50, I thought it would be prudent to have an overall physical exam. To my surprise, I had a serious problem that had not been evidenced by any symptoms.Faced with the prospect of battling cancer, I burned up the Internet seeking information regarding my options. My urologist at the time recommended the traditional route of a prostatectomy, a procedure fraught with negatives, including incontinence and impotence. Another option, although not recommended due my "young" age, was radial seeding.

In my research on the Internet, I discovered another option that had not been well publicized, and certainly wasn't an option discussed by my doctors at that time ---- LRPS. Laproscopic radical prostatectomy surgery is a procedure using micro surgical instruments inserted in the body via a few small incisions. The doctor is guided by a camera and is able to use great precision in performing surgery. The upside of this procedure is that it is relatively bloodless, less intrusive as there is not a large incision, and facilitates nerve-sparing procedures to reduce the risk of incontinence and impotence.Despite being a relatively new procedure with not much history, it sounded like a perfect solution. Recovery from this surgery is measured in a few weeks instead of months, the hospital stay is typically only one day versus five to seven days, the surgery is less intrusive and virtually bloodless, and the risk of nerve damage resulting in incontinence and/or impotence is greatly reduced.

As a technologist (and occasional poker player), I decided this was the right solution for me. I found two doctors in northern New Jersey, 20 minutes from my home. Dr. Esposito was having much success with this procedure. In fact, they had improved the LRPS procedure by using a newer technology called the Da Vinci system. This system leverages LRPS and uses robotics to ensure greater precision in execution of the surgery. As an example, using this system they're able to use a much higher number of stitches than humanly possible when reconnecting the urethra. The precision also helps with nerve-sparing techniques.

In my case, the procedure was remarkably successful. One day after surgery, I walked out of the hospital. Except for a few uncomfortable days with a catheter in place and two to three weeks of limited incontinence, all is well. Technology saved my life on two fronts. First, access to information on the Web increased my awareness about my options and prior patients' experiences. I became aware of LRPS and of outstanding doctors who were using this procedure only six miles from my home. Secondly, the Da Vinci system that employs robotics in laproscopic surgery reduced my recovery time and significantly mitigated the downside risks of surgery. While technology helped me to live a longer and more productive life, I'd be remiss in not recognizing the outstanding skills of Doctor Michael Esposito, my urologist.

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Low PSA may not rule out prostate cancer-(ET-  28/11/2005)

 Even if patients have relatively low prostate specific antigen (PSA) levels, a biological marker for the disease, abnormalities detected by digital rectal examination (DRE) can help identify prostate cancer, re-enforcing the importance of this procedure, new study findings suggest. Some doctors believe the use of DRE in patients with low serum PSA levels - lower than 4 ng/mL - is not necessary.

To further investigate, Dr. Caleb B. Bozeman and colleagues at Louisiana State University Health Sciences Center in Shreveport identified 916 patients with abnormal DRE findings and a PSA level lower than 4.0 ng/mL. Most patients underwent standard rectal biopsies. According to the team's paper, published in the medical journal Urology, prostate cancer was diagnosed in 81 men, or 8.8 percent. The investigators found that the predictive value of the DRE increased as PSA levels increased, with cancer detected in 1.8 percent of those with levels between 0.0 and 0.9 ng/mL, versus 21 percent among those with levels between 3.0 and 3.9 ng/mL.

Age was also a significant predictor, with cancer diagnosed among 5.4 percent of those younger than 50 years and among 11.3 percent older than 70 years. The authors also noted that during surgery, 19 percent of the prostate cancers were diagnosed on the side opposite the original abnormality, defined as "serendipitous detection." "Our study found that the abnormality on the DRE in patients diagnosed with prostate cancer was most likely to represent cancer and thus, in most patients, cancer was not diagnosed serendipitously," Bozeman and his associates write. However, they add, "one could argue that patients with abnormal DRE findings and a serum PSA less than 2.0 ng/mL could simply be followed up closely and do not require a prostate biopsy."

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Protein Signals Aggressive Prostate Cancer  -(ET- 19/08/2005)

Testing prostate tumor tissue for activated Stat5 protein can help identify men with an aggressive form of the cancer. That's the conclusion of a study in the Aug. 15 issue of Clinical Cancer Research.Researchers at the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C., analyzed prostate cancer tissue from 357 men and matched the Stat5 levels in those samples to the men's outcomes.

They found that the presence of Stat5 protein in the nucleus of prostate cancer cells was a significant predictor of when men would develop a recurrence of aggressive prostate cancer years after their initial treatment for the disease. When activated, Stat5 signals cancer cells to grow and survive, the researchers said. Testing for Stat5 levels in prostate cancer patients may help doctors better target treatment, the study authors said. "Most patients diagnosed with prostate cancer have slow-growing tumors that don't need aggressive therapy, but doctors do not have a way to identify the few men whose cancer is potentially dangerous. The result is that many patients are over-treated," study principal investigator Dr. Marja Nevalainen, an assistant professor in the department of oncology, said in a prepared statement. "If future studies with Stat5 continue to show that it can help in predicting disease outcome, then we can test tumor biopsy samples for Stat5 and tailor treatment accordingly," Nevalainen said.
 

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