The prostate-specific antigen (PSA) test used for cancer screening is anything but perfect, which is why the American Cancer Society advises men to carefully weigh the test’s risks and benefits.

Still, we do know that in general (though not always), a lower PSA score is associated with a lower risk of aggressive cancer. Researchers wanted to know what happens to men who are diagnosed with cancer but have relatively low PSA levels — 4.0 ng/mL or less. They found that 54% of those men had low-risk disease, as measured by that PSA reading, stage of the cancer, and Gleason score.

But more than 75% of them received aggressive treatment — a radical prostatectomy or radiation therapy. And men whose cancer was found via PSA screening were 49% more likely to receive that surgery and 39% more likely to have radiation than men whose cancer was detected in other ways — even though they were less likely to have high-grade disease.

In other words, screening with the PSA test seems to be associated with relatively aggressive treatment, even for men who are statistically at low risk of a life-threatening cancer. “These results underscore the fact that PSA level, the current biomarker, is not a sufficient basis for treatment decisions,” the authors write, adding that if the PSA threshold for a recommended biopsy was lowered further, there would  be many more men receiving potentially unnecessary treatments.

The study is published in the Archives of Internal Medicine.

Of course, statistics can be reassuring, but they won’t guarantee that a man’s cancer will be slow-growing and not dangerous. “The message isn’t, ‘You shouldn’t treat them all,’ but that we need to be individualized” about treatment decisions,” says Robert DiPaola, one of the study’s authors, the director of The Cancer Institute of New Jersey and associate dean for oncology programs at UMDNJ-Robert Wood Johnson Medical School. Ultimately we need additional research on how the molecular pathways and genetics of a particular man’s tumor predict its fate, he says.

For now, discussions between a man and his doctor over whether to get a biopsy or whether to treat non-aggressive cancer need to include what we do and do not know about the statistics, and that ultimately, “we can’t totally predict where he’ll fall,” DiPaola tells the Health Blog.

In the meantime, says DiPaola, at his own institution, “we’re seeing more and more patients who are wanting to consider the option of active surveillance.” An editorial (sub. required) accompanying the study suggests that “active surveillance is a reasonable strategy for men with low-risk localized disease.” The editorial’s co-authors conclude that:

As we enter the third decade of the PSA era, the health care challenge is now to mitigate the harms of overdiagnosis and overtreatment by developing and implementing strategies to minimize  screening among those with limited life expectancies, to increase the uptake of active surveillance, and to discover biomarkers that better identify the patients most likely to benefit from treatment.

Source: The Wall Street Journal

Popularity: 3% [?]

The various forms of prostate cancer treatment — from surgery to radiation to hormones — can all have long-term effects on men’s quality of life when it comes to sexual function and urinary problems, a new study finds.

On the other hand, researchers found, none of the treatments seemed to have strong effects on men’s overall quality of life — including energy levels, pain, emotional well-being and ability to perform day-to-day physical tasks, like walking, climbing stairs and carrying groceries.

The findings, reported in the Journal of Urology, are based on 1,269 U.S. men who were followed for four years after treatment for earlier-stage prostate cancer.

The majority — 60 percent — underwent radical prostatectomy, surgical removal of the prostate gland. Another 17 percent had brachytherapy, an internal form of radiation therapy in which radioactive “seeds” are implanted in the prostate gland, and 12 percent had externally delivered radiation.

Another 6 percent of patients had a combination of the two radiation therapies, and five percent were treated with drugs that block the male hormones that feed prostate cancer growth.

It’s well known that all of these treatments can cause erectile dysfunction, and that surgery and radiation often lead to urinary incontinence. But much less has been known about how these problems affect men’s quality of life in the long run, according to the researchers, led by Dr. George J. Huang of the University of Pittsburgh School of Medicine.

The issue is important because while prostate cancer is one of the most common cancers in men, affecting about 160 per 100,000 every year and killing 26 of those 100,000, most tumors grow slowly and never cause any harm.

In this study, the researchers found that, in general, men who had surgery or any form of radiation saw their urinary symptoms worsen in the first year after treatment, based on their responses to standard quality-of-life questionnaires. As a group, surgery patients had the most problems.

Then, in the second year after treatment, the surgery and radiation groups all showed a general improvement in urinary symptoms — though they did not fully return to their pre-treatment quality-of-life ratings. The extent to which the men were “bothered” by their urinary problems also waned, moving close to their pre-treatment ratings.

Men who underwent hormone therapy showed a different pattern: they tended to report a gradual, moderate worsening in their urinary function over four years.

The finding, Huang and his colleagues write, is somewhat surprising and the reason for it is not clear. They speculate that hormonal therapy may have effects on the pelvic muscles and urinary tract that, over time, can create urinary problems — in a manner similar to the way natural estrogen declines can affect women’s urinary continence after menopause.

When it came to sexual function, all of the treatment groups reported declines in the first year after treatment — with the steepest drop seen among surgery patients. However, surgery patients also showed an improvement over the second year, whereas the other treatment groups did not — such that men who had surgery were faring similarly to other men at the end of the study period.

In addition, while men in all of the treatment groups tended to say they were more bothered by sexual problems after treatment than before, their “bother scores” declined less than their objective ratings of sexual function.

“This finding,” Huang and his colleagues write, “provides indirect evidence suggesting that while erectile dysfunction may be common, patients seem to adjust to these changes.”

And when it came to men’s ratings of their overall quality of life, none of the prostate cancer treatments seemed to have a significant impact.

“All treatment types,” the researchers write, “adversely impact urinary and sexual function but do not appear to significantly impact the overall sense of well-being.”

The decision over the type of prostate cancer therapy to pursue must be made on an individual basis, by men and their doctors. But knowing what to generally expect in terms of long-term quality of life can help in guiding those decisions, the researchers say.

Source: Reuters

Popularity: 3% [?]

Firm claims urology-focused acquisition will transform it from pharma company to diversified physician partner.

Endo Pharmaceuticals is buying urological products and services firm HealthTronics for $223 million in cash plus the assumption of around $35 million in debt. Endo said the acquisition will provide it with new urology products including benign prostatic hyperplasia and prostate cancer therapies, as well as lithotripsy and anatomical pathology services for the diagnosis and detection of cancer and other diseases.

Endo focuses on the research, development, sale, and marketing of branded and generic prescription pharmaceuticals for the treatment and management of pain, bladder cancer, prostate cancer, and the early onset of puberty in children.

The firm said that acquiring HealthTronics will diversify its revenue base and boost its position as a provider of multiple medical solutions and delivery mechanisms in urology. “This strategic acquisition immediately elevates Endo from a pharmaceutical company to a diversified partner to physicians and payers in the treatment and diagnosis of urological and pain-related conditions,” stated Dave Holveck, president and CEO.

Source: GEN

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During Celgene’s R&D day tomorrow–the first it has hosted in five years–the developer will attempt to show analysts that it has a promising drug pipeline beyond Revlimid, its top-selling multiple myeloma drug. Revlimid and its predecessor drug Thalomid accounted for almost 80 percent of the biotech’s sales last year. Specifically, Reuters says Celgene will detail its programs for “lung cancer; chemotherapy-induced anemia; multiple myeloma; Crohn’s disease, a gastrointestinal disorder; psoriasis, a skin disorder; and psoriatic arthritis.”

Analysts are also waiting to see if Celgene will produce data supporting Revlimid as a maintenance treatment for multiple myeloma. That could boost the drug’s sales from $1.7 billion in 2009 to $3.8 billion by 2013. The drug is also in clinical trials for chronic lymphocytic leukemia, non-Hodgkin’s lymphoma, prostate cancer and colorectal cancer.

Source: FierceBiotech

Popularity: 3% [?]

A drug already used in men with enlarged prostates seems to cut the risk of prostate cancer developing, a large international study has shown.

A four-year trial in more than 6,500 men found those who took dutasteride had a 23% lower risk of prostate cancer than those who took a dummy pill.

The men in the study, published in the New England Journal of Medicine, were all at high risk of the disease.

UK experts welcomed the results but said longer-term research was needed.

It is not the first time that this class of drugs has been found to have potential effects on the prevention of prostate cancer.

In 2003, researchers showed a similar drug, finasteride, cut the risk of prostate cancer by a quarter in healthy men but also found that the tumours that were detected were more aggressive.

Both drugs are prescribed in men who have an enlarged but benign prostate gland – an extremely common condition that happens with age and can cause symptoms such as frequent and painful urination.

High-risk patients

The latest trial, which was funded by GlaxoSmithKline which makes dutasteride, looked at men aged between 50 and 75 years who were high risk for prostate cancer because they had high PSA scores – a blood test which may indicate disease – but had been found not to have prostate cancer.

They were treated with a daily dose of dutasteride or a dummy pill.

Over the study, prostate cancer was found in 659 of the men taking the drug and 858 of the men taking a placebo.

Among men with a family history of prostate cancer, the drug reduced the relative risk of a prostate cancer diagnosis by 31.4%.

The researchers believe that most of the tumours detected during the trial – which tended to be moderately aggressive – would have been present from the beginning but were too small to be detected.

They say this supports the idea that the drug shrinks early prostate tumours or prevents them from growing to a size at which they would be detected and need treatment.

Study leader Dr Gerald Andriole, chief of urologic surgery at Washington University School of Medicine, said the drug might potentially offer thousands of men a chance to reduce their risk of the disease.

“This means more men could avoid unnecessary treatment for prostate cancer along with the costs and harmful side effects that can occur with treatment.”

The National Institute for Health and Clinical Excellence (NICE) are already looking into whether dutasteride should be used for prostate cancer prevention and are due to report later this year.

Martin Ledwick, Cancer Research UK’s head information nurse, said the results in the high risk population were interesting.

But he added: “Further research to see if the effects are maintained in the longer term is an important next step.”

Dr Helen Rippon, head of research management at The Prostate Cancer Charity, agreed: “Of course, we don’t yet know what will happen to these men in the coming years and whether they will still go on to develop the disease and it will be many years before we know if the drug can provide any long-term benefit to men.”

Source: BBC NEWS

Popularity: 4% [?]

Infertile men may have a higher risk of developing prostate cancer, US data suggests.

Researchers looked at the cancer records of men attending infertility clinics in California.

They found men unable to father a child were nearly three times more likely to be diagnosed with prostate cancer than normal.

The authors of the study, published in the journal Cancer, say more work must be done to confirm the possible link.

If confirmed, it might be appropriate for infertile men to be given early prostate cancer screening, they say.

Study leader, Dr Thomas Walsh of the University of Washington in Seattle said: “These are some of the first data to suggest that male reproductive health in early life may be a risk factor for serious malignant disease in later life.

“It is important for investigators and physicians to do further research to find out what might be the common underlying cause that may lead to both infertility and later the development of prostate cancer.”

Risk factors

Prostate cancer is the most common cancer in men. Risk factors include age, family

More recently, it has been suggested that fatherhood status might be linked with prostate cancer but studies have shown conflicting results.

The new study looked at the risk of prostate cancer in 22,562 men checked for infertility in 15 clinics in California between 1967 to 1998.

About 4,500 of these men were found to have male infertility – and 19 went on to develop the most aggressive form of prostate cancer.

In a similar sample of men in the general population, 16 men were diagnosed with the high risk form of the disease.

Overall, infertile men were found to be 2.6 times more likely to be diagnosed with the most aggressive form of prostate cancer.

Genetic clues

But Dr Helen Rippon, head of research management at The Prostate Cancer Charity, said with such small numbers of men affected, it is difficult to draw any firm conclusions about whether the suggested link does exist.

She said: “This potential new risk factor would need to be backed up by further, large scale studies before any recommendations can be made about targeting early screening for prostate cancer at men with fertility problems.”

Ed Yong, head of health evidence and information at Cancer Research UK, said: “It’s unlikely that being infertile directly leads to prostate cancer.

“Instead, both infertility and a higher risk of prostate cancer might stem from a common genetic fault, or some aspect of our lifestyle or environment.”

Source: BBC NEWS

Popularity: 4% [?]

The most commonly used tool for detecting prostate cancer, routine PSA screening, has become “a hugely expensive public health disaster,” its discoverer said on Wednesday.

Dr. Richard Ablin of the University of Arizona joined the ongoing debate over the blood test, saying the screening procedure is too costly and ineffective.

“I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster,” Ablin wrote in a commentary for The New York Times.

Ablin said that as Congress searches for ways to cut costs in the U.S. health care system, a significant savings could come from changing the way PSA is used.

“The test’s popularity has led to a hugely expensive public health disaster,” he wrote.

He said the annual bill for PSA screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

“As I’ve been trying to make clear for many years now, PSA testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t,” he wrote.

“Instead, the test simply reveals how much of the prostate antigen a man has in his blood.”

Prostate cancer is the second most common cancer in men worldwide after lung cancer, killing 254,000 men a year.

PSA is a protein made only by prostate cells, and levels can shoot up as a prostate tumor proliferates. But levels can also rise as the prostate naturally enlarges with age.

A high PSA reading is usually followed by a biopsy, which is a sample of the prostate tissue taken and examined for signs of a tumor.

SLOWLY TURNING AGAINST

Doctors have routinely recommended PSA tests to men over 50 in the belief that early diagnosis and aggressive treatment for any cancer is better than standing by and doing nothing.

But prostate cancer can often be a slow-growing tumor and men will often die of something else before the cancer becomes dangerous.

Prostate cancer treatments, including surgery or radiation, can cause incontinence and erectile dysfunction in about a third of patients. Many men also experience bowel problems.

Citing recent studies and reversals of some early screening proponents, Ablin said the medical community is slowly turning against PSA screening.

“So why is it still used? Because drug companies continue peddling the tests and advocacy groups push ‘prostate cancer awareness’ by encouraging men to get screened,” Ablin wrote.

Ablin said PSA testing does have a place, after treatment for prostate cancer and for men with a family history of prostate cancer.

“Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit,” Ablin wrote.

He urged the medical community to “confront reality and stop the inappropriate use of PSA screening.”

Source: Reuters

Popularity: 2% [?]

New research suggests that the type of specialist a prostate cancer patient sees — rather than the patient’s own preference — may determine the treatment he receives.

This is problematic, the study’s authors say, because none of the options now available for treating localized prostate cancer have been shown to be any better than the others.

“The different treatments for prostate cancer…entail different side effects, different recovery profiles, and they require different time commitments,” Dr. Thomas L. Jang of The Cancer Institute of New Jersey in New Brunswick, one of the study’s authors, told Reuters Health. For this reason, he and his colleagues say, it should be the patient’s preferences — rather than the physician’s specialty — that guides treatment decisions.

Current options available for treating prostate cancer that has not spread include watchful waiting, in which a patient receives no treatment but is monitored closely; hormone therapy; radiation therapy; or surgery to remove the prostate. Radiation and surgery both carry the risk of urinary incontinence and impotence; hormone therapy can cause hot flashes, breast tenderness, and loss of sex drive; while watchful waiting may lead to anxiety in men who fear their cancer will spread.

Surveys have suggested that specialists are more likely to recommend the type of treatment they provide; for example, radiation oncologists prefer radiation therapy, while urologists choose surgery.

To investigate whether the type of physician a prostate cancer saw would actually influence the type of treatment he got, Jang and his team looked at Medicare data on more than 85,000 men 65 and older diagnosed between 1994 and 2002 with localized prostate cancer. Within nine months of diagnosis, 21 percent had undergone prostate removal; 42 percent had radiation; 17 percent had hormone therapy; and 20 percent watchful waiting. Jang conducted the study, which is published in the Archives of Internal Medicine, while at Memorial-Sloan Kettering Cancer Center in New York City.

Half of the men had only seen a urologist, while 44 percent had seen a radiation oncologist and a urologist, 3 percent had seen a urologist and a medical oncologist, and 3 percent had seen all three specialists.

One-third of the men who had only seen a urologist underwent prostate surgery, and surgery was the most common treatment for the men who were 65 to 74 years old and only saw a urologist. However, among men of any age who saw a radiation oncologist as well as a urologist, radiation therapy was the most common treatment; 83 percent of these men received radiation therapy.

And men who had been seen by a urologist and a medical oncologist, or a urologist only, were more likely to receive watchful waiting or hormone therapy than men who had seen both urologists and radiation oncologists.

Only about one in five men saw their primary care physician after their diagnosis of prostate cancer and before they received treatment (or within nine months of diagnosis). Nearly 60 percent of these men received watchful waiting, compared to 7 percent of men who hadn’t seen their primary care doctor.

When the researchers looked at individual urologists who had cared for at least 10 of the study participants, they found sharp doctor-to-doctor differences in whether a patient was referred to a radiation oncologists; some urologists frequently made these referrals, while others did so much less often.

Men newly diagnosed with prostate cancer face “a lot of confusion,” Jang noted, because there are so many treatment options available. “The physician who is providing the counseling for these patients should go to great lengths to provide a balanced perspective, an unbiased perspective, on these treatment options.”

And if patients don’t feel they are getting unbiased advice, Jang added, they should get a second opinion. “It’s really our responsibility to provide these men with every single available treatment option.”

SOURCE: Archives of Internal Medicine, March 8, 2010.

Popularity: 2% [?]

The American Cancer Society put out updated guidelines for prostate cancer screening today and they look, well, a lot like the current ones.

After reviewing the recent scientific literature, there’s still no evidence that routine screening for men of any age makes sense, according to the committee that issued the guidelines.

They continue to recommend that men of average risk receive information and weigh the “uncertainties, risks, and potential benefits” of screening starting at age 50. Higher-risk individuals — African-Americans or those with one relative diagnosed with prostate cancer before age 65 — should be presented with the information at age 45. Men with a strong family history should start thinking about screening at age 40.

The group also emphasizes the importance of joint decision-making between the patient and his doctor about whether to be screened for prostate cancer. Men don’t always get the information they need to make such decisions about prostate screening, according to the cancer society and findings from other studies.

“Men without access to regular care should not be tested unless high-quality informed decision-making as well as appropriate counseling and follow-up care for those who test positive can be assured,” Otis Brawley, chief medical officer of the American Cancer Society said in a statement. “Without those, community-based screening should not be initiated.”

Prostate cancer screening has long been debated. That’s because screening for slow-growing diseases, like prostate cancer tends to be, may lead to unnecessary treatment.

Source: The Wall Street Journal

Popularity: 3% [?]

A mid-stage trial for abiraterone–an oral drug which inspired a billion-dollar buyout less than a year ago –has produced another set of promising results for men with advanced, treatment-resistant prostate cancer.

For most of the 47 men recruited for the Phase II trial, the cancer had already spread to the bone. All of the patients had received hormone therapy as well as chemotherapy but were no longer responding to standard treatment. About half of the men saw their PSA levels drop by half, a key biomarker for disease activity. And three out of four of the patients experienced a drop in the number of tumor cells circulating in the blood.

“Docetaxel is an important drug, but it extends life for an average of just two to three months, so there is a desperate need to improve treatment options for late-stage prostate cancer patients,” said chief investigator Dr. Johann de Bono. “In this trial, abiraterone shrank or stabilized men’s cancers for an average of almost six months, which is a very impressive result.”

Scientists at the UK’s Cancer Research UK and the Institute for Cancer Research at London’s Royal Marsden Hospital have been studying the drug closely. Two years ago researchers said that the therapy was responsible for shrinking tumors in 80 percent of the men taking it.  Johnson & Johnson acquired the drug when it bought out Cougar Biotechnology last year for $970 million. And Cougar had licensed the drug from BTG.

Source: FierceBiotech

Popularity: 3% [?]