News in Brief
Putting pen to paper, or fingers to keyboard, and pouring out inner thoughts seems to improve several quality of life aspects for cancer patients, according to a recent study published in the Journal of Clinical Oncology. In the study, 277 recently diagnosed renal carcinoma patients were randomly asked to write either about neutral topics, or about their deepest thoughts and emotions regarding their cancer experience, on four separate occasions over ten days. Multiple measures of quality of life were assessed over the following ten months. At the end of the ten months, patients who did the soul-baring exercise had improved cancer symptoms, physical functioning, and possibly less fatigue, than patients who wrote on neutral topics.Expressive writing helped both men and women, regardless of individual coping mechanisms and social support. How exactly this Tolstoy effect helps is not fully clear, but an area of the brain involved in soothing emotional distress also plays a part in emotional language. Intrusive thoughts and avoidance behaviors can have negative effects on the immune and endocrine systems, which can worsen cancer-related symptoms. Giving those thoughts an outlet may decrease stress, which in turn can impact health. Depression and stress often occur together, and depression has been linked to shorter survival times for cancer patients. While this finding was not investigated specifically for men with prostate cancer, buying a notebook and finding some quiet time to reflect, might be a good idea.
In a study published in The Lancet Oncology, researchers from the United Kingdom, New Zealand and Australia report that having an additional five rounds of radiotherapy at a slightly higher dose delayed the time to disease progression in men initially treated for localized prostate cancer with conformal radiotherapy—a type of external beam radiotherapy—and concurrent (neoadjuvant) hormone therapy. At 10 years of follow-up, 55% of men who received the “escalated” dose radiotherapy had stable disease, compared to only 43% of the men who had received fewer sessions at lower doses. Salvage hormone therapy, initiated to control recurrent disease, was lower in the escalated-dose group as well—at 10 years, men in this group were 24% less likely to need this follow-up hormone therapy. The researchers had previously reported similar results of this Phase III randomized controlled trial at five years of follow-up. The study authors currently note that: “This advantage of reducing or delaying the initiation of long-term [hormone therapy], which is associated with well-documented andropausal side-effects, must be balanced against the known small increase in bowel side-effects from the five extra treatments in the escalated-dose group, which we and others have reported.
Researchers Report Testosterone Replacement Therapy is Safe
The male hormone testosterone is considered the fuel for prostate cancer initiation and progression. Thus, is it not surprising that some men who have been on testosterone replacement therapy (TRT) and are later given a diagnosis of prostate cancer have wondered if there is a connection between the treatment and their disease. A recent study of hypogonadal men on TRT found no evidence of an increased risk of prostate cancer. “Our evidence suggests that long-term testosterone replacement therapy in hypogonadal men is safe, provided that proper monitoring according to the guideline is performed,” said Farid Saad, PhD, DVM, the first author of two related studies. “The majority of men we studied were overweight or obese, so losing weight wasn’t deleterious for them.” The data from the studies were released at the American Society of Andrology’s 2013 meeting and reported this week in Renal and Urology News.
Statins May Reduce Prostate Cancer Deaths
The role of statins in mitigating prostate cancer risks has been debated often during the past few years. Now a new study out of the Fred Hutchinson Cancer Research Center in Seattle, and published today in The Prostate, reports that men with prostate cancer who take cholesterol-lowering statins are significantly less likely to die from their cancer than men who don’t take statins. The study followed almost 1,000 men; 30 percent reported taking statins to control their cholesterol levels. In an eight year follow-up, researchers discovered that the risk of death from prostate cancer among those who took statins was 1 percent compared to 5 percent for nonusers. The study was led by PCF-funded researcher Janet Stanford, PhD. “If the results of our study are validated in other patient cohorts with extended follow-up for cause-specific death, an intervention trial of statin drugs in prostate cancer patients may be justified,” says Stanford.
Xtandi Passes First Gate in EU Approval Process
Xtandi (enzalutamide) has been given its first nod of approval in the European Union. The novel drug, a once-daily oral inhibitor of androgen receptor signaling—a key driver in prostate cancer progression— was recommended by the European Medicines Agency for approval by the European Commission (EC) this week. Xtandi is recommended for treatment of men with metastatic castration-resistant prostate cancer whose disease has progressed during or after chemotherapy. The drug was approved by the U.S. Food and Drug Administration in August 2012. The R&D period for Xtandi was a relatively short nine years from original idea through clinical trials. PCF invested $14.75 million in research to forward the drug’s development and move into the clinic. The Prostate Cancer Clinical trials Consortium, funded in part by PCF, helped accelerate the drug’s approval for patients. Final decisions by the EC usually occur within 60 days of the EMA’s recommendation for approval.
Pee-to-Play Game Streams Awareness Message to Baseball Fans
When it comes to healthcare messages, it takes innovation and some base humor to reach men. Now the Phillies’ AAA minor league team, the Lehigh Valley Iron Pigs, has hit the proverbial nail not on, but in the head, so to speak. When the baseball season begins next week, screens installed above one urinal in each of the ballpark’s men’s room will display a downhill snowmobile competition. How to play? Simply directing the user’s stream left or right will move the driver in that direction. The game screens will display information on prostate cancer when the game is not in action. Players will be given a score at the end of their game and high scorers (names only) will be displayed in real time on video boards inside the park. Players will also be ranked and recognized on the team’s website. The urinal gaming system is already in use in the U.K.
Another Step Forward for Precision Medicine
Oxford University announced this week that the first-multi-gene test that can help predict cancer patients’ responses to treatment using the latest DNA sequencing techniques has been launched by the country’s National Health System. Oxford scientists are the first to make such a multi-gene test possible in the NHS. The current test looks for mutations in 46 genes and there is hope of soon verifying the test with 150 genes. The test requires a very small amount of DNA (5 nanograms) and can detect mutations present in only 5% of the tumor cells present, making it more precise that other current technologies. The £300 test could reduce drug costs by placing patients on the right treatments and reducing the time needed to prescribe the right treatment. It can also spare patients from unnecessary side effects.
U.S. Cancer Survivors Increasing
According to a report from the American Cancer Society and the NCI, the number of U.S. cancer survivors is rising: projected to increase by a third by 2022. The study states that while the incidence of cancer is decreasing, the number of survivors is on the rise with the aging American population. Nearly 50% of U.S. survivors are 70 or older while a mere 5% are 40 or older. Almost two-thirds of the survivors were diagnosed 5 or more years ago, while 15% were diagnosed 20 or more years ago. “Many survivors… must cope with the long-term effects of treatment as well as psychological concerns such as fear of recurrence,” said Elizabeth R. Ward, senior author. “It is vital that healthcare providers are aware of the special needs of cancer patients and caregivers.” The most common cancers among men living with the disease are prostate, colorectal and melanoma.
Deciphering the African-American Disparity
African-American men continue to bear a disproportionate prostate cancer burden, compared to European-American men. They are 60% more likely to be diagnosed with the disease, have earlier disease onset and an increased proportion of advanced disease, bone metastases and death. Researchers at Detroit’s Wayne State University recently studied 639 tumor samples; 270 were from African Americans and 369 from European Americans. They identified key genes that impact PCa aggressiveness, recurrence, mortality and disparities: 95 genes were overexpressed specifically in African-American prostate cases compared to Caucasians and 132 were over expressed in the European-American samples. The results highlight the potential for identifying molecular differences between prostate cancer in the two population groups and designing better treatments targeted to the cancer subtypes and molecular differences.
Norwegian drug maker, Algeta reports that Alpharadin (Radium-223) can now be made available to U.S. prostate cancer patients in a serious condition and who are unable to participate in a controlled clinical trial. Access will administered by Algeta’s partner, Bayer. Alpharadin is designed to treat prostate cancer bone metastases which can lead to spinal-cord compression, paralysis and bladder dysfunction. Studies show that the drug significantly delays the time to a first skeletal-related event. By carrying microscopic amounts of radium, Alpharadin enters a patient’s bone and disperses small amounts of radiation, attacking the prostate cancer. The Prostate Cancer Foundation was the first to fund the proof of concept of alpha-pharmaceuticals at University of Texas MD Anderson Cancer Center through Dr. Christopher J. Logothetis. This first of its kind drug was granted Fast Track designation by the U.S. Food and Drug Administration (FDA) in August 2011.
Prostate Cancer Champions, Tester, Blunt, Team Up to Battle Prostate Cancer
Senators Roy Blunt (Mo.-R) and Jon Tester (Mont.-D) are introducing the Prostate Cancer Act to streamline and expand prostate cancer research supported by the federal government. The measure would strengthen research on improvements to current screening tests and develop methods to distinguish between different forms of prostate cancer. The legislation would also establish an interagency task force to eliminate duplication of work between agencies in the field of prostate cancer research and treatment. Blunt, a three-time cancer survivor, stressed the need to spend federal dollars wisely on prostate cancer research and education. The Act also establishes tele-health projects in rural areas and communities with high veterans populations to boost efficient use of specialist care and more effectively use “tumor boards” to counsel patients using technology. Research shows that residents in rural areas and veterans are especially impacted by prostate cancer.
Phase I Results Show Focal Laser Ablation of Low-Risk Prostate Cancer Feasible, Appears Safe
Men with low-risk prostate cancer may soon have a new treatment option, apart from active surveillance or aggressive treatments such as surgery to remove the gland or radiation therapy--both of which risk unwelcome side effects such as urinary, bowel, or sexual dysfunction. Researchers from the University of Chicago have published results of a small Phase I trial that used laser-generated heat to ablate cancerous sections of men’s prostates. Under MRI guidance, nine men with Gleason scores of 7 or less underwent focal laser ablations that involved inserting a tiny optical fiber, a laser and cooling device through a small transperineal catheter. Six months after that outpatient procedure, on re-biopsy, seven of the nine men showed no evidence of cancer. Additionally none of the men suffered any significant bowel, bladder or sexual side effects. Phase II trials are now underway, details of which can be found here. Plug in identifier: NCT01792024
Mushroom and Soybean Extract May Boost Effectiveness of Androgen Deprivation Therapy
GCP, or genistein-combined poloysaccharide—found in shiitake mushrooms and soybeans and produced as a proprietary extract found in health food stores has been shown effective in treating mice models of advanced prostate cancer. Although the research is early and has not been verified in humans, it holds promise in enhancing men’s response to hormone therapies used to control metastatic prostate cancer. Researchers at University of California Davis previously found that when a protein linked to cancer spread (Filamin A) is cleaved, metastatic prostate cancer cells responded better to hormone therapy. Now, the same group published results showing that GCP induces cleavage of Filamin A, whereas hormone therapy prevented the protein from being cut. In mice models of advanced prostate cancer, the animals given GCP had lower rates of cancer recurrence. The researchers hope to start clinical testing in the immediate future.
Estrogen Patches Show Promise Against Prostate Cancer
A study published in Lancet Oncology indicates that estrogen replacement patches used to treat menopause symptom in women, also lowers testosterone in prostate cancer patients with results comparable to using Lupron or other LHRHa injections. Current hormone treatments for prostate cancer can cause serious side effects including osteoporosis, bone fractures and diabetes. The cancer Research UK trial was led by researchers at Imperial College London and the Medical Research Council Clinical Trials Unit in London. According to Ruth Langley, lead author of the study, “these promising new findings suggest we might be able to use estrogen patches or an estrogen gel to treat prostate cancer without significantly increasing the risk of heart attack or stroke.” A larger trial with 660 men to study the long-tern effectiveness and safety of the patches is planned.
Latinos Face Cancer Care Barriers
According to a study out of UCLA’s School of Nursing and published in Qualitative Health Research, a combination of financial, cultural, and communications barriers plays a role in preventing underserved Latino men with prostate cancer from accessing care and treatment. AMoing the cited barriers were financial hardship, difficulty in understanding insurance policies, lack of doctor continuity and care coordination, multiple doctor referrals and a lack of health literacy and language problems. These problems were seen as intensifying the gravity of the diagnosis and left many participants feeling hopeless. Latino men are more likely to be diagnosed with later-stage disease than Caucasians. According to Sally L. Maliski, senior author of the study, “these overlapping obstacles make it clear that we need a system where not only is care affordable, but where we can use a multifaceted approach to improve access, health literacy and greatly improve care coordination.”
Virus Engineered to Target Prostate Cancer Cells
A virus that is deadly to many types of birds, including chickens, is being explored as a potential targeted therapy for men with prostate cancer. The Newcastle disease virus (NDV)— named for its place of discovery in the UK in 1926—is non-toxic to humans, but it kills human tumor cells with relish. This, of course, has made the virus, attractive to cancer researchers, and early clinical trials have shown promise, but also difficulty, as the virus, when delivered systemically is unable to get to and inside tumor cells in concentrations high enough to overcome the cancers. Now, in results published in the Journal of Virology, researchers have genetically engineered NDV so that it’s only activated when cleaved by prostate-specific antigen (PSA), thus homing the engineered NDV directly to prostate cells. The researchers report that their rejiggered NDV kills both androgen-dependent and androgen-independent prostate cancer cells, indicating potential benefit to men with hormone-refractory prostate cancer with fewer side effects.
High-Fiber Intake in Mice Shrinks Prostate Tumors
Researchers have long believed that native Chinese and Japanese men who consume diets high in fiber have very low rates of prostate cancer progression. This may be in part due to the compound IP6, a major player in high-fiber diets. In a new study published in Cancer Prevention Research, investigators from the University of Colorado Cancer Center investigated the effects of IP6 on tumor growth in mice. One cohort was fed water infused with one percent, two percent or four percent of IP6; the other group was given water without IP6. MRI scans were taken of both cohorts and found that tumor sizes shrank significantly in the group fed IP6-infused drinking water. More research is needed on the role of the IP6 compound in prostate cancer and prostate cancer tumor suppression, but in the meantime, a little extra fiber in a man’s diet, such as whole grains, nuts, seeds, wheat germ and sesame, can’t hurt.
Household and Industrial Chemicals Linked to Diseases, Including Prostate Cancer
According to “State of the Science of Endocrine-Disrupting Chemicals,” a report published by the United Nations Environment Program and the World Health Organization, endocrine disrupting chemicals (EDCs) may be linked to several diseases and disorders, including prostate, breast and thyroid cancers, and attention deficit and hyperactivity in children. EDC chemicals are found in many common household and industrial products and enter the environment through industrial and urban discharges, according to the report’s authors. Though more research is needed, this study is a vital step in understanding links between EDC chemicals and some diseases. Simultaneously, prostate cancer epigenetics researcher, Gail Prins, PhD, University of Illinois at Chicago, has published several research studies on the role of EDCs in prostate cancer, suggesting that the chemicals could increase the sensitivity of prostate cancers and may be responsible for precancerous lesions.
Out of Jeopardy and Into Med School
Aficionados of Jeopardy watched IBM's Watson trounce the show's best performing candidates. Now engineers at IBM are sending Watson to medical school. According to Newsday, "IBM's Watson may not be hanging up a shingle, but the supercomputer will help doctors at New York-based Memorial Sloan-Kettering Cancer Center evaluate patients' lung cancer treatments." Watson absorbed data from 1,500 lung-cancer cases from Memorial Sloan-Kettering and more than 2 million pages of text from 42 medical journals in preparing for his new role. Prostate cancer will be one of the next medical specialties for Watson. Patients should not expect to someday walk up to a Watson station and withdraw medical advice and referrals to treatment as they currently do cash from an ATM. But, as scientific discovery accelerates and advances continue to be made, they can draw higher levels of confidence if their physicians are accessing Watson-generated information.
Japanese Male Cohort and Genetic Test for Prostate Cancer
Using genetic data from some 4,000 Japanese men with prostate cancer and comparing that to DNA of men without the disease, researchers in Japan have created a new genetic blood test that includes 16 DNA markers for the presence of prostate cancer. Its ability to predict the presence of prostate cancer was not influenced by PSA levels. The researchers looked only at men with mildly elevated PSA levels. Only 11 percent of men deemed low-risk by the genetic test had prostate cancer, whereas 42 percent of men whose genetic test predicted cancer actually had the disease. The study was published in the journal PLoS One. The authors wrote: “The model could have a potential to affect clinical decision when it is applied to patients with gray-zone PSA, which should be confirmed in future clinical studies.”
More Data Links Prostate Cancer With Dairy Consumption
Prior studies have shown that higher overall milk intake is associated with a greater risk of prostate cancer. Now, a new study in the Journal of Nutrition gives nuance to those findings, showing that the type and amount of dairy consumed not only may affect incidence of prostate cancer but a man’s odd of survival once disease is diagnosed. In a prospective study of 21,660 physicians who were followed for 28 years from baseline entry into the study, doctors who consumed more than 2.5 servings per day of dairy had a 12 percent greater risk of developing prostate cancer than doctors who had half a serving or less daily. While all milk types were associated with increased risk of prostate cancer, only whole milk consumption was associated with progression to fatal disease. An unproven theory for this association is that low levels of estrogen found in milk may fuel prostate cancer in some men.
Stress May Dampen Response to Anti-Cancer Therapies
Heightened stress levels have been shown to have deleterious effects on patients with multiple sclerosis, increase the risk of dementia in the aged, and speed up cellular DNA aging. A new study in the Journal of Clinical Investigation further indicts stress: calm mice, either implanted with prostate cancer cells or genetically modified to develop the disease, fared better than their stress-out counterparts in response to chemotherapy drugs. The calm critters’ tumors shrank when given anti-cancer drugs, whereas stressed-out mice showed significantly more limited cancer cell death. Tantalizingly, when the stressed mice were given beta-blockers, a common drug used to treat hypertension, their tumor cells reacted to chemotherapy just as positively as the calm mice. Beta-blockers block the effects of adrenaline and can be used to treat or possibly prevent post-traumatic stress syndrome (PTSD).The researchers postulate that treating prostate cancer patients who have high levels of adrenaline with beta blockers could improve their response to anti-cancer treatments.
UK Prostate Cancer Cases to Triple by 2015
According to data from Cancer Research UK and reported in UK News, the risk of being diagnosed with prostate cancer in that country has tripled in 25 years, spurred by an ageing population and increased testing for the disease. The lifetime risk of prostate cancer is expected to jump from 5 percent (1 in 20) for boys born in 1990 to more than 14 percent (1 in 7) for those born in 2015. These numbers closely reflect the US risk of 1 in 6 men being diagnosed with the disease. The US has been testing more widely for a longer period of time and also has an ageing population. On a positive note, Cancer Research UK reports that deaths from the disease are 18% lower than 20 years ago. This is attributed to better treatments and patients being diagnosed earlier, vastly improving survival.
Balds Take Note
Mounting evidence suggests that male baldness by the age of 40 can indicate increased risk for enlarged prostate or prostate cancer. The reason: high levels of testosterone create high levels of dihydrotestosterone, causing male pattern baldness. High levels of testosterone can also affect prostate stem cells in men’s late teens and early twenties, turning them into future cancer cells, and fuel the growth and progression of prostate cancer. In the tenth study focusing on baldness, the Cancer Center in Victoria, Australia monitored 9,448 men in a long-term health study. The results, published in Cancer Epidemiology, Biomarkers and Prevention, showed men, mostly bald by 40, were significantly more likely to develop early-onset cancer in their fifties or sixties. They were also more likely to be diagnosed with a tumor upon biopsy. Other studies have shown that bald men are also at higher risk for having an enlarged prostate.
Cancer Rates in US and China
The American Cancer Society’s annual report on cancer prevalence and mortality shows cancer deaths are down 20 percent since their peak in 1991. (The data are from 2009, the most recent available.) Death rates showed steep declines in the past two decades for the four major cancers—lung, colorectal, breast, prostate—with a decrease of more than 40 percent for prostate cancer. Despite an aging U.S. population, cancer deaths decreased during this time span from 215.1 per 100,000 people to 173.1 per 100,000. This stands in contrast to rising cancer incidence and death rates for in 2009 per the 2012 China Cancer Registry Annual Report, published by the country’s Ministry of Health. That report found prevalence of cancers on the mainland doubling in the past two decades, as well as increased rates of cancer-related deaths. Mainland Chinese in 2009 experienced death rates of 180.54 per 100,000. China has a rapidly aging population and treatments generally start later in the disease course.
Lower Income Patients Under-Represented in Clinical Trials
A study in the Journal of Clinical Oncology finds that patients lower on the socioeconomic scale are under-represented in clinical trials. The study surveyed 5,499 patients diagnosed with prostate, breast, colorectal, or lung cancer and found that 10 percent of patients making $50,000 or more per year participated in trials, compared to only 7.6 percent of those making less than that amount. The result held, even for older patients who had uniform access to Medicare. The study authors write that participation barriers faced by low-income patients should be better understood in order to ensure that all demographics of the US population are included in clinical trials. Because certain drugs have been shown to be more effective in demographic subgroups of the population, a broader clinical trial base will help to ensure that study results will apply to the general population.
Fiber for Chemoprevention
A study out of the University of Colorado Cancer Center finds that mice with prostate cancer fed a diet high in fiber experienced a profound reduction in tumor size, primarily, say the researchers, due to the ability of the active component of fiber (IP6) to block tumors from growing blood vessels and producing the energy needed to sustain cancerous growth. The authors postulate that because men in Asian countries consume far greater amounts of fiber in their diets than Western men, this may account for lower rates of malignant prostate cancer in Asian men compared to their Western counterparts. Because IPS, which is found in foods such as soybeans, nuts, cereals, and legumes, acted as a chemopreventive in mice in this study, the authors say their results hold the promise of “controlling the clinical progression of prostate cancer in patients diagnosed early, at the PIN stage of the disease.” (PIN, or prostatic intraepithelial neoplasia, denotes pre-cancerous lesion.)
UroToday.com Expands its Coverage of Prostate Cancer
UroToday.com, an online publication of Digital Science Press, has recently expanded their coverage of prostate cancer with the addition of two new areas of interest: “immunotherapy treatment for men with treatment-resistant prostate cancer” and “advances in treatments for metastatic treatment-resistant prostate cancer.” (Treatment-resistant prostate cancer is also known as castration-resistant prostate cancer, CRPC.) Initial items published in these sections feature the work of PCF-funded researchers, Drs. Steve Cho, Martin Pomper, Gerhardt Attard and Johann de Bono. The online publication also produces a print version of its interview compilations for 2012: “Best of Prostate” and “Best of mCRPC.” UroToday’s expansion decision is likely spurred by recent research and treatment advances in both areas of new coverage.
Enzyme Identified as a Potential Metastatic Driver of Prostate Cancer
Cancer generally kills only when it spreads or metastasizes throughout the body. New research out of the Mayo Clinic in Florida has found that a protease enzyme known as PRSS3 is upregulated in prostate cancer, especially in aggressive metastatic disease. In looking through databases of prostate tissue samples, the study authors also found that expression levels of PRSS3 in primary tumors is predictive of cancer progression post prostatectomy. The researchers used mice models to demonstrate that silencing, or inhibiting, PRSS3 suppressed cancer spread. Also promising news: they mapped the enzyme and found a nook where an inhibiting compound can attach and prevent PRSS3 from initiating cancer spread. This preclinical work suggests PRSS3 is a new target in the fight against metastatic prostate cancer, one that can be used to predict aggressiveness of a primary tumor and also as a molecule to inhibit on order to prevent lethal disease development.
Even the REST Exercise Program Benefits Cancer Patients
A recent analysis of 56 studies showed that men with prostate and other cancers who walked or cycled at the time of their adjuvant medical treatment experienced less cancer-related fatigue compared to sedentary men. Now, research out of the Mayo Clinic shows that even less vigorous, at-home exercises—sitting or standing resistance curls with an exercise band and light walking—lessened fatigue and improved mobility in patients with late stage cancers. The Mayo study evaluated the REST program (Rapid, Easy, Strength Training) that patients can learn in a single visit to a physical therapist. Unfortunately, a Mayo Clinic sister study found that only 17 percent of prostate cancer patients reported having physicians who fully addressed their fatigue. In a media release, study author Dr. Andrea Cheville lamented the widespread problem of under-addressing fatigue issues in cancer patients: “Fatigue…not only significantly diminishes quality of life, but is also associated with reduced survival.”
Britain Just Says Yes to Science
As the US teeters on the fiscal cliff, facing cuts to the tune of 8.2 percent in 2013 scientific funding, Britain has taken the opposite tack. Even amidst austerity measures, the UK decided to put their financial house back in order. Chancellor George Osborne, head of the Ministry of Finance, announced a windfall of funding—600 million British pounds, close to one trillion US dollars—in added funding for key scientific areas over the next three years—a move praised by scientific champions. Reuters quoted the director of the Wellcome Trust as saying that “…investment in world-class science [is] integral to any strategy for driving growth, even in times of austerity.” According to the White House, sequestration here would result in budget cuts of $586 million to the National Science Foundation, $2.5 billion to the NIH, and $400 million to the US Dept. of Energy’s Office of Science, among others.
Provenge Plus Two to Enter Clinical Trials
Provenge is a personalized cancer vaccine; it consists of laboratory-modified white blood cells—collected from a man with prostate cancer—that when injected back into the patient’s body, are better able to find and attack cancer cells. FDA-approved for the treatment of advanced prostate cancer in 2010, the vaccine’s mechanism of action is to boost patients’ immune reactions against cancer. While Provenge has shown overall survival benefit in some men with prostate cancer, it is not curative. This week, researchers at Georgia Health Sciences University announced preclinical results on prostate cancer mice models demonstrating that when Provenge is combined with two other anti-cancer drugs, half of the mice lived significantly longer with complete tumor regression. Buoyed by these encouraging results, Provenge’s maker, Dendron Corporation, will collaborate with the researchers on a first-in-kind human trial of these three drugs in combination to treat men with advanced prostate cancer.
Future Watch: Whole-Body DNA Blood Test to Detect Cancer
Imagine going for your routine physical and the doctor adds a test to your usual blood draw workup—a whole-body blood scan for signs of cancer. Such imaginings drew closer to reality this week with a study published in Science Translational Medicine that reported finding the genetic detritus of spent cancer cells circulating in the blood of patients with colon and breast cancer; none was detected in healthy subjects. Because most cancer cells harbor aberrations or alterations in their chromosomes--such as structural rearrangements, or abnormal copy numbers that can increase the levels of protein or RNA made from cancer-driver genes—gene sequencing tests run on blood plasma are able to spot these chromosomal misfires. The upside of such a test: early warning of cancer, even before symptoms, decreased biopsies, peace of mind; the downside: cost, and detection of non-life threatening cancers.
Higher Sensitivity, Lower Cost Test for Post-Prostectomy PSA Screening and Predicting Recurrence
According to a report from GenomeWeb, Quanterix and BioMérieux recently announced a partnership giving BioMérieux worldwide exclusive rights to Quanterix's Single Molecule Array, or SiMoA, a clinical assay technology that allows various tests to be run on a single molecule on a single platform. This unique technology will facilitate upwards of a thousand -fold improvement in sensitivity at lower cost. Quanterix will provide BioMérieux with a SiMoA instrument, which will be utilized primarily for infectious disease testing, but also for other assays such as a post-prostatectomy prostate specific antigen screening test. GenomeWeb reports that the partnership a will produced a menu of tests including "tests whose current medical value could be improved, such as the PSA test," to predict prostate cancer recurrence, as well assays to quantify biomarkers that are "currently difficult or impossible to measure."
US HIFU, a company that designs and produces "minimally invasive high intensity focused ultrasound (HIFU) technologies," is expanding its Indianapolis operation over the next two years in anticipation of approval for using their technologies to treat prostate cancer here in the U.S. The company’s technology is being studied in U.S. clinical trials for treatment of prostate cancer and around the world to treat other cancers and soft tissue diseases. Currently available in other countries, there is no indication yet as to when HIFU might be cleared for patient treatment in the U.S. A study in The Lancet Oncology this year suggested HIFU may lessen side effects in men treated for localized prostate cancer when compared to more conventional treatments such as radiotherapy and surgery. While researchers agree more study is needed, HIFU treatment is seen as potentially the most beneficial to men with low-risk disease.
Time to Man Up
A recent survey conducted by Janssen Biotech Inc. shows men have a surprising lack of awareness about prostate cancer, underscoring a significant gap between facts and beliefs around the disease. Sixty-three percent of men believe they will not be diagnosed and more than half (52 percent) believe that, if diagnosed, the disease would not be fatal. The majority of those surveyed, (93 percent) could not recognize at least two symptoms of the disease. Fifty-eight percent expressed concerns about losing intimacy and nearly a third (28 percent) said they would forgo treatment if it could mean losing their ability to be intimate. Not surprisingly, 81 percent of men surveyed said they would be grateful if their partner scheduled their doctor appointments. It appears that men still have a long way to go in taking responsibility for their health. Thank goodness for Movember, a beacon of hope for men’s health and prostate cancer awareness across the globe.
Researchers at AACR’s Science of Cancer Health Disparities conference reported that oncologists discussed aspects of clinical trials nearly twice as frequently with Caucasian versus African-American patients. Discourse analysis evaluated for the five basic elements of consent (including trial purpose, risks and benefits, alternatives to participating and the voluntary nature of participation). Word count was an objective measure of face-to-face discussion. Findings showed that clinicians mentioned clinical trials a mean of 2.73 times to African-Americans and 4.27 times to Caucasians. When mentioned, the word count was less for African-Americans (1,089.64 vs. 1,867.09). Discussing risks, clinicians said 211.9 words to African-Americans and 390.27 words to Caucasians. The risks were mentioned 1.91 times to African-Americans and 3.18 times to Caucasians. Clinicians also mentioned voluntary participation more frequently to Caucasians than African-Americans (2.1 vs. 1.55). Because minority patients tend to receive less information, this may explain their under-representation in clinical cancer trials.
Walking or Cycling Helps Beat Cancer-Related Fatigue
Once upon a time, after a back strain, doctors told patients to get plenty of rest. That advice was upended when research showed that for the majority, controlled exercise worked better than extended rest. In a similar vein, a review of the research published this week in the Cochrane Library shows that cancer patients with solid tumors (most specifically, those with breast or prostate cancer) who participated in walking or cycling exercise programs during and after adjuvant treatments for their cancers experienced less cancer-related fatigue than those who did not exercise. The Cochrane study reviewed data from 56 studies that included 4,068 participants. Cancer patients with blood cancers such as leukemia did not benefit from exercise programs, and none of the participants reduced cancer-related fatigue through resistance exercises such as weight lifting. Because individual circumstance may vary, it’s important to check with your doctor before initiating any exercise program.
Good for the Heart and the Prostate?
Resveratrol is a polyphenolic phytochemical found in nature with high concentrations in peanuts, mulberry skins and grapeskins, and consequently, in red wine. It has been shown to reduce the risk of heart disease and inflammation due to its antioxidant properties. Now, according to research data from the University of Missouri (MU) and published in Cancer Science, resveratrol may have a positive effect on radiation therapy, making prostate tumor cells more susceptible to radiation treatment. The next step would be to test the procedure in an animal model before any potential new treatments can be developed and clinical trials can be initiated. To your health and cheers!
November is National Hospice and Palliative Care Month
Hospice care is end-of-life care that includes palliative care to ease symptoms. Palliative care, however can be delivered at any point in a patient’s disease course to alleviate symptoms. Such is the case with androgen deprivation therapy (ADT) which is often used early on a patient’s treatment plan. Research has shown that patients receiving palliative care services report significantly reduced pain levels (86 percent lower) than patients receiving the usual care. And for those who, despite medicine’s best efforts, are in the terminal phase of their disease, a study of 4,493 terminally ill patients found that patients receiving hospice care lived an average of one month longer than similar patients not enrolled in a hospice care program. The study, published in the Journal of Pain and Symptom Management, reviewed patients with congestive heart failure and several cancers, including prostate cancer.
Assessing the Emotional Toll of Prostate Cancer
Irishhealth.com recently reported on a study surveying 1,000 Irish residents touched by prostate cancer. Not surprisingly, results showed that beyond the physical effects, the disease affects people mentally and financially. One in three indicated that prostate cancer is a “constant worry” for their loved ones while one in five described it as mentally and emotionally draining. Another one in five worried about loss of earnings. However, not all the results were negative. Almost four out of five men with prostate cancer said that knowing recent advances in treatment for the disease may enable them to live longer gives them hope.
Recurrent Prostate Cancer May Be Explained Through Deeper Understanding of Androgen Receptor
Androgens are male hormones that fuel the growth and spread of prostate cancer. Therefore, Androgen Deprivation Therapy (ADT) is the primary treatment for prostate cancer. Despite this treatment, more than 30 percent of all prostate cancers become treatment-resistant and recur. This cancer recurrence and resistance to therapy has been attributed to the abnormal activity of the Androgen Receptor (AR), which in a normal cell mediates the activity of androgens. Researchers at Roswell Park Cancer Institute and the National Cancer Institute found that over time, AR becomes androgen-independent and continues to drive prostate cancer progression even in the absence of androgens. Researchers also found that AR may be activated through a metabolic process—resulting in tumor changes, or growth. Understanding AR’s role in recurrence will provide more effective treatments and therapies for patients with the most advanced disease.
Gene Signatures for Aggressive Prostate Cancers
One of the holy grails of prostate cancer is to determine which cancers require aggressive treatments. Researchers in the U.S. have advanced this cause, finding of a 6-gene signature that separates men with advanced forms of prostate cancer into two groups: those likely to survive more than three years (low-risk) and those likely to succumb to their disease in less than one year (high-risk). The test is a simple blood test, and follows another study by British and U.S. researchers that found a 9-gene signature that also stratifies such men into low and high-risk groups. Both gene signatures involve the immune system, suggesting a malfunction of this system in high-risk patients. Recently, others have announced a multi-gene signature under development that can be used early in the disease to predict which men may be eligible to defer treatment because their tumors are low-risk.
Enhanced PCa Imaging
This morning’s Medical Express reports that Mayo Clinic received U.S. FDA approval to produce and administer Choline C 11 injection, an imaging agent used during a positron emission tomography (PET) scan to help detect sites of recurrent prostate cancer. It is the first, and currently only, institution in North America approved to produce this imaging agent.
Choline C 11 is a radioactive form of the vitamin choline. Clinicians inject a small amount into a patient's vein and then use a PET scanner and computer to make detailed pictures of areas where the agent collects. Since cancer cells take up more Choline C 11 than do normal cells, the images can be used to help find areas of possible cancer in the body when other imaging techniques are non-informative. Once a site is identified, a biopsy and pathologic examination can verify whether prostate cancer has recurred.
Stem-Like Cancer Cells May Drive Resistance to Prostate Cancer Chemotherapeutic
Resistance to the chemotherapeutic docetaxel often precedes fatality in men with treatment resistant prostate cancer—an aggressive form of the disease. Now, a research team led by Dr. Carlos Cordon-Cardo at Mount Sinai School of Medicine in New York has identified a subpopulation of prostate cancer cells that may be responsible for acquired resistance to docetaxel and that are found in significantly higher numbers in men with metastatic disease. The researchers found that the subpopulation had stem-cell like qualities that may provoke tumor aggression and that they were able to inhibit these cells in preclinical work with drugs or gene knockout strategies. The next step say the researchers is to determine the contribution this subpopulation of cells makes to the development of treatment resistance and determine what molecular pathways are involved so drugs can be targeted appropriately. The study was reported in Cancer Cell.
Movember’s “Growing” Influence
Movember, the annual global campaign to grow moustaches for prostate cancer awareness and research funding, continues to inspire the world. While not yet an official Movember country, Uganda’s Cancer Institute (UCI), Rotary Uganda, Grameen Foundation and Victoria University will promote "Early Presentation for Prostate Cancer Screening" with a focus on men above 40 years who are more prone to the disease. According to UCI, prostate cancer is now the most common cancer among men in Uganda, with age standardized incidence rates of 40 per 100,000 per annum and a 4.5 percent increase each year. Unfortunately, the outcome of men diagnosed with prostate cancer in Uganda is poor, only 50 percent alive five years after diagnosis, compared to 97 percent in the U.S. This is attributed to later diagnoses when the disease is often less treatable.
A recent study conducted by University of Pittsburgh researchers (published in the peer-reviewed American Journal of Pathology) investigated genetic abnormalities in prostate cancer patients and whether they could be used to predict cancer recurrence and, if so, how soon. Prostate cancer patients had high numbers of “copy number variations” –an abnormal number of copies of a particular DNA region.
By comparing particular amplifications and deletions and the size of copy number variants, the researchers were able to build a prediction model to identify patients who would relapse and those who would relapse quickest. The prediction models could be used on DNA extracted from prostate cancer tissue, normal prostate tissue or blood. This study raises hope that a test may one day predict the prognosis of patients with prostate cancer and aid treatment decisions. These findings will require further validation and a simple, inexpensive test needs development and testing.
Improved Survival for Patients
According to data released by Decision Resources’ Pharmacor advisory service, (a biopharmaceutical industry information source for commercially significant disease topics) the number of men living with prostate cancer that has spread (metastatic) should exceed half a million in 2016, from a current level of 436,000, as a result of improved overall survival associated with new drug launches since 2010. The service also predicts that the number of men with prostate cancer who develop metastatic disease per year—most frequently following metastatic recurrence of non-metastatic disease—will decline, decreasing by 25 percent over the next 20 years. Pharmacor’s data indicates this trend will primarily be the result of recent declines in the number of men being diagnosed with advanced disease and the prolonged length of time it takes for the disease to metastasize.
According to Urology Times this week, less than 5% of websites describing prostate cancer are written below a high school reading level, even though 90 million American adults read below this level, a new study found. The median reading level was 12th grade, according to study authors from Loyola University Medical Center in Maywood, IL, who first reported their findings online.
"This is problematic for one-third of Americans who seek to further educate themselves using online resources," senior author Gopal Gupta, MD, and colleagues wrote.
The team identified 62 websites by searching for "prostate cancer," “prostate cancer treatment," and "prostatectomy" on Google, Yahoo, and used word processing software to test the readability of the first 300 words of each website.
The challenge for organizations providing complex information for consumers is to pull it out of the “deep science” and make it easily digestible by a broad range of readers.
Research Migration Trends
China continues to invest aggressively in cancer research as cancer rates in that country continue to rise, particularly in metropolitan areas where western diets are growing in popularity. In Shanghai, prostate cancer cases are increasing 13 percent annually. Following PCF China’s First Prostate Cancer Symposium held at Peking University’s Wu Jieping Urology Center in March of this year, the U.S.-based National Foundation for Cancer Research and the Chinese Academy for Medical Sciences today concluded a three day symposium today in Beijing. A recent Nature survey of 2,300 researchers reported that most respondents believe that China will have the greatest research impact in 2020, but that few researchers would consider relocating there. Another country to watch is India. In the U.S., 38% of the bioscience human capital currently represents immigrants from China and India.
Decorating Gold Particles with Green Tea Compound May Limit Radiation Doses Needed to Kill Prostate Cancer Cells
Researchers now have built a “golden bullet” to deliver radiation directly to prostate tumor cells at much lower doses than used in traditional radiotherapy treatments. Decorating tiny gold particles with a natural compound found in green tea—epigallocatechin-gallate (EGCg)—gets a twofer response. First, the EGCc acts on the gold to reduce it to nanoparticle size, helping it to stay put in the tumor once it gets there and second, it takes it to the tumor cells directly because EGCg has an affinity to a receptor that is abundant on prostate cancer cells. Initial lab studies showed an 80% reduction in tumor size. If further studies in larger animals are successful, it can be fast tracked to human trials, says Cathy S. Cutler, an author on the study.
Stem-Like Cancer Cells May Drive Resistance to Prostate Cancer Chemotherapeutic
Resistance to the chemotherapeutic docetaxel often precedes fatality in men with hormone-refractory prostate cancer (HRPC)—an aggressive form of the disease. Now, a research team led by Dr. Carlos Cordon-Cardo at Mount Sinai School of Medicine in New York has identified a subpopulation of prostate cancer cells that may be responsible for acquired resistance to docetaxel and that are found in significantly higher numbers in men with metastatic disease. The researchers found that the subpopulation had stem-cell like qualities that may provoke tumor aggression and that they were able to inhibit these cells in preclinical work with drugs or gene knockout strategies. The next step say the researchers is to determine the contribution this subpopulation of cells makes to the development of HRPC and determine what molecular pathways are involved so drugs can be targeted appropriately.
Bar Code Tests Spot Aggressive Prostate Cancers
One of the holy grails of prostate cancer is to determine which cancers require aggressive treatments. U.S. researchers have advanced this cause, finding of a 6-gene signature that separates men with advanced forms of prostate cancer into two groups: those likely to survive more than 3 years (low-risk) and those likely to succumb to their disease in less than one year (high-risk). The test is a simple blood test, and follows another study by British and U.S. researchers that found a 9-gene signature that also stratifies such men into low and high risk groups. Both gene signatures involve the immune system, suggesting a malfunction of this system in high-risk patients. Recently others have announced a multi-gene signature under development that can be used early in the disease to predict which men may be eligible to defer treatment because their tumors are low-risk.