2010 Annual Report on Prostate Diseases Pathophysiology More deaths if no prostate cancer therapy Prostatic Adenocarcinoma Calcium consumption may up prostate cancer risk Dog Sniffs Out Prostate Cancer in Small Study Mixed Fruit Juice reduces Prostate Cancer Risk Drinking Green Tea Daily lowers Prostate Cancer Risk Why you should consider a prostate cancer PSA test today What Dennis Hopper's Death Can Teach Us About Prostate Cancer Prostate cancer patients with low-risk tumors could hold off treatment What Can Go Wrong With the Prostate: Cancer, BPH, and Prostatitis Ultra-sensitive test to tell prostate cancer patients if they are cured after operation Sound waves prostate cancer treatment may have lesser side effects on the patient Prostate Cancer Hormone Therapy May Prove Successful in Treatment of Surgery-Resistant Cancer 　 　 2010 Annual Report on Prostate Diseases Prostate disorders usually develop after age 50, but some men experience them at a younger age. The three most common conditions are prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. Although they share some of the same symptoms, they are very different. Treatments vary, too. For example, two men with prostate cancer might opt for treatments as divergent as radical surgery and doing nothing at all. Even getting screened for prostate cancer, which seems like it would be a no-brainer, requires thoughtful consideration. That’s because most men usually feel compelled to undergo treatment if cancer is diagnosed, risking complications like impotence and incontinence that can undermine quality of life. Whether you are considering medication for BPH or erectile dysfunction, or debating between radiation therapy and surgery for prostate cancer, you need to review your options carefully. This report, which provides an objective assessment of the risks and benefits of various procedures, can help. More than a primer on the most common prostate conditions, this unique publication includes roundtable discussions with experts at the forefront of prostate cancer research; assessments of different therapies from Harvard Medical School doctors; interviews with patients about their treatment decisions; and the latest thinking on complementary therapies. It also includes helpful tips on managing and treating erectile dysfunction and impotence caused by prostate disease therapies. Prepared by the editors of Harvard Health Publications in consultation with Marc B. Garnick, M.D., Clinical Professor of Medicine, Harvard Medical School, and Hematology/Oncology Division, Beth Israel Deaconess Medical Center. 136 pages. (2010) A year of advances and breakthroughs in prostate disease What made news in 2009 Monitoring prostate health A look at the prostate and some tests you might need Prostate enlargement (benign prostatic hyperplasia) Getting this “going”—and “growing”—problem under control Inflammation of the prostate (prostatitis) Help for an all-too-common condition Prostate cancer What you need to know at every stage of the disease Erectile dysfunction and incontinence Some solutions to consider Complementary therapies for prostate disease What works — and what doesn’t Take charge of your condition Participate in a clinical trial or support group Resources Organizations and publications you can turn to for more information Glossary Definitions of medical terms used in this report Searching PubMed in five easy steps How to access the studies cited in this report PSA screening: What makes sense? Making decisions when questions remain Since its introduction in the late 1980s, the prostate-specific antigen (PSA) test has been hailed as a way to detect prostate cancer in its earliest, most curable stage. It has been called one of the most important tests a man can have. So why are many experts now stepping back, and even discouraging the use of widespread PSA screening? The shift comes on the heels of a growing body of evidence that shows the benefits of PSA screening may not outweigh the potential harm of unnecessary treatment. PSA screening has always been somewhat controversial. That’s because PSA tests often alert doctors to the presence of cancer, but there is no precise way to determine, definitively, whether the cancers detected would have ever caused symptoms or harm during a man’s lifetime. One study estimated overdetection to rise with age, from 27% at age 55 to 56% by age 75. Despite this, to be on the safe side, most men with elevated PSA levels will opt for treatment, frequently suffering side effects such as incontinence and impotence. Increasingly, there are questions about the effectiveness of PSA screening for prostate cancer. Just how many lives are actually being saved? And is the emotional and physical toll on the millions of men who are being overdiagnosed and overtreated worth it? Two long-awaited studies—one conducted in the United States and the other in Europe—were supposed to help settle the debate over the value of PSA testing. Instead, the trials, published in The New England Journal of Medicine in March 2009, seemed to come to opposite conclusions. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial reported no survival benefit with PSA screening and digital rectal examination, but the European Randomized Study of Screening for Prostate Cancer (ERSPC) found a 20% reduction in prostate cancer deaths. The ERSPC study estimated that for every life saved, 48 men are treated and nearly 1,068 men are screened. Although experts are somewhat split on the value of PSA tests as a screening tool, there is widespread agreement on two major points: overdiagnosis and overtreatment rates are far too high, and there is an urgent need to refine PSA testing to be a more effective screening tool. The principal investigator of the Prostate Cancer Prevention Trial and his colleagues wrote an editorial in The Journal of the American Medical Association in October 2009 that took a closer look at the issues. They pointed out that while the amount of prostate cancer diagnosed has risen dramatically since PSA testing began, there has not been a proportional decrease in the number of men with metastatic tumors. It appears screening may be detecting a disproportionate number of lower-risk cancers, while missing many of the most aggressive tumors, which may advance too rapidly to be found with periodic testing. The debate over the effectiveness of PSA screening has quickly filtered into the offices of general practitioners and urologists. On a daily basis, confused men are asking their doctors: “Should I have a PSA test or not?” To help men sort through the latest thoughts on PSA screening, the editors of Harvard Medical School’s 2010 Annual Report on Prostate Diseases invited three Harvard experts to participate in a roundtable discussion on screening. The panelists represent physicians on the front lines of the debate… Article Source:http://www.health.harvard.edu/special_health_reports/Prostate_Disease.htm Back To Top What Can Go Wrong With the Prostate: Cancer, BPH, and Prostatitis For most young men, the prostate falls into the category “obscure body parts” that includes the spleen—that is, it’s in there someplace, it probably does something useful, but it’s best dealt with on a need-to-know basis. Unfortunately, most men are going to need to know about the prostate sometime, because this little gland is the source of three of the major health problems that affect men: ■Prostate cancer, the most common major cancer in men ■Benign enlargement of the prostate (BPH, or benign prostatic hyperplasia), one of the most common benign tumors in men and a source of symptoms for most men as they age ■Prostatitis, painful inflammation of the prostate, the most common cause of urinary tract infections in men Worse, because there’s no “statute of limitations” on prostate problems, some men are unlucky enough to endure more than one of these disorders. For example, having BPH or prostatitis doesn’t mean a man won’t have further difficulty—either a return of symptoms or a new problem entirely, such as prostate cancer. When it comes to making the diagnosis of prostate cancer and planning treatment, the other prostate disorders must be considered, too. So it’s important that men know about all three problems—what they are, how they are treated, and their telltale symptoms. Fortunately, effective treatment and relief of symptoms is available for all three prostate disorders. Even prostate cancer, when caught early, is treatable—generally without causing loss of urinary control or sexual function. In fact, many prostate cancers may not need to be immediately treated and can be safety followed under a program of active surveillance. Clinical trials are ongoing to understand which cancers need to be treated aggressively with surgery or radiation, and which can be observed with deferred therapy or no therapy. For the first time ever, we are very close to understanding how to keep advanced cancer in check, perhaps even for years. Article Source: http://www.pcf.org/site/c.leJRIROrEpH/b.5813303/k.CDC2/What_Can_Go_Wrong_With_the_Prostate_Cancer_BPH_and_Prostatitis.htm Back To Top Calcium consumption may up prostate cancer risk Calcium consumption — even at relatively low levels and from non-dairy food sources such as soy, grains and green vegetables — may increase prostate cancer risk among Chinese men, according to a new study. The study has been published in Cancer Research, a journal of the American Association for Cancer Research. "Our results support the notion that calcium plays a risk in enhancing the role of prostate cancer development," said lead researcher Lesley M. Butler, Ph.D., assistant professor of epidemiology at Colorado State University, Fort Collins, Colo. "This study is the first to report an association at such low levels and among primarily non-dairy foods." Some studies conducted in North American and European populations have linked high consumption of dairy products to an increased risk of prostate cancer. A few studies have suggested that calcium in milk is the causative factor, however the evidence is not clear. In an Asian diet, non-dairy foods like tofu, grains and vegetables such as broccoli, kale and bok choy are the major contributors of calcium intake. Therefore, Butler and colleagues speculated that people who are exposed to those calcium-rich food sources in an Asian diet may also be at increased risk for prostate cancer. Using data from the Singapore Chinese Health Study, the researchers evaluated whether dietary calcium increased prostate cancer risk in a population of 27,293 Chinese men aged 45 to 74 years, with low dairy consumption. The study was restricted to men who belonged to two major dialect groups of Chinese people living in Singapore: the Hokkiens and the Cantonese. Participants completed a food frequency questionnaire to assess their diet over the past year. Of these men, 298 were diagnosed with incident prostate cancer. Butler and colleagues at Colorado State University, the National University of Singapore and the University of Minnesota assessed the participant''s diet at baseline. Since it is suggested that calcium is absorbed more so in smaller individuals, the researchers accounted for body mass index (BMI) in this Chinese population. Results showed a 25 percent increased risk of prostate cancer when comparing those who consumed, on average, 659 mg vs. 211 mg of total calcium a day, according to the study. Major food sources of calcium in this population consisted of: vegetables (19.3 percent), dairy (17.3 percent), grain products (14.7 percent), soyfoods (11.8 percent), fruit (7.3 percent) and fish (6.2 percent). However, the researchers stress that there was no positive association with prostate cancer risk and any one particular food source. Among men with less than average BMI (median BMI was 22.9 kg/m2), the researchers found a twofold increased risk of prostate cancer. "It was somewhat surprising that our finding was consistent with previous studies because nearly all of them were conducted among Western populations with diets relatively high in calcium and primarily from dairy food sources," Butler said. Article Source: http://timesofindia.indiatimes.com/life/health-fitness/health/Calcium-consumption-may-up-prostate-cancer-risk/articleshow/6002588.cms Back To Top Dog Sniffs Out Prostate Cancer in Small Study TUESDAY, June 1 (HealthDay News) -- New research suggests that dogs can sniff out signs of prostate cancer in human urine, adding to the ongoing debate over the disease-detecting powers of man's best friend. Some scientists have questioned similar reports of dogs with such diagnostic powers in recent years, but the lead author of this latest study said the findings are promising and could lead to better cancer-sensing technology. "The dogs are certainly recognizing the odor of a molecule that is produced by cancer cells," said French researcher Jean-Nicolas Cornu, who works at Hospital Tenon in Paris. The problem, he said, is that "we do not know what this molecule is, and the dog cannot tell us." Still, the report could represent a significant development since cancer often goes undetected until it is too late to treat. The detection of prostate cancer has been particularly controversial. Some researchers think many patients are treated unnecessarily because existing tests of prostate-specific antigen (PSA) aren't accurate enough and fail to distinguish between dangerous and harmless cancers. Urine tests can turn up signs of prostate cancer, Cornu said, but miss some cases. Some types of molecules give a distinct odor to urine, "but today there is no means to screen odors from urine and separate them," he said, and no way to link them to cancer. Enter the dog, whose powers of smell are far greater than those of humans. For this study, two researchers spent a year training a Belgian Malinois shepherd, a breed already used to detect drugs and bombs. The dog was trained to differentiate between urine samples from men with prostate cancer and men without. Ultimately, researchers placed groups of five urine samples in front of the dog to see if it could identify the sole sample from a man with prostate cancer. The dog correctly classified 63 out of 66 specimens. If the findings hold up in other studies, they'll be "pretty impressive," said urologist Dr. Anthony Y. Smith, who was to moderate a discussion on the findings Tuesday at the American Urological Association annual meeting in San Francisco. Skeptical researchers are concerned about factors that could throw off the results, said Smith, chief of urology at the University of New Mexico. Among other things, scientists wonder if the animals used in such studies pick up on subconscious signals from researchers. Still, in this study, it's hard to imagine anything "other than the dogs somehow being able to smell something that we don't smell," Smith said. If these findings are valid, they could lead to the development of more accurate tests that don't require unnecessary biopsies, Smith said. The next steps are to determine precisely what the dogs are sniffing and to develop an "electronic nose" to detect it, Cornu said. Other dogs are already being trained, he said. Could doctors and hospitals employ dogs and researchers to detect prostate cancer? Cornu said that's possible, but it could cost as much as hiring two full-time scientists. Article Source: http://www.businessweek.com/lifestyle/content/healthday/639647.html Back To Top Drinking Green Tea Daily lowers Prostate Cancer Risk Japanese scientists suggest that drinking daily five or more cups of green tea could halve the risk of developing advanced prostate cancer. According to the article published in the American Journal of Epidemiology, there was a 50 percent lower risk of having advanced prostate cancer in men who drank five or more cups of green tea daily compared with those who had less than a cup. Findings show while drinking green tea lowers the risk of advanced prostate cancer; it is not associated with localized prostate cancer. Researchers claim that a substance called catechin in green tea is responsible for reducing cancer risk by curbing testosterone levels which cause prostate cancer. The study suggests that the lower incidence of prostate cancer in Asians may be linked to the higher consumption of green tea. Previous studies had reported various health benefits for the green tea catechin including reduced heart attack and cancer risks. Article Source: http://www.healthjockey.com/2007/12/20/drinking-green-tea-daily-lowers-prostate-cancer-risk/ Back To Top Mixed Fruit Juice reduces Prostate Cancer Risk Researchers have conducted a study which has found that drinking a mixed fruit juice containing fruits like blueberry, grape and raspberry on a daily basis can cut the risk of prostate cancer. According to lead researcher Dr.Jas Singh of Sydney University, “We have undertaken efficacy studies on individual components of fruit drinks and found these are effective in suppressing cell growth in culture. We reasoned that synergistic or additive effects are likely to be achieved when they are combined.” The researchers came to this conclusion after they observed the effects of the mixed fruit drinks on both cancer cell cultures in a laboratory and genetically engineered mice with human prostate tumors. They found that after just two weeks of consuming the mixed fruit juice solution which was added to the lab mice’s drinking water, their tumors had shrunk by 25%. Further, the researchers are planning to see whether a daily glass or two of this very drink could treat the disease and even help to prevent the tumor from developing. For this, they are planning a small study of 150 men with prostate cancer who will be made to drink three glasses of the juice everyday. According to Debbie Clayton of the Prostate Cancer Charity, “These studies will need to involve much larger numbers of men and it may be several years before we are able to offer men clear guidance on how the drink may help them. In the meantime, we would recommend that men include a variety of fresh fruit and vegetables in their diet, ensuring they get a ‘rainbow’ of colors.” Article Source: http://www.healthjockey.com/2007/12/10/mixed-fruit-juice-reduces-prostate-cancer-risk/ Back To Top More deaths if no prostate cancer therapy DETROIT, June 2 (UPI) -- Prostate cancer patients who refuse treatment don't do as well as those who choose radiation treatment, U.S. researchers found. Researchers at Henry Ford Hospital in Detroit found the 10-year overall survival rate for men who chose "watchful waiting" was 51 percent. It was 68 percent for those who had radiation treatment. "Surgery has been shown to offer a survival advantage to patients with prostate cancer when compared with other treatment options," lead author Dr. Naveen Pokala of Henry Ford Hospital said in a statement. "However, a significant number of patients refuse surgery and instead opt for other treatments such as radiotherapy." Pokala and colleagues examined national data of 9,704 male patients with a mean age of 64.4, and of whom 77 percent were white and 16.4 percent black. Nearly 30 percent refused any treatment, while 70 percent chose radiation therapy. The study was presented at the American Urology Association's annual meeting in San Francisco. Article Source: http://www.upi.com/Health_News/2010/06/02/More-deaths-if-no-prostate-cancer-therapy/UPI-71111275526401/ Back To Top What Dennis Hopper's Death Can Teach Us About Prostate Cancer Article by Toni Brayer MD (June 01, 2010) in Health When Dennis Hopper died of prostate cancer at age 74, my husband asked me, "Hey, I thought prostate cancer didn't kill men and it is slow growing." Well, he is right about it usually being slow growing, but prostate cancer is still the 2nd leading cause of cancer death in men. His question made me realize that there are some facts that everyone should know about prostate cancer. Prostate cancer is very rare in men under age 40, and the incidence increases with age. African-American men are at higher risk, and Asian and Latin men are less likely than white guys to get it. We do not know why these ethnic differences occur. Family history is important, and men with an affected brother or father are twice as likely to get prostate cancer. Although genes are undoubtedly responsible, there are no genetic tests that can predict it. Some studies show obese men and men who eat large quantities of red meat and dairy products are more at risk. A vasectomy doesn't seem to matter, nor does exercise or prior prostatitis. Prostate cancer grows slowly, and the PSA (prostate specific antigen) test or a digital rectal exam can screen for an enlarged prostate. The PSA test can be false positive for many reasons, and the only way to diagnose suspected prostate cancer is by a biopsy. The most important marker for a cancer in the prostate is the "Gleason" score. This grade (1-10) tells us how advanced or aggressive the cancer is. The pathologist can see if the cells are suspicious for atypical changes or are high-grade. The extent of the tumor determines the stage. Once a cancer has been diagnosed, graded and staged, the confusing choices of treatment come into play. Because most prostate cancer occurs in older men and it is slow growing, many men choose "watchful waiting". By following PSA tests and ultrasounds, we can determine if the cancer is growing. For many men, nothing more needs to be done, because the cancer causes them no problems. For younger men or men with high Gleason scores, treatment is usually surgical removal of the prostate or radiation of the prostate gland. Radiotherapy can also occur with seed implantation of radioactive material. Hormone therapy or cryoablation is also used less often. The Prostate Cancer Foundation and the Mayo Clinic have more good info if you wish to delve further. RIP, Dennis Hopper. I think I'll take a stroll down memory lane and rent "Easy Rider" again. I haven't seen it for 40 years! Article Source: http://www.opposingviews.com/i/what-dennis-hopper-s-death-can-teach-us-about-prostate-cancer Back To Top Prostatic Adenocarcinoma Adenocarcinoma of the prostate is common. It is the most common non-skin malignancy in elderly men. It is rare before the age of 50, but autopsy studies have found prostatic adenocarcinoma in 80% of men more than 80 years old. Many of these carcinomas are small and clinically insignificant. However, some are not, and prostatic adenocarcinoma is second only to lung carcinoma as a cause for tumor-related deaths among males. (Bostwick et al, 2004) Men with a higher likelihood of developing a prostate cancer (in the U.S.) include those of older age, black race, and family history. Those with an affected first-degree relative have a much greater risk. (Bostwick et al, 2004) Prostate cancers may be detected by digital examination, by ultrasonography (transrectal ultrasound), or by screening with a blood test for prostate specific antigen (PSA). None of these methods can reliably detect all prostate cancers, particularly the small cancers. Widespread PSA screening is not cost-effective. Men whose life expectancy is less than 10 years not pursue prostate cancer early detection because the likelihood of benefitis outweighed by the risk of harms from treatment. Men at higher risk for prostate cancer at earlier ages, including men of African American ancestry or a family history of prostate cancer in nonelderly relatives, should be provided the opportunity for informed decision making at an earlier age than average-risk men. (Wolf et al, 2010) PSA is a glycoprotein produced almost exclusively in the epithelium of the prostate gland. In the circulation PSA may be complexed to serum proteins (complexed PSA, or cPSA) or may be free (fPSA). The cPSA and fPSA together comprise total PSA (tPSA). The tPSA is normally less than 4 ng/mL (normal ranges vary depending upon which assay is used). A mildly increased tPSA in a patient with a very large prostate can be due to nodular hyperplasia, or to prostatitis, rather than carcinoma. The fPSA correlates more closely with benign prostatic conditions than the tPSA. The cPSA has a greater sensitivity for prostatic adenocarcinomas at the low ranges of elevation. A rising tPSA is suspicious for prostatic carcinoma, even if the tPSA is in the normal range. Transrectal needle biopsy, often guided by ultrasound, is useful to confirm the diagnosis, although incidental carcinomas can be found in transurethral resections for nodular hyperplasia. (Jung et al, 2006) Men who have findings suspicious for carcinoma on digital rectal examination and a tPSA of <4 ng/mL have a probability of cancer of at least 10%, while those with tPSA levels from 4 to 10 ng/mL have a 25% probability. Men with tPSA's above 10 ng/mL have a >50% likelihood of having a prostate cancer. (Demura et al, 1996) Prostatic adenocarcinomas are composed of small glands that are back-to-back, with little or no intervening stroma. Cytologic features of adenocarcinoma include enlarged round, hyperchromatic nuclei that have a single prominent nucleolus. Mitotic figures suggest carcinoma. Less differentiated carcinomas have fused glands called cribriform glands, as well as solid nests or sheets of tumor cells, and many tumors have two or more of these patterns. Prostatic adenocarcinomas almost always arise in the posterior outer zone of the prostate and are often multifocal. (Pearson et al, 1996) Prostatic adenocarcinomas are usually graded according to the Gleason grading system based on the pattern of growth. There are 5 grades (from 1 to 5) based upon the architectural patterns. Adenocarcinomas of the prostate are given two grade based on the most common and second most common architectural patterns. These two grades are added to get a final grade of 2 to 10. The stage is determined by the size and location of the cancer, whether it has invaded the prostatic capsule or seminal vesicle, and whether it has metastasized. The grade and the stage correlate well with each other and with the prognosis. The prognosis of prostatic adenocarcinoma varies widely with tumor stage and grade. Cancers with a Gleason score of <6 are generally low grade and not aggressive. Advanced prostatic adenocarcinomas typically cause urinary obstruction, metastasize to regional (pelvic) lymph nodes and to the bones, causing blastic metastases in most cases. Metastases to the lungs and liver are seen in a minority of cases. (Gleason, 1992) (Bostwick, 1996) (Epstein, 2010) American Urological Society Clinical Staging Stage Definition 10-year Survival A1 Incidental, <5% of volume 93-98% A2 Incidental, >5% of volume, or high grade 50% B1 Palpable nodule in one lobe but <1.5 cm in diameter 70-75% B2 Larger palpable nodule 62% C1 Invades capsule of prostate 40-50% C2 Invades seminal vesicle 33-39% D1 Metastases to regional lymph nodes, or extensive regional spread 17-20% D2 Evident distant metastases Article Source: http://library.med.utah.edu/WebPath/TUTORIAL/PROSTATE/PROSTATE.html Back To Top Pathophysiology Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time, these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells that can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder. The prostate is a zinc accumulating, citrate producing organ. The protein ZIP-1 is responsible for the active transport of zinc into prostate cells. One of zinc's important roles is to change the metabolism of the cell in order to produce citrate, an important component of semen. The process of zinc accumulation, alteration of metabolism, and citrate production is energy inefficient, and prostate cells sacrifice enormous amounts of energy (ATP) in order to accomplish this task. Prostate cancer cells are generally devoid of zinc. This allows prostate cancer cells to save energy not making citrate, and utilize the new abundance of energy to grow and spread. The absence of zinc is thought to occur via a silencing of the gene that produces the transporter protein ZIP-1. ZIP-1 is now called a tumor suppressor gene product for the gene SLC39A1. The cause of the epigenetic silencing is unknown. Strategies which transport zinc into transformed prostate cells effectively eliminate these cells in animals. Zinc inhibits NF-κB pathways, is anti-proliferative, and induces apoptosis in abnormal cells. Unfortunately, oral ingestion of zinc is ineffective since high concentrations of zinc into prostate cells is not possible without the active transporter, ZIP- Journal-molecular cancer, review, 2006 5:17, doi:10.1186/1476-4598-5-17 RUNX2 is a transcription factor that prevents cancer cells from undergoing apoptosis thereby contributing to the development of prostate cancer. The PI3k/Akt signaling cascade works with the transforming growth factor beta/SMAD signaling cascade to ensure prostate cancer cell survival and protection against apoptosis. X-linked inhibitor of apoptosis (XIAP) is hypothesized to promote prostate cancer cell survival and growth and is a target of research because if this inhibitor can be shut down then the apoptosis cascade can carry on its function in preventing cancer cell proliferation. Macrophage inhibitory cytokine-1 (MIC-1) stimulates the focal adhesion kinase (FAK) signaling pathway which leads to prostate cancer cell growth and survival. The androgen receptor helps prostate cancer cells to survive and is a target for many anti cancer research studies; so far, inhibiting the androgen receptor has only proven to be effective in mouse studies. Prostate specific membrane antigen (PSMA) stimulates the development of prostate cancer by increasing folate levels for the cancer cells to use to survive and grow; PSMA increases available folates for use by hydrolyzing glutamated folates. Article Source:http://en.wikipedia.org/wiki/Prostate_cancer Back To Top Prostate Cancer Hormone Therapy May Prove Successful in Treatment of Surgery-Resistant Cancer Recent research into the efficacy of a new form of hormone therapy for patients with a certain type of prostate cancer has yielded encouraging results, according to a study published April 15, 2010 in The Lancet. The results indicate that the new hormone treatment, known as MDV3100, demonstrates "encouraging antitumor activity in patients with castration-resistant prostate cancer," a form of the cancer resistant to the surgical removal of the testicles. The study involved 140 American with castration-resistant prostate cancer who were given varying doses of MDV3100, ranging from 30 to 600 milligrams of the medication daily. Researchers noted that the primary objective of the trial was to "identify the safety and tolerability profile of MDV3100 and to establish the maximum tolerated dose," which was determined to be 240 milligrams of the medication. Prostate cancer becomes castration-resistant when cancerous cells continue to grow, re-grow and thrive without as much testosterone, which allows the tumors in the prostate to mature. It is not clear whether or not the treatment will receive federal approval, as only two of the three required research phases have been completed. Completion of the third phase is underway, with researchers working to compare the treatment to a placebo to determine if the therapy prolongs the life of men with prostate cancer. Article Source: http://www.drugwatch.com/news/2010/04/15/prostate-cancer-hormone-therapy-may-prove-successful-treatment-surgery-resistant-can/ Back To Top Prostate cancer patients with low-risk tumors could hold off treatment With the advent of PSA (prostate antigen) screening nearly 20 years ago, doctors started to detect prostate cancers at much earlier stages. This was explained by corresponding author Dr. Martin Sanda, Director of the Prostate Cancer Center at BIDMC and Associate Professor of Surgery at Harvard Medical School. Dr Martin Sanda commented, “Consequently, while PSA testing has enabled us to successfully begin aggressive treatment of high-risk cancers at an earlier stage, it has also resulted in the diagnosis of cancers that are so small they pose no near-term danger and possibly no long-term danger.” Sanda, jointly with coauthors from Brigham and Women’s Hospital, the Harvard School of Public Health and the University of California, San Francisco, checked the Health Professionals Follow-Up Study which is a big cohort study including about 51,529 men who have apparently been followed since 1986. Every two years, the participants supposedly replied to questionnaires about diseases and health-related topics, as well as whether they have been diagnosed with prostate cancer. A sum of about 3,331 men apparently accounted to receive a diagnosis of prostate cancer between 1986 and 2007. Additional study discovered that among this sub-group, about 342 men, just over 10 percent had apparently chosen to postpone treatment for one year or longer. After 10 to 15 years, half of the men who had primarily delayed treatment apparently still had not gone through any treatment for prostate cancer. Sanda explained, “We wanted to find out how this group of men fared in the long-term. So we looked at the data they provided us at an average of eight years after their initial diagnosis, and compared it with data provided by prostate-cancer patients who had opted for aggressive treatment, such as surgery, radiotherapy or hormonal therapy. We found that the deaths attributed to prostate cancer were very low among the men with low-risk tumors. Our analysis showed that only two percent of the men who deferred treatment eventually died of the disease, compared with one percent of the men who began treatment immediately following their diagnosis. This is not a statistically significant difference.” The three types of prostate cancer were identified as high risk, which may be big, quicker growing cancers, intermediate risk and low-risk, which could be small and slower growing cancers. There is apparently plenty of proof that treating intermediate and high-risk cancers with surgery, radiation or hormone therapy may save lives. But how to take care for low-risk cancer supposedly is not certain. Sanda remarked, “These findings showed that men diagnosed with low-risk tumors who deferred treatment were still doing fine an average of eight years — and up to 20 years — following their diagnosis. In fact, only half of these men wound up undergoing any treatment 10 to 15 years post-diagnosis. This means that they were able to avoid the disruption in their quality of life which might have occurred had they undergone immediate treatment.” Sanda adds, “If this approach was more broadly accepted as a standard care option for suitable low-risk prostate cancers, it might help us avoid throwing the baby out with the bathwater when it comes to the PSA test. Instead of just abandoning the PSA test because it might be leading to an overdiagnosis of prostate cancer, we could conduct PSA screening in a way that allows more aggressive prostate cancers to be treated, while less aggressive tumors could initially be monitored.” Sanda believes that this would avoid problems due to treatment of ‘overdiagnosed’ low-risk cancers, while preserving the life saving benefits of treating aggressive cancers that have been detected through PSA testing. Article Source: http://www.healthjockey.com/2009/09/15/prostate-cancer-patients-with-low-risk-tumors-could-hold-off-treatment/ Back To Top Ultra-sensitive test to tell prostate cancer patients if they are cured after operation Scientists are developing an ultra-sensitive test which will accurately predict whether men with prostate cancer are cured after surgery. The test should allow doctors to tell patients that the cancer has been completely removed, or recommend further treatment to stop it coming back. It is 300 times more reliable than current commercial tests that measure levels of protein called PSA (prostate-specific antigen) in the blood. Men who have had their cancerous prostate gland removed are checked for PSA, which signals the presence of cancer cells that may have spread to the rest of the body. But existing tests often fail to detect these cells, resulting in cancer recurring in 40 per cent of patients who had been given the all-clear. The new VeriSens test uses nanoparticle-based technology that appears to more accurately chart the course of the disease after surgery. It may pick up cancer recurrence earlier, when secondary treatment is more effective for a patient's survival. The study results were released yesterday by scientists at Chicago's Northwestern University Feinberg School of Medicine and the University International Institute for Nanotechnology. Co-principal investigator Dr C. Shad Thaxton said: 'This test may provide early and more accurate answers. 'It detects PSA at levels in the blood that cannot be detected by conventional tests. 'It may allow physicians to act at the earliest and most sensitive time, which will provide the patient with the best chance of long-term survival.' Dr Thaxton said the next step for scientists was a clinical trial to compare the nano-particle PSA test to traditional PSA tests and determine if earlier detection and treatment can save lives. Fellow researcher Dr William Catalona added: 'It should be especially useful in the early identification of men who would benefit from postoperative radiation therapy and those who need postoperative salvage radiation therapy for recurrence.' John Neate, chief executive of the Prostate Cancer Charity, said: 'This new study describes a new diagnostic tool, a nanoparticle-based PSA test, which appears to give very accurate PSA readings at much lower levels than the standard follow-up tests currently used. 'It is too soon to know whether the test will have a place in clinical practice. 'Only through further studies would the researchers be able to identify whether being able to detect the return of prostate cancer at an earlier stage would have the desired effect of improving long-term survival.' Article Source: http://www.dailymail.co.uk/health/article-1283472/Prostate-cancer-test-let-patients-know-cured-operation.html?ITO=1490 Back To Top Sound waves prostate cancer treatment may have lesser side effects on the patient Prostate cancer may now be effectively treated in a non-invasive manner, which may even result in lesser side effects. Such a treatment is believed to be possible through an experimental cancer therapy, called the High-Intensity-Focused Ultrasound (HIFU). This therapy, which uses sound waves to destroy the tumor cells, is believed to have been tested in a trial conducted in London at the University College Hospital and the Princess Grace Hospital. The study experts have explained that HIFU is a therapy which uses high frequency sound waves to heat a specific area to the temperature of about 80-90◦C. This therapy may possibly be used to treat either the entire prostate or merely a specific targeted cancer region. Men suffering from prostate cancer may usually be treated with either radiotherapy or surgery. Often surgery may require the patient to stay in the hospital for a period of 2-3 days; while radiotherapy may notably require daily treatment as an outpatient for atleast 1 month. Thereby, in order to better understand the effect of the HIFU therapy on patients with prostate cancer, the study investigators notably tested this therapy on more than 150 such patients. It was further also stated that these patients were treated with this particular therapy under general anesthesia. The experts have stated that five hours after receiving the HIFU therapy, the patients were evidently discharged from the hospitals. More so, out of some of the patients which were followed for a year, around 92% of them didn’t seem to re-experience prostate cancer. Even though it was noted that this study may not be a comparative study, it is presumed that the presently used treatments may reveal similar statistics of men showing no recurrence of the disease after one year. Lead study expert, Dr. Hashim Ahmed, UCL’s division of surgical and interventional science, says that, “This study suggests it’s possible that HIFU may one day play a role in treating men with early prostate cancer with fewer side effects. But we don’t yet know for sure if HIFU is more effective than traditional treatments so it will be important to carry out further studies involving a larger number of patients followed over a longer period of time to truly compare the long term effectiveness of this treatment.” Apart from this, Professor Peter Johnson, chief clinician at the Cancer Research UK, says that, “This technique needs careful evaluation to make sure that it can produce the same results as the proven treatments for early prostate cancer. If the treatment can be shown to have less side effects then that will be excellent news, but more research is needed to show this. Cancer Research UK is funding a trial to look at this question and we hope that further studies can be carried out to compare HIFU to standard treatments.” Out of the patients followed for one year after their HIFU therapy, it was observed that 1 man had incontinence, while around 30-40% of them had impotence. On the other hand, neither of the patients was noted to experience any bowel-related issues. In contrast to this, a different ratio was presumed to take place for the patients who may either undergo surgery or radiotherapy. It was presumed that around 5-20% of these patients may experience incontinence, while almost 50% may have impotence. Apart from this, around 5-20% of the patients may even experience various other ill-effects of radiotherapy like pain, bleeding and diarrhea. Article Source: http://www.healthjockey.com/2009/07/02/sound-waves-prostate-cancer-treatment-may-have-lesser-side-effects-on-the-patient/ Back To Top Why you should consider a prostate cancer PSA test today Prostate cancer kills if allowed to grow. If ever there was a good reason to have a simple blood test, this is it. The prostate cancer PSA (prostate specific antigen) test is one of the tests given to determine if cancer cells are present in an otherwise healthy prostate. It is a simple blood test to help doctors diagnose and identify the existence of prostate cancer. The PSA test, although considered a prostate-specific test, is not really an absolute definitive test for the cancer. Depending on the research conducted, the PSA test is known to be somewhere between 85 and 95 percent accurate in identifying prostate cancer. While an elevated PSA test may suggest the presence of prostate cancer, it’s not an absolute. However, if you have an elevated result, your doctor will probably want to do additional testing for a more complete and accurate assessment of the potential cancer. The last thing you want to do is to allow prostate cancer to grow beyond the prostate gland. The good news is that benign prostatic hyperplasia (BPH), better known as an enlarged prostate, can also elevate the PSA test results. Even prostatitis and lower urinary tract symptoms can show elevated levels of PSA, so if you have an elevated test result, don’t panic. A normal result from a PSA test doesn’t guarantee that you’re free from cancer, nor does a higher-than-normal result mean you do have cancer. It’s critical that you follow your doctor’s lead in regard to dealing with the PSA test results. The results are an indication, and should be used as a tool to develop a complete diagnosis. To complicate matters more, PSA levels can also increase with age. The relative size of your prostate also plays a factor in interpreting the results. As many as two out of three people with elevated PSA readings do not have a malignancy. TEST BENEFITS Here’s a quick list of the benefits and reasons why you should consider getting a PSA test: 1. It’s possible to detect a cancerous condition before any symptoms are known. 2. Early detection catches prostate cancer before it has spread, increasing the chances of a complete cure. 3. The PSA blood test has been recognized as a contributing factor that has significantly reduced the number of prostate cancer deaths. While the PSA test can also deliver a false positive about 20 percent of the time, it is recognized as a good indicator of potential cancerous conditions and should be taken seriously. A 2005 Harvard study indicated that men having an annual PSA test were almost three times less likely to die of prostate cancer than men who didn’t bother with the test. So, the best reason to have the test is that without it, you greatly increase the chances of dying from prostate cancer. Article Source: http://www.silive.com/healthfit/index.ssf/2010/05/why_you_should_consider_a_prostate_cancer_psa_test_today.html Back To Top