Prostate Cancer Test May Aid Treatment Choice!

April 20, 2010 (Washington, D.C.) -- Researchers are developing a new blood test to help identify which men with early prostate cancer can forgo immediate treatment.

In a small preliminary study, the test proved 70% accurate in predicting which men had more aggressive tumors that require treatment.

The results have yet to be replicated, a necessary step before acceptance by the medical community.

But the test shows promise for safely identifying men who can undergo active surveillance -- close monitoring for signs of tumor growth -- rather than treatment, says Robert W. Veltri, PhD, an associate professor of urology and oncology at Johns Hopkins University.

"The goal of the new test, which measures blood levels of three different forms of PSA, is to determine who will and who will not progress and require treatment," Veltri says.

The findings were presented at the annual meeting of the American Association for Cancer Research.

Prostate Cancer: To Treat or Not?

To treat or not to treat is one of the most difficult dilemmas facing men with prostate cancer, especially men with early, localized cancer that is contained within the prostate, when it is curable.

Because prostate cancer often grows so slowly it may never become life-threatening, many of these men, particularly older men, may die of other causes before the prostate cancer causes problems. But in some men, the cancer will spread beyond the prostate without treatment. Then it may no longer be curable.

As a result, there has been a long-running debate in the medical community about the value of treatment to destroy cancer cells vs. active surveillance, also known as watchful waiting.

Watchful waiting consists of close monitoring with periodic digital rectal exams, yearly biopsies, and PSA (prostate-specific antigen) blood tests.

New Prostate Cancer Test Shows Promise

Rising PSA levels can be a sign of prostate cancer spread in men with early cancer. But the PSA test can't distinguish between slow-growing and aggressive cancers, Veltri tells WebMD.

"Because of PSA, there is overdiagnosis and overtreatment of prostate cancer," he says.

The new blood test, known as the Prostate Health Index (PHI), measures three forms of PSA, including pro-PSA. Pro-PSA is a shortened molecule that is missing a few of the amino acids that make up the PSA protein. It's the most accurate form of PSA, Veltri says.

The federally funded study involved 71 men who were diagnosed as having small, low-grade, and low-stage prostate cancer based on their PSA results. At the time of their diagnosis, their blood had been banked.

By an average of nearly four years later, 39 had unfavorable biopsy results that signaled a need for treatment.

The PHI test was performed on blood samples from all 71 men.

"When we combined the [biopsy results] and the serum Prostate Health Index, we were able to predict seven in 10 men that might progress," Veltri says.

Veltri says the PHI test won't replace biopsies but will hopefully allow men to have them every other year instead of year.

His lab is now conducting an expanded study to look for other biomarkers that may predict aggressive cancers.

Test May Predict Prostate Cancer Spread

Also at the meeting, researchers reported using a microchip to detect circulating tumor cells in the blood of people with prostate cancer.

The presence of circulating tumor cells, or CTCs, in the blood is an indication of cancer spread, says Sunitha Nagrath, PhD, an instructor of surgery and bioengineering at Harvard Medical School.

CTCs also carry molecular signatures that can be used to guide targeted drug therapy, she says. The problem: There are only a few CTCs in millions of cells, she tells WebMD. "It’s like looking for a needle in a haystack."

The CTC-chip can capture about 200 circulating tumor cells from a teaspoon of blood, she says.

In a small pilot study, the researchers found CTCs in nearly half of 20 people with early-stage prostate cancer and in two-thirds of people with advanced cancer.

"We think that's an indicator they are more prone to metastasis (cancer spread), but that remains to be proven," Nagrath says.

The test is not commercially available.

"Eventually we hope that when a patient walks in, we can take a simple blood test that tells us if a cancer will spread and also about its molecular signature," she says.

Massimo Cristofanilli, MD, chairman of the department of medical oncology at Fox Chase Cancer Center, is cautiously enthusiastic, saying that a lot more work is needed before either test can be integrated into patient care.

With the CTC chip, he says, one of the issues to be worked out is when to give the test: at the time of diagnosis, surgery, or a few weeks afterward.

There's also the issue of who will pay for new tests, he says. "Insurance will not cover every test for very patient," Cristofanilli tells WebMD.

Article courtesy of WebMD.

Are Prostatitis & Periodontal Disease Linked?

ScienceDaily (Apr. 28, 2010) — Researchers from Case Western Reserve University School of Dental Medicine and University Hospitals Case Medical Center report initial results from a small sample that inflammation from gum disease and prostate problems just might be linked. They discuss their new evidence in the Journal of Periodontology, the official journal of the American Academy of Periodontology.The researchers compared two markers: the prostate-specific antigen (PSA) used to measure inflammation levels in prostate disease, and clinical attachment level (CAL) of the gums and teeth, which can be an indicator for periodontitis.

A PSA elevation of 4.0 ng/ml in the blood can be a sign of inflammation or malignancy. Patients with healthy prostate glands have lower than 4.0ng/ml levels. A CAL number greater than 2.7 mm indicates periodontitis.

Like prostatitis, periodontitis also produces high inflammation levels.

"Subjects with both high CAL levels and moderate to severe prostatitis have higher levels of PSA or inflammation," stated Nabil Bissada, chair of the department of periodontics in the dental school.

Bissada added that this might explain why PSA levels can be high in prostatitis, but sometimes cannot be explained by what is happening in the prostate glands.

"It is something outside the prostate gland that is causing an inflammatory reaction," he said.

Because periodontitis has been linked to heart disease, diabetes and rheumatoid arthritis, the researchers felt a link might exist to prostate disease.

Thirty-five men from a sample of 150 patients qualified for the study, funded by the department of periodontology at the dental school. The participants were selected from patients at the University Hospitals Case Medical Center with mild to severe prostatitis, who had undergone needle biopsies and were found to have inflammation and in some patients, malignancies.

The participants were divided into two groups: those with high PSA levels for moderate or severe prostatitis or a malignancy and those with PSA levels below 4 ng/ml. All had not had dental work done for at least three months and were given an examination to measure the gum health.

Looking at the results, the researchers from the dental school and the department of urology and the Institute of Pathology at the hospital found those with the most severe form of the prostatitis also showed signs for periodontitis.

Other authors on the paper, "Association between Periodontal Disease and Prostate-Specific Antigen Levels in Chronic Prostatitis Patients," were: Nishant Joshi, Sena Narendran, Rick Jurevic and Robert Skillicorn from the CWRU dental school; and Donald Bodner and Gregory T. MacLennon from the University Hospitals Case Medical Center.

Prostate Health Guide!

The Keys to Promoting Good Prostrate Health–Diet and Exercise, Supplements, and Alternative Therapies. Given the amount of attention that is being placed on prostate health in recent years, the question that many men are asking themselves has become “how to promote good prostate health.”

Prostate cancer is the most common malignancy in males, and is responsible for an increasing number of deaths every year as Americans are living well into their late seventies and eighties.

The most important thing that you can do to ensure that you have a healthy prostate is to eat a diet that is high in fruits and vegetables, and get plenty of exercise. The body can produce its own anti cancer agents if it has the raw materials, almost all of which are found in fruit and vegetable matter. Exercise is also very important in the promotion of prostate health, since a body that receives enough exercise has lower fat levels, fewer toxins, and a healthier immune system than one that does not receive enough exercise.

Another important component of prostate health is taking supplements that promote good prostate health. A traditional folk remedy for prostate problems is to eat pumpkin seeds. Modern scientific studies have revealed that the element Zinc is vital to maintaining prostate function. Though it is approximately the size of a walnut, the prostate is the body’s leading consumer of Zinc. It turns out that pumpkin seeds have a very high Zinc content. It is amazing how often folk remedies stand up in the face of scientific inquiry.

The prostate is a gland that is almost never thought about until it causes trouble. Prostate problems are relatively rare in younger men, but become increasingly common as men age beyond the age of fifty. It is therefore very important to take care of the prostate since life spans are increasing and prostate problems that never developed since the individual died before their onset are becoming more and more prevalent. Look to good prostrate health.

Article courtesy of prostatehealthnews.org

Proper Prostate Nutrition

Prostate Cancer Nutrition

- If you have been diagnosed with prostate cancer, you may want to consider revamping your diet in an effort to increase your chance of living longer and staying healthy through treatments. Below are some of the best “cancer fighters”; in fact, some may be in your fridge, freezer, or pantry right now.

Blueberries & Strawberries – Full of free radical-fighting antioxidants, these delicious summer fruits are also helpful in the war against cancer. Don’t fret if they are out of season; most grocery stores stock these power boosters in the freezer section (and they are just as healthy as their fresh versions.) Throw some on cereal, create a smoothie, or just eat them raw.

Anything with Fiber – It has long been accepted that people who eat serious amounts of fiber are, generally, healthier. And that goes for individuals who have been diagnosed with cancer, too. Choose sources of fiber that have little fat and sugar, such as whole grain cereals sans sweetener and any of the wide variety of beans (kidney, great northern, white, lima) available.

Soy – The lower incidence of cancers in soy-eating countries (especially those in Asian) has raised many persons’ eyebrows and encouraged those who have been diagnosed with cancer to try soy foods. It’s easy to replace your cereal milk with soy milk or to put a little soy milk in your coffee. (But not your decaf coffee; many people feel that the process used to decaffeinate the dark brew is actually harmful.) You can also try your hand at making tofu; just go easy on the oils. Tofu is like a sponge and will readily soak up cooking fats.

Fish – If you want a cancer-fighter, try some healthy omega-3 laden fish. Look for bluefish, swordfish, tuna, and salmon for the most bang. Is it expensive? Perhaps (except for canned tuna). However, it’s long been known that it’s one of the best ways to rid your bodies of the toxins that many people feel allow cancers to grow.

Green Tea – Again, in the Asian countries where cancer is rarer, people tend to drink copious amounts of green tea. Try yours with a little honey, but lay off the processed sugar for the most benefit.

Article courtesy of prostatehealthnews.org

Coffee May Help Reduce Advanced Prostate Cancer

ScienceDaily (Dec. 8, 2009) — While it is too early for physicians to start advising their male patients to take up the habit of regular coffee drinking, data presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference revealed a strong inverse association between coffee consumption and the risk of lethal and advanced prostate cancers.

"Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer. It was plausible that there may be an association between coffee and prostate cancer," said Kathryn M. Wilson, Ph.D., a postdoctoral fellow at the Channing Laboratory, Harvard Medical School and the Harvard School of Public Health.

In a prospective investigation, Wilson and colleagues found that men who drank the most coffee had a 60 percent lower risk of aggressive prostate cancer than men who did not drink any coffee. This is the first study of its kind to look at both overall risk of prostate cancer and risk of localized, advanced and lethal disease.

"Few studies have looked prospectively at this association, and none have looked at coffee and specific prostate cancer outcomes," said Wilson. "We specifically looked at different types of prostate cancer, such as advanced vs. localized cancers or high-grade vs. low-grade cancers."

Caffeine is actually not the key factor in this association, according to Wilson. The researchers are unsure which components of the beverage are most important, as coffee contains many biologically active compounds like antioxidants and minerals.

Using the Health Professionals' Follow-Up Study, the researchers documented the regular and decaffeinated coffee intake of nearly 50,000 men every four years from 1986 to 2006; 4,975 of these men developed prostate cancer over that time. They also examined the cross-sectional association between coffee consumption and levels of circulating hormones in blood samples collected from a subset of men in the cohort.

"Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be very exciting if this association is confirmed in other studies," said Wilson. "Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer."

This association might also help understand the biology of prostate cancer and possible chemoprevention measures.

Stage 4 Prostate Cancer Information

- As with all cancers, prostate cancer is staged according to how far along the cancer has progressed. Usually, these stages are represented with Roman numerals, such as I, II, III, and IV, a system that was developed by the American Join Committee on Cancer to standardize staging. As you might expect, stage IV (or 4) is the most advanced type of prostate cancer.

If you have been diagnosed with a stage 4 prostate cancer, you might be wondering how it relates to the other stages. Often, cancer patients are confused by the staging designations and require some further clarification. As a quick primer, the stages of prostate cancer are listed below:

Stage I – Cancer is well within the prostate gland and has not spread. If you’ve had a biopsy, fewer than 5% of the biopsy tissue contained cancer.

Stage II – In this state, the cancer is also within the prostrate gland and hasn’t spread. However, during a biopsy, the tissue contained more than 5% cancerous cells.

Stage III – At this point, the cancer has spread outside the prostate gland area, but not to the lymph nodes or other body parts that are farther away from the prostate.

Stage IV – In stage 4, the prostate cancer has spread to other areas of the body, including some that are considered “far away” from the prostate gland (such as the lymph nodes.)

As you can see, stage 4 cancers need to be dealt with more aggressively and efficiently than other types. In fact, many stage 1 patients may choose to adopt a “wait and see” attitude toward their cancer rather than immediately attacking the cancer at its source. However, this isn’t an option for stage 4 patients.

By the time it reaches a stage 4 prostate cancer , you may need to choose radiation or chemotherapy in addition to surgery to eradicate the cancer. At this point, your doctor can provide you with all the answers you need to make the most informed decision possible.

Article courtesy of prostatehealthnews.org

Prostate Treatments & PSA Predicts Death From Prostate Cancer

ScienceDaily (Nov. 9, 2009) — Men whose prostate specific antigen (PSA) rise within 18 months of radiotherapy are more likely to develop spread and die of their disease, according to an international study led by Fox Chase Cancer Center radiation oncologist Mark K. Buyyounouski, M.D., M.S. and presented today at the annual meeting of the American Society for Radiation Oncology (ASTRO).

"PSA is the gold standard for following prostate cancer patients after they receive radiation or surgery. But we haven't know if having PSA rise sooner means a patient has a greater danger of dying of prostate cancer, though it seems logical," Buyyounouski says.

Using a single institution database, Buyyounouski and colleagues showed previously that men who suffered an early biochemical failure, which is defined as their lowest PSA level plus 2 ng/mL, were at greater risk of dying of prostate cancer. The new study confirms those results using a multinational database and shows that the measure is ready for use in the clinic.

"Now we can use the simple criteria from this study, which is widely available for anyone who has PSA testing, to identify men who have a greater than 25% chance of dying from prostate cancer in the next five years. That is huge. There is nothing else that can do that," says Buyyounouski.

A total of 2,132 men with clinically localized prostate cancer who suffered biochemical failure after treatment were studied. The median interval between treatment and biochemical failure was 35.2 months for the entire study group. However, 19% of patients developed biochemical failure at 18 months or less. The five-year cancer-specific survival for these men was 69.5% compared with 89.8% for men who developed biochemical failure after 18 months.

A multivariate analysis showed that the interval to biochemical failure correlated with cancer specific survival, as did Gleason score, tumor stage, age, and PSA doubling time. However, the interval to biochemical failure had the best predictive value for cancer-specific mortality, compared with the other variables.

Currently, most physicians do not start treatment based on biochemical failure alone, but rather wait until the PSA reaches a high level or there is some other evidence tumor spread. "The potential impact of this finding is that patients can initiate treatment far sooner without waiting for other signs or symptoms of prostate cancer," Buyyounouski says. "If a patient has biochemical failure at 16 months, rather than wait and learn later that the PSA is rising sharply and risk the development of distant metastasis, therapy can be started sooner based on the increased risk of death."