Tuesday, August 16, 2011

New analysis indicates that risk of bladder cancer from smoking greater than previously reported

CHICAGO – An analysis of data that includes nearly 500,000 individuals indicates that the risk of bladder cancer among smokers is higher than reported from previous population data, and that the risk for women smokers is comparable with that of men, according to a study in the August 17 issue of JAMA.

More than 350,000 individuals are diagnosed with bladder cancer per year worldwide, including more than 70,000 per year in the United States. Tobacco smoking is the best established risk factor for bladder cancer in both men and women, with previous studies indicating that current cigarette smoking triples bladder cancer risk relative to never smoking, according to background information in the article. "However, the composition of cigarettes has changed during the past 50 years, leading to a reduction in tar and nicotine concentrations in cigarette smoke, but also to an apparent increase in the concentration of specific carcinogens, including beta-napthylamine, a known bladder carcinogen …," the authors write. They add that changing smoking prevalence and cigarette composition warrant revisiting risk estimates for smoking and bladder cancer.

Neal D. Freedman, Ph.D., M.P.H., of the National Cancer Institute, Department of Health and Human Services, Rockville, Md., and colleagues conducted a study to examine the association between tobacco smoking and bladder cancer using data from men (n = 281,394) and women (n = 186,134) in the National Institutes of Health-AARP (NIH-AARP) Diet and Health Study, who completed a lifestyle questionnaire and were followed up between October 1995 and December 2006. Previous studies of smoking and incident bladder cancer were identified by systematic review of the available literature.

During the course of follow-up, 3,896 men and 627 women were newly diagnosed with bladder cancer. Cigarette smoking was a significant risk factor for bladder cancer in both sexes. Relative to never smokers, former and current smokers had increased risk of bladder cancer in both men and women. Analysis of the data indicated that former smokers had a 2.2 times increased risk of bladder cancer and that for current smokers, the risk was about 4 times higher, relative to never smokers. "In contrast, the summary risk estimate for current smoking in 7 previous studies (initiated between 1963 and 1987) was 2.94," the authors write.

Ever smoking explained a similar proportion of bladder cancer in both sexes, with population attributable risks of 50 percent in men and 52 percent in women.

The researchers write that factors that may have strengthened the cigarette smoking-bladder cancer association include changes in the constituents of cigarette smoke (such as increased concentrations of beta-napthylamine), and increased awareness of bladder cancer risk in smokers, which may prompt earlier diagnostic workup.

"These results support the hypothesis that the risk of bladder cancer associated with cigarette smoking has increased with time in the United States, perhaps a reflection of changing cigarette composition. Prevention efforts should continue to focus on reducing the prevalence of cigarette smoking."

Friday, August 12, 2011


Prostate cancer that has become resistant to hormone treatment and that does not respond to radiation or chemotherapy requires new methods of treatment. By attacking stem cell-like cells in prostate cancer, researchers at Lund University are working on a project to develop a new treatment option.

A successful interdisciplinary project is underway between two research groups, in which senior researcher Rebecka Hellsten and Professor Anders Bjartell at the Faculty of Medicine’s division for Urological Cancer Research, Skåne University Hospital in Malmö, and Professor Olov Sterner and Assistant Professor Martin Johansson at the Lund University division of Organic Chemistry recently published their latest research findings in the scientific online journal PLoS ONE.

“Prostatic tumours are thought to consist only of about 0.1 per cent cancer stem cells, but if you are not successful in eradicating that tumour cell population, there is a risk of subsequent uncontrolled growth of the tumour. The cancer stem cells are often unresponsive to both hormonal treatment and to chemotherapy, so it is essential to develop a direct treatment towards all types of cancer cells”, says Anders Bjartell.

Exploring the tumour biology of prostate cancer, the research group have now observed that the protein STAT3 is active in the stem cell-like cells. In their previous studies, they have proven that the natural compound galiellalactone affects STAT3 and has inhibitory effects on the growth of prostate cancer.

Through the development of new specific STAT3-inhibitors with galiellalactone as a model, the researchers hope to develop targeted therapies that attack the stem cell-like cancer cells in prostate cancer and prevent the tumour from growing and spreading.

Monday, August 8, 2011

Men Have Overly Optimistic Expectations About Recovery from Prostate Cancer Surgery


Nearly half of men undergoing surgery for prostate cancer expect better recovery from the side effects of the surgery than they actually attain one year after the operation, a University of Michigan Comprehensive Cancer Center study finds.
In addition, prior to surgery, a small proportion of men had expected to have better urinary continence and sexual functions a year after the surgery than they had before it – the exact opposite of what typically happens.

“This is a belief that does not reflect preoperative counseling which, on the contrary, alerts men to urinary and sexual problems after surgery,” says study author Daniela Wittmann, M.S.W, sexual health coordinator at the U-M prostate cancer survivorship program.

The study, published in the August issue of the Journal of Urology, surveyed 152 men undergoing radical prostatectomy, an operation to remove the prostate. All of the men filled out questionnaires before surgery, after receiving preoperative counseling. The questions asked the men about their expectations of urinary, bowel, hormonal and sexual function a year after the surgery.

The study showed that for the most part, men’s expectations of hormonal and bowel function matched what happened one year after surgery. But, when it came to urinary incontinence only 36 percent of the men’s expectations corresponded to what happened one year post-surgery.

In addition, only 40 percent of men found what they expected for sexual function to be true one year post-surgery.

Also, 46 percent of the men found worse than expected outcomes in urinary incontinence and 44 percent of men found worse than expected outcomes in sexual function one year after surgery.

"When we provide preoperative education, we can only inform men in terms of overall statistics. We can't predict for the individual,” explains Wittmann. “This may mean that, if in doubt, people tend toward being hopeful and optimistic, perhaps overly optimistic.”

The researchers suggest that it is important to provide men with tools for urinary and sexual recovery after surgery and with support that will lead to the best possible outcome.

Patients who undergo surgery for prostate cancer at U-M participate in the prostate cancer survivorship program. The program includes partners as well. It is designed to provide men with excellent surgical care along with tailored, couples-oriented support both before and after surgery to help ease recovery from the side-effects of surgery.
“Although preoperative education is very important and should be explicit about the general expectations regarding outcomes, we also need to help men and their partners with the recovery process after surgery in order to help them regain their intimate lives,” says Wittmann.

Improved radical surgery techniques provide positive outcomes for bladder cancer patients


Bladder cancer patients who have radical surgery at university hospitals can benefit from excellent local control of the disease, acceptable clinical outcomes and low death rates, according to research in the August issue of the urology journal BJUI.

Researchers studied 2,287 patients who had radical cystectomy surgery, where the bladder is removed, together with nearby tissue and organs as required. The surgery was performed at eight Canadian academic centres between 1998 and 2008.

The study found that there were three independent factors, apart from pathological stage at surgery, that influenced survival rates. Patients who smoked had lower survival rates, while patients who had pelvic lymphadenectomy - lymph nodes removed from the pelvic area - had higher survival rates, as did patients who received adjuvant chemotherapy, which aims to destroy microscopic cancer cells left after surgery.

However, the researchers found that neoadjuvant chemotherapy - which is often recommended prior to surgery to improve outcomes - tends to be under utilised for bladder cancer in Canada.

"Recent advances in combined radiation with chemotherapy have challenged the role of radical cystectomy (RC) with pelvic lymphadenectomy, which is used to treat muscle invasive and refractory non-muscle invasive bladder cancer" says co-author Dr Wassim Kassouf, from McGill University Health Centre, Quebec, Canada.

"These bladder-preservation strategies are potentially attractive in terms of health-related quality of life and cancer outcomes, but they only tend to work in highly selected patients.

"Advances in RC surgery have improved surgical care and techniques and reduced complications and mortality rates. The aim of our study was to evaluate a contemporary series of patients with bladder cancer to assess the clinical outcomes and identify any variables that affected their long-term health."

Key findings of the study included:

- 79% of the patients were male, the median age was 68 and the average follow-up of live patients was just over 29 months. 66% reported a family history of tobacco smoking.
- More than three-quarters of the patients had high-grade tumours. Pathological specimen examination revealed no evidence of cancer in 7% of patients, muscle invasive disease in 73% and positive nodal involvement in 25%.
- Adjuvant chemotherapy was offered to 19% of patients and neoadjuvant chemotherapy to just over 3%.
- All patients had previously undergone transurethral resection of bladder tumours and the median time from this to RC surgery was 49 days. This is similar to waiting times reported in international studies conducted in Sweden (49 days), the USA (42 days) and Germany (54 days).
- The 30, 60 and 90-day death rates were 1.3%, 2.6% and 3.2% respectively. Cancer returned in 33% of patients within a median of 10 months. Local recurrence rates were 6% in the overall group and 4% in the organ-confirmed node-negative group.
- The five-year overall, recurrence-free and cancer-specific survival rates were 57%, 48% and 67% respectively.

Multivariate analysis showed that lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy and an absence of smoking were associated with prolonged disease-specific and overall survival.

"Our study shows that very good results can be achieved when RC is performed at academic centres within a universal healthcare system and that it remains an effective clinical option for treating patients with bladder cancer" says Dr Kassouf.