Tuesday, April 17, 2012
Kidney cancer patients do better when whole kidney is not removed
Surgery to remove only the tumor preferable to removing entire kidney
Kidney cancer patients who had only their tumor removed had better survival than patients who had their entire kidney removed, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.
After an average of five years, 25 percent of patients who had a so-called partial nephrectomy, in which only the tumor and a small margin of healthy tissue is removed, had died, while 42 percent of patients who had radical nephrectomy, in which the entire kidney is removed, had died, the study found. Results appear in the April 18 Journal of the American Medical Association.
"For patients who are candidates for partial nephrectomy, it should be the preferred treatment option. We found that patients who were younger or had pre-existing medical conditions benefited most from partial nephrectomy," said lead study author Hung-Jui Tan, M.D., a urology resident at the U-M Medical School.
The researchers looked at 7,138 Medicare beneficiaries with early stage kidney cancer up to eight years after treatment. Patients were equally likely to die of kidney cancer, regardless of the type of surgery they received, suggesting that each procedure was equally likely to cure the cancer. The survival discrepancy was found in the number of patients who died from any cause.
The study showed that if only seven patients chose partial nephrectomy over radical nephrectomy, it would save one extra life.
Early stage kidney cancers have become more common recently. These are often discovered by chance when patients receive an X-ray or CT scan for something unrelated.
"As more and more people are identified with these small, early stage cancers, there's more interest in understanding how best to treat these patients," says senior study author David C. Miller, M.D., M.P.H., assistant professor of urology at the U-M Medical School and member of U-M's Institute for Health Care Policy and Innovation.
The question, though, is whether partial nephrectomy – which is a more technically challenging procedure and potentially associated with more short-term complications – is preferable to radical nephrectomy. Removing a kidney can increase the risk of chronic kidney disease, which is associated with lipid disorders, cardiovascular disease and renal failure.
The debate is similar to breast cancer surgery, in which studies have found that lumpectomy plus radiation is comparable to mastectomy. While that choice often comes down to a cosmetic trade-off, the trade-off with kidney cancer is a potential higher risk of short-term complications with partial nephrectomy vs. avoiding chronic kidney disease in the long term.
"This study does not suggest every patient with early stage kidney cancer should get a partial nephrectomy. It supports the notion that we need to expand the use of partial nephrectomy and make it a preferred treatment choice for patients with small tumors as much as possible, to optimize long term survival," Miller says.
Intensity Modulated Radiation Therapy optimal for localized prostate cancer
A treatment for localized prostate cancer known as Intensity Modulated Radiation Therapy (IMRT) is better than conventional conformal radiation therapy (CRT) for reducing certain side effects and preventing cancer recurrence, according to a study published in the April 18, 2012 issue of the Journal of the American Medical Association. In 2012, approximately 241,740 American men will be diagnosed with prostate cancer.
The study also showed IMRT to be as effective as proton therapy, a newer technique that has grown in popularity in recent years.
Ronald Chen, MD, MPH, senior author, says, "Patients and doctors are often drawn to new treatments, but there have not been many studies that directly compare new radiation therapy options to older ones."
Chen is assistant professor of radiation oncology and a research fellow at the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. He is a member of UNC Lineberger Comprehensive Cancer Center.
He explains, "In the past 10 years, IMRT has largely replaced conventional CRT as the main radiation technique for prostate cancer, without much data to support it. This study validated our change in practice, showing that IMRT better controls prostate cancer and results in fewer side effects.
"Our data show that in comparing IMRT to proton therapy, IMRT patients had a lower rate of gastrointestinal side effects, but there were no significant differences in rates of other side effects or additional therapies."
Study scientists report that compared to CRT, IMRT was associated with fewer diagnoses of gastrointestinal (GI) symptoms, such as rectal bleeding or diarrhea, hip fractures and additional cancer therapy, but more difficulty with sexual function. Proton therapy was associated with more GI problems than IMRT.
The UNC team used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2000-2009 for approximately 13,000 patients with non-metastatic prostate cancer. SEER is composed of 16 population-based cancer registries representing approximately 26 percent of the US population.
This study is an example of comparative effectiveness research, which seeks to inform health care decisions by providing new research-based evidence about the benefits and harms of different health care interventions.
Tim Carey, MD, director of the Sheps Center at UNC, said, "This type of research is critical, comparing one type of treatment with alternatives, so that patients and their providers can arrive at the best decisions for each individual."
CRT, IMRT and Proton therapy represent three types of radiation, each attempting to deliver radiation treatment to a tumor while minimizing radiation dose to surrounding organs. Use of proton therapy use in prostate cancer is controversial because of its high cost and unproven benefit compared to other standard forms of radiation like IMRT.
The study also showed IMRT to be as effective as proton therapy, a newer technique that has grown in popularity in recent years.
Ronald Chen, MD, MPH, senior author, says, "Patients and doctors are often drawn to new treatments, but there have not been many studies that directly compare new radiation therapy options to older ones."
Chen is assistant professor of radiation oncology and a research fellow at the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. He is a member of UNC Lineberger Comprehensive Cancer Center.
He explains, "In the past 10 years, IMRT has largely replaced conventional CRT as the main radiation technique for prostate cancer, without much data to support it. This study validated our change in practice, showing that IMRT better controls prostate cancer and results in fewer side effects.
"Our data show that in comparing IMRT to proton therapy, IMRT patients had a lower rate of gastrointestinal side effects, but there were no significant differences in rates of other side effects or additional therapies."
Study scientists report that compared to CRT, IMRT was associated with fewer diagnoses of gastrointestinal (GI) symptoms, such as rectal bleeding or diarrhea, hip fractures and additional cancer therapy, but more difficulty with sexual function. Proton therapy was associated with more GI problems than IMRT.
The UNC team used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2000-2009 for approximately 13,000 patients with non-metastatic prostate cancer. SEER is composed of 16 population-based cancer registries representing approximately 26 percent of the US population.
This study is an example of comparative effectiveness research, which seeks to inform health care decisions by providing new research-based evidence about the benefits and harms of different health care interventions.
Tim Carey, MD, director of the Sheps Center at UNC, said, "This type of research is critical, comparing one type of treatment with alternatives, so that patients and their providers can arrive at the best decisions for each individual."
CRT, IMRT and Proton therapy represent three types of radiation, each attempting to deliver radiation treatment to a tumor while minimizing radiation dose to surrounding organs. Use of proton therapy use in prostate cancer is controversial because of its high cost and unproven benefit compared to other standard forms of radiation like IMRT.
Adverse effects among different radiation therapies for prostate cancer
In an analysis of three different types of radiation therapy used to treat localized prostate cancer, compared with conformal radiation therapy, intensity-modulated radiation therapy (IMRT) was associated with fewer diagnoses of gastrointestinal adverse effects, hip fractures, and receipt of additional cancer treatments but more erectile dysfunction, while proton therapy was associated with more gastrointestinal adverse effects than IMRT, according to a study in the April 18 issue of JAMA, a theme issue on comparative effectiveness research.
Ronald C. Chen, M.D., M.P.H., of the University of North Carolina at Chapel Hill, presented the findings of the study at a JAMA media briefing at the National Press Club.
"Prostate cancer is the most common malignancy in men, with more than 200,000 diagnoses and 30,000 deaths per year. Recent advances in technology have led to costlier treatments such as minimally invasive radical prostatectomy, intensity-modulated radiation therapy, and proton therapy. The adoption of these technologies resulted in a $350 million increase in health care expenditures in 2005 alone," according to background information in the article. Various organizations have called for comparative effectiveness research of localized prostate cancer treatments. "The clinical benefit from these newer treatments is unproven, and comparative effectiveness research examining different radiation techniques is lacking," the authors write.
Dr. Chen and colleagues conducted a study to examine the comparative adverse effects and disease control outcomes after different radiation techniques in a recent cohort of prostate cancer patients. Specifically, the researchers compared IMRT, which has been rapidly adopted and is currently the most commonly used technique, with the older conformal radiation therapy; and compared proton therapy, the use of which also has increased, with IMRT. The population-based study used Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with localized prostate cancer. The primary outcomes measured were rates of gastrointestinal adverse effects (such as rectal bleeding or diarrhea) and urinary adverse effects, erectile dysfunction, hip fractures, and receipt of additional cancer therapy – as an indicator for disease recurrence.
The use of IMRT vs. conformal radiation therapy increased from 0.15 percent in 2000 to 95.9 percent in 2008. In the propensity-score adjusted analysis (n = 12,976), the researchers found that men treated with IMRT were less likely to receive a diagnosis of gastrointestinal adverse effects and hip fracture but more likely to receive a diagnosis of erectile dysfunction. Also, IMRT patients were nearly 20 percent less likely to receive additional cancer therapy.
In a propensity score-matched comparison between IMRT and proton therapy (n = 1,368), IMRT patients had a 34 percent lower risk of gastrointestinal adverse effects. There were no significant differences in rates of other adverse effects or additional therapies between IMRT and proton therapy.
"Proton therapy is a high-profile, high-cost prostate cancer treatment. Since 2007, multiple proton facilities have been built, and direct-to-consumer advertising is likely to lead to a substantial increase in use," the authors write. "Overall, our results do not clearly demonstrate a clinical benefit to support the recent increase in proton therapy use for prostate cancer."
The researchers add that the findings that patients receiving IMRT were less likely than those receiving conformal radiation therapy to undergo additional cancer treatments is consistent with the use of IMRT to deliver dose-escalated treatment, resulting in improved cancer control, as demonstrated by randomized trials. "Taken together, these results suggest that IMRT facilitated radiation dose escalation without compromising acceptable long-term morbidity."
"Comparative effectiveness research in localized prostate cancer treatments is needed because of the large number of men with this disease and the continued trend of a rapid increase in use of newer and costlier treatments with unproven clinical benefit," the authors write.
Ronald C. Chen, M.D., M.P.H., of the University of North Carolina at Chapel Hill, presented the findings of the study at a JAMA media briefing at the National Press Club.
"Prostate cancer is the most common malignancy in men, with more than 200,000 diagnoses and 30,000 deaths per year. Recent advances in technology have led to costlier treatments such as minimally invasive radical prostatectomy, intensity-modulated radiation therapy, and proton therapy. The adoption of these technologies resulted in a $350 million increase in health care expenditures in 2005 alone," according to background information in the article. Various organizations have called for comparative effectiveness research of localized prostate cancer treatments. "The clinical benefit from these newer treatments is unproven, and comparative effectiveness research examining different radiation techniques is lacking," the authors write.
Dr. Chen and colleagues conducted a study to examine the comparative adverse effects and disease control outcomes after different radiation techniques in a recent cohort of prostate cancer patients. Specifically, the researchers compared IMRT, which has been rapidly adopted and is currently the most commonly used technique, with the older conformal radiation therapy; and compared proton therapy, the use of which also has increased, with IMRT. The population-based study used Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with localized prostate cancer. The primary outcomes measured were rates of gastrointestinal adverse effects (such as rectal bleeding or diarrhea) and urinary adverse effects, erectile dysfunction, hip fractures, and receipt of additional cancer therapy – as an indicator for disease recurrence.
The use of IMRT vs. conformal radiation therapy increased from 0.15 percent in 2000 to 95.9 percent in 2008. In the propensity-score adjusted analysis (n = 12,976), the researchers found that men treated with IMRT were less likely to receive a diagnosis of gastrointestinal adverse effects and hip fracture but more likely to receive a diagnosis of erectile dysfunction. Also, IMRT patients were nearly 20 percent less likely to receive additional cancer therapy.
In a propensity score-matched comparison between IMRT and proton therapy (n = 1,368), IMRT patients had a 34 percent lower risk of gastrointestinal adverse effects. There were no significant differences in rates of other adverse effects or additional therapies between IMRT and proton therapy.
"Proton therapy is a high-profile, high-cost prostate cancer treatment. Since 2007, multiple proton facilities have been built, and direct-to-consumer advertising is likely to lead to a substantial increase in use," the authors write. "Overall, our results do not clearly demonstrate a clinical benefit to support the recent increase in proton therapy use for prostate cancer."
The researchers add that the findings that patients receiving IMRT were less likely than those receiving conformal radiation therapy to undergo additional cancer treatments is consistent with the use of IMRT to deliver dose-escalated treatment, resulting in improved cancer control, as demonstrated by randomized trials. "Taken together, these results suggest that IMRT facilitated radiation dose escalation without compromising acceptable long-term morbidity."
"Comparative effectiveness research in localized prostate cancer treatments is needed because of the large number of men with this disease and the continued trend of a rapid increase in use of newer and costlier treatments with unproven clinical benefit," the authors write.
Friday, February 17, 2012
Botanical Formula Effective In Treating Prostate Cancer
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A study published online in The International Journal of Oncology reports findings from a team of scientists at Indiana University, Methodist Research Institute, who examined a botanical formula containing botanical extracts, phytonutrients, botanically-enhanced medicinal mushrooms, and antioxidants, that kills aggressive prostate cancer tumors.
The researchers conducted experiments in mice using a human prostate cancer tumor model. This is the third publication from a major university study reporting important findings of this particular multi-nutrient prostate formula to fight the invasive behavior of aggressive prostate cancer cells, tumor growth and metastasis.
Dr. Daniel Sliva, who led the research, commented:
"Multiple studies demonstrate that this prostate formula is a possible treatment for hormone refractory (androgen independent) prostate cancer."
The findings of the study demonstrate that the prostate formula substantially inhibited tumor growth in aggressive, hormone refractory, androgen independent human-prostate cancer cells. After evaluating the formula's potential toxicity, it was deemed safe, with no signs of toxicity at the highest dosages.
Dr. Isaac Eliaz, researcher and formulator, declares:
"This study is a milestone in the research of this formula, demonstrating its safety and effectiveness in treating human prostate cancer in an animal model. These positive results offer a significant contribution to the field of prostate cancer research, and add to the growing body of published data substantiating the role of natural compounds in the treatment of prostate cancer."
The study, which used a xenograft tumor model of human prostate cancer in mice, revealed that in comparison to controls, oral administration of the formula achieved a statistically important suppression of 27% in tumor growth.
What proved even more significant was that the formula suppressed the expression of several genes that affect cancer proliferation and metastasis, three of which, IGF2, NRNF2 and PLAU/uPA are connected to potentially producing metastasis, other than controlling aggressive prostate cancer growth. The formula was also observed to substantially increase the expression of CDKN1A, a gene that fights prostate cancer by specifically inhibiting other cancer promoting cellular mechanisms.
The formula's abilities to suppress specific genes that are associated with aggressive prostate cancer growth and proliferation, and increase the expression of cancer-fighting genes, proves that this integrative formula has multiple anti-cancer mechanisms and genetic targets. The pre-clinical in vivo study supports earlier published in vitro data, which also demonstrate the formula's ability of decreasing expression of PLAU/uPA genes in aggressive, hormone-independent prostate cancer cells.
Dr. Sliva concludes:
"In summary, this dietary supplement is a natural compound for the possible therapy of human hormone refractory (independent) prostate cancer."
The formula's ongoing research in prostate cancer models continue to demonstrate promising results, with further studies coming up.
A study published online in The International Journal of Oncology reports findings from a team of scientists at Indiana University, Methodist Research Institute, who examined a botanical formula containing botanical extracts, phytonutrients, botanically-enhanced medicinal mushrooms, and antioxidants, that kills aggressive prostate cancer tumors.
The researchers conducted experiments in mice using a human prostate cancer tumor model. This is the third publication from a major university study reporting important findings of this particular multi-nutrient prostate formula to fight the invasive behavior of aggressive prostate cancer cells, tumor growth and metastasis.
Dr. Daniel Sliva, who led the research, commented:
"Multiple studies demonstrate that this prostate formula is a possible treatment for hormone refractory (androgen independent) prostate cancer."
The findings of the study demonstrate that the prostate formula substantially inhibited tumor growth in aggressive, hormone refractory, androgen independent human-prostate cancer cells. After evaluating the formula's potential toxicity, it was deemed safe, with no signs of toxicity at the highest dosages.
Dr. Isaac Eliaz, researcher and formulator, declares:
"This study is a milestone in the research of this formula, demonstrating its safety and effectiveness in treating human prostate cancer in an animal model. These positive results offer a significant contribution to the field of prostate cancer research, and add to the growing body of published data substantiating the role of natural compounds in the treatment of prostate cancer."
The study, which used a xenograft tumor model of human prostate cancer in mice, revealed that in comparison to controls, oral administration of the formula achieved a statistically important suppression of 27% in tumor growth.
What proved even more significant was that the formula suppressed the expression of several genes that affect cancer proliferation and metastasis, three of which, IGF2, NRNF2 and PLAU/uPA are connected to potentially producing metastasis, other than controlling aggressive prostate cancer growth. The formula was also observed to substantially increase the expression of CDKN1A, a gene that fights prostate cancer by specifically inhibiting other cancer promoting cellular mechanisms.
The formula's abilities to suppress specific genes that are associated with aggressive prostate cancer growth and proliferation, and increase the expression of cancer-fighting genes, proves that this integrative formula has multiple anti-cancer mechanisms and genetic targets. The pre-clinical in vivo study supports earlier published in vitro data, which also demonstrate the formula's ability of decreasing expression of PLAU/uPA genes in aggressive, hormone-independent prostate cancer cells.
Dr. Sliva concludes:
"In summary, this dietary supplement is a natural compound for the possible therapy of human hormone refractory (independent) prostate cancer."
The formula's ongoing research in prostate cancer models continue to demonstrate promising results, with further studies coming up.
Thursday, February 16, 2012
Four new drugs will change prostate cancer care, Colorado expert says
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Four new drugs could transform prostate cancer from terminal to chronic disease
Not just chemo — new, targeted drugs act in novel and interesting ways
These drugs mark first major advances in prostate cancer care in nearly 15 years
After a decade and a half of near stagnation, four new drugs could help make advanced prostate cancer a chronic illness instead of a terminal disease, a leading Colorado prostate cancer expert says.
“It’s not just chemotherapy. The drugs have different and innovative methods of action. One is a bone protective agent; another’s a more effective hormone agent; another is radiotherapy; and the final one is the first drug tested for cancer immunotherapy,” says E. David Crawford, MD, investigator at the University of Colorado Cancer Center and head of urologic oncology at University of Colorado Hospital.
“Even without the addition of any more drugs, we may now have the tools that in combination will allow us to extend the survival prognosis of a prostate cancer patient long enough to make prostate cancer a disease a patient is more likely to die with than from,” Crawford says.
Along with Thomas Flaig, MD, Crawford describes these advances in prostate cancer treatment in a recent review for the journal Oncology.
First is the drug Denosumab, which Crawford says, “has three uses in protecting the bones of prostate cancer patients.” It can prevent bone fractures in patients with existing bone metastasis; it can prevent osteoporosis in patients whose calcium is depleted as a side-effect of hormone therapy; and (pending FDA approval) it has been shown to hold off the occurrence of bone metastasis for an average of four months in patients whose spiking PSA scores predict the likely onset of bone involvement.
Second is the drug Alpharadin, which is one of a novel and exciting class of “radiopharmaceuticals” – drugs that emit radiation and allow doctors to precisely deliver radiation to tumor sites. In the case of Alpharadin, it emits alpha rather than beta particles, which allows more precise tumor targeting of bone metastasis sites with less collateral damage to surrounding bone marrow.
Third, the drug Prostvac is the first “immunotherapy” drug used for the treatment of cancer. The drug acts like a vaccine, priming the immune system to recognize and thus fight against prostate cancer cells. In a phase II clinical trial of 125 patients, the drug extended the median survival time from 16.6 to 25.1 months.
Finally, the drug Abiraterone Acetate completely suppresses the body’s ability to make testosterone, which many prostate cancers need to grow (as opposed to previous drugs, which hoped to out-compete testosterone with estrogen, or imperfectly controlled testosterone production).
Crawford notes that these drugs are being approved for use only after more established therapies have failed and hopes that in coming years science may accelerate the use of these drugs to first-line therapies.
“Before we just had hormone therapy, then we got chemo, and each therapy we added packed on another couple months of survival. Now with these news drugs we’re tacking on even more time. The light at the end of the tunnel is the hope that we’ll turn this into a chronic disease and now we might have the tools that in some combination will do it,” Crawford says.
* To learn more about these and other cutting-edge strategies to combat advanced prostate cancer, refer for Crawford and Flaig’s recent review, Optimizing Outcomes of Advanced Prostate Cancer: Drug Sequencing and Novel Therapeutic Approaches.
Ω
Four new drugs could transform prostate cancer from terminal to chronic disease
Not just chemo — new, targeted drugs act in novel and interesting ways
These drugs mark first major advances in prostate cancer care in nearly 15 years
After a decade and a half of near stagnation, four new drugs could help make advanced prostate cancer a chronic illness instead of a terminal disease, a leading Colorado prostate cancer expert says.
“It’s not just chemotherapy. The drugs have different and innovative methods of action. One is a bone protective agent; another’s a more effective hormone agent; another is radiotherapy; and the final one is the first drug tested for cancer immunotherapy,” says E. David Crawford, MD, investigator at the University of Colorado Cancer Center and head of urologic oncology at University of Colorado Hospital.
“Even without the addition of any more drugs, we may now have the tools that in combination will allow us to extend the survival prognosis of a prostate cancer patient long enough to make prostate cancer a disease a patient is more likely to die with than from,” Crawford says.
Along with Thomas Flaig, MD, Crawford describes these advances in prostate cancer treatment in a recent review for the journal Oncology.
First is the drug Denosumab, which Crawford says, “has three uses in protecting the bones of prostate cancer patients.” It can prevent bone fractures in patients with existing bone metastasis; it can prevent osteoporosis in patients whose calcium is depleted as a side-effect of hormone therapy; and (pending FDA approval) it has been shown to hold off the occurrence of bone metastasis for an average of four months in patients whose spiking PSA scores predict the likely onset of bone involvement.
Second is the drug Alpharadin, which is one of a novel and exciting class of “radiopharmaceuticals” – drugs that emit radiation and allow doctors to precisely deliver radiation to tumor sites. In the case of Alpharadin, it emits alpha rather than beta particles, which allows more precise tumor targeting of bone metastasis sites with less collateral damage to surrounding bone marrow.
Third, the drug Prostvac is the first “immunotherapy” drug used for the treatment of cancer. The drug acts like a vaccine, priming the immune system to recognize and thus fight against prostate cancer cells. In a phase II clinical trial of 125 patients, the drug extended the median survival time from 16.6 to 25.1 months.
Finally, the drug Abiraterone Acetate completely suppresses the body’s ability to make testosterone, which many prostate cancers need to grow (as opposed to previous drugs, which hoped to out-compete testosterone with estrogen, or imperfectly controlled testosterone production).
Crawford notes that these drugs are being approved for use only after more established therapies have failed and hopes that in coming years science may accelerate the use of these drugs to first-line therapies.
“Before we just had hormone therapy, then we got chemo, and each therapy we added packed on another couple months of survival. Now with these news drugs we’re tacking on even more time. The light at the end of the tunnel is the hope that we’ll turn this into a chronic disease and now we might have the tools that in some combination will do it,” Crawford says.
* To learn more about these and other cutting-edge strategies to combat advanced prostate cancer, refer for Crawford and Flaig’s recent review, Optimizing Outcomes of Advanced Prostate Cancer: Drug Sequencing and Novel Therapeutic Approaches.
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Thursday, February 2, 2012
A New Screening Method for Prostate Cancer: PSA Velocity Risk Count Testing
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A new study by NYU Langone Medical Center and Northwestern University Feinberg School of Medicine shows novel PSA velocity (PSAV) risk count testing may provide a more effective way for physicians to screen men for clinically significant prostate cancer. The new study, published online by the British Journal of Urology International on February 1, 2012, shows the benefits of tracking a man’s PSA levels over time to help doctors more accurately assess his risk of life-threatening prostate cancer.
“Risk count could represent a new way to screen for prostate cancer by focusing on men with the greatest risk of harmful prostate cancers,” said lead author Stacy Loeb, MD, an urologist in the Department of Urology and the Joel E. Smilow Comprehensive Prostate Cancer Center at NYU Langone. “The goal of risk count is to help identify the aggressive, clinically significant prostate cancers before advanced symptoms develop, while decreasing the diagnosis of insignificant cancers.”
Prostate cancer is the second leading cause of cancer death in American men, with an estimated 1 in 6 men diagnosed with the disease during their lifetime. Prostate cancer does not present symptoms until advanced stages so screening for the disease is vital. Currently, a PSA blood test is the standard screening method to evaluate a man’s risk of prostate cancer. It measures the amount of prostate-specific antigen in the blood, a substance made only in the prostate gland. An elevated PSA can indicate the presence of disease. However, PSA can also be elevated with benign prostate enlargement and one high PSA value does not always mean an aggressive prostate cancer is present.
The new PSAV risk count screening works by monitoring fluctuations in PSA levels over time to analyze a man’s risk of prostate cancer, instead of relying on just one PSA test result to assign prostate cancer risk. The risk count is calculated by counting the number of times in a row that the PSA level in the blood increases by 0.4 ng/mL. If PSA goes up by more than 0.4 units multiple years in a row, the risk count rises indicating the patient has an increased risk of aggressive prostate cancer. For example, a man who has a PSA screening for two years in a row would be given a “2” risk count if his serial PSA velocity measurements increased by more than 0.4 units, a “1” risk count if there was only one increase by more than 0.4 units, and a “0” risk count if there was no increase by more than 0.4 units.
In the study, researchers showed PSAV risk count could improve the specificity of screening for prostate cancer and advanced stages of the disease. Researchers evaluated 18, 214 men undergoing prostate cancer screening, 1,125 of which were diagnosed with the disease. The study results show sustained rises in PSA levels over time indicate a significantly greater risk of prostate cancer and more aggressive disease. In the study, a risk count of “2” was associated with a greater than 8-times risk of prostate cancer and a 5-fold greater risk of aggressive disease.
The authors conclude risk count screening may be useful in diagnosing aggressive prostate cancer earlier while possibly reducing unnecessary biopsy, as well as the overdiagnosis and resulting overtreatment of low-risk prostate cancer.
“A persistently rising PSA is a harbinger for life-threatening prostate cancer,” said the study’s senior author, William Catalona, MD, professor of Urology at Northwestern University. “Our study findings show looking at how much PSA changes over time helps distinguish which cancers are aggressive more so than a single PSA value.”
In an accompanying editorial, Dr. H. Ballentine Carter from the Brady Urological Institute at Johns Hopkins who initially suggested the concept of looking at PSA changes over time, affirms that in order to determine the likelihood of aggressive prostate cancer, “you want to know your patient’s risk count, not just their age and PSA level.”
A new study by NYU Langone Medical Center and Northwestern University Feinberg School of Medicine shows novel PSA velocity (PSAV) risk count testing may provide a more effective way for physicians to screen men for clinically significant prostate cancer. The new study, published online by the British Journal of Urology International on February 1, 2012, shows the benefits of tracking a man’s PSA levels over time to help doctors more accurately assess his risk of life-threatening prostate cancer.
“Risk count could represent a new way to screen for prostate cancer by focusing on men with the greatest risk of harmful prostate cancers,” said lead author Stacy Loeb, MD, an urologist in the Department of Urology and the Joel E. Smilow Comprehensive Prostate Cancer Center at NYU Langone. “The goal of risk count is to help identify the aggressive, clinically significant prostate cancers before advanced symptoms develop, while decreasing the diagnosis of insignificant cancers.”
Prostate cancer is the second leading cause of cancer death in American men, with an estimated 1 in 6 men diagnosed with the disease during their lifetime. Prostate cancer does not present symptoms until advanced stages so screening for the disease is vital. Currently, a PSA blood test is the standard screening method to evaluate a man’s risk of prostate cancer. It measures the amount of prostate-specific antigen in the blood, a substance made only in the prostate gland. An elevated PSA can indicate the presence of disease. However, PSA can also be elevated with benign prostate enlargement and one high PSA value does not always mean an aggressive prostate cancer is present.
The new PSAV risk count screening works by monitoring fluctuations in PSA levels over time to analyze a man’s risk of prostate cancer, instead of relying on just one PSA test result to assign prostate cancer risk. The risk count is calculated by counting the number of times in a row that the PSA level in the blood increases by 0.4 ng/mL. If PSA goes up by more than 0.4 units multiple years in a row, the risk count rises indicating the patient has an increased risk of aggressive prostate cancer. For example, a man who has a PSA screening for two years in a row would be given a “2” risk count if his serial PSA velocity measurements increased by more than 0.4 units, a “1” risk count if there was only one increase by more than 0.4 units, and a “0” risk count if there was no increase by more than 0.4 units.
In the study, researchers showed PSAV risk count could improve the specificity of screening for prostate cancer and advanced stages of the disease. Researchers evaluated 18, 214 men undergoing prostate cancer screening, 1,125 of which were diagnosed with the disease. The study results show sustained rises in PSA levels over time indicate a significantly greater risk of prostate cancer and more aggressive disease. In the study, a risk count of “2” was associated with a greater than 8-times risk of prostate cancer and a 5-fold greater risk of aggressive disease.
The authors conclude risk count screening may be useful in diagnosing aggressive prostate cancer earlier while possibly reducing unnecessary biopsy, as well as the overdiagnosis and resulting overtreatment of low-risk prostate cancer.
“A persistently rising PSA is a harbinger for life-threatening prostate cancer,” said the study’s senior author, William Catalona, MD, professor of Urology at Northwestern University. “Our study findings show looking at how much PSA changes over time helps distinguish which cancers are aggressive more so than a single PSA value.”
In an accompanying editorial, Dr. H. Ballentine Carter from the Brady Urological Institute at Johns Hopkins who initially suggested the concept of looking at PSA changes over time, affirms that in order to determine the likelihood of aggressive prostate cancer, “you want to know your patient’s risk count, not just their age and PSA level.”
Occasional binge drinking not harmful
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No effect on heart disease and mortality among moderate drinkers
Most studies have found that binge drinking is associated with a loss of alcohol's protective effect against ischemic heart disease (IHD) and most studies have found an increase of coronary risk among binge drinkers.
This study followed 26,786 men and women who participated in the Danish National Cohort Study in 1994, 2000, and 2005 and sought to see if binge drinking increased the risk of IHD or all-cause mortality among "light-to-moderate" drinkers: (up to 21 drinks/week for men and up to 14 drinks/week for women). A "drink" was 12g.
"Binge drinking" (more that 5 drinks on an occasion) did not show differences in risk of ischemic heart disease (coronary disease) or total mortality than among always moderate drinkers. These results are somewhat different from results of many other epidemiologic studies that have shown increased risk of health problems (even higher risk of coronary disease) to be associated with what was referred to as "binge drinking."
Why there were no adverse effects of binge drinking in this study has provoked considerable discussion among members of the Forum. The assessments of alcohol were based on consumption in the week prior to the examination, so data was not available to judge whether or not binge-drinking episodes occurred rarely or regularly. Data was available for smoking, education, physical activity, BMI, and self-reported hypertension and diabetes. There was a strong increase in IHD risk and mortality from binge drinking among heavy drinkers, but the authors were comparing outcomes in binge vs. non-binge drinkers among subjects in the "light-to-moderate" categories, and so in all comparisons, the relative risk of IHD and all-cause mortality was higher for non-drinkers than for all other categories of drinkers.
The general consensus of opinion among Forum members is the definition of "binge drinking." The rapid consumption of more than 5 drinks on an empty stomach surely has different effects than the consumption of alcohol over several hours with food, such as during a prolonged dinner. The rate of consumption strongly affects the consequences of alcohol; the speed of drinking and context should constitute part of the definition of 'bingeing' and not just the total number of drinks.
The Forum concludes that "binge drinking," however defined, is not a healthy pattern of alcohol consumption. But the circumstances of consumption (rate of consumption, with or without food, etc.) may also be important in its definition and in judging its effects on health.
The Forum does not take the results of this single study to support binge drinking. What the Danish results suggest is that the occasional "excess" embedded in a moderate consumption pattern is not shown to be harmful in this study. As recognized in responsible drinking guidelines from Australia, Canada and the US, occasional episodes of consumption greater than the recommended daily levels do not necessarily change the classification of a normally moderate drinker into that of an abuser.
No effect on heart disease and mortality among moderate drinkers
Most studies have found that binge drinking is associated with a loss of alcohol's protective effect against ischemic heart disease (IHD) and most studies have found an increase of coronary risk among binge drinkers.
This study followed 26,786 men and women who participated in the Danish National Cohort Study in 1994, 2000, and 2005 and sought to see if binge drinking increased the risk of IHD or all-cause mortality among "light-to-moderate" drinkers: (up to 21 drinks/week for men and up to 14 drinks/week for women). A "drink" was 12g.
"Binge drinking" (more that 5 drinks on an occasion) did not show differences in risk of ischemic heart disease (coronary disease) or total mortality than among always moderate drinkers. These results are somewhat different from results of many other epidemiologic studies that have shown increased risk of health problems (even higher risk of coronary disease) to be associated with what was referred to as "binge drinking."
Why there were no adverse effects of binge drinking in this study has provoked considerable discussion among members of the Forum. The assessments of alcohol were based on consumption in the week prior to the examination, so data was not available to judge whether or not binge-drinking episodes occurred rarely or regularly. Data was available for smoking, education, physical activity, BMI, and self-reported hypertension and diabetes. There was a strong increase in IHD risk and mortality from binge drinking among heavy drinkers, but the authors were comparing outcomes in binge vs. non-binge drinkers among subjects in the "light-to-moderate" categories, and so in all comparisons, the relative risk of IHD and all-cause mortality was higher for non-drinkers than for all other categories of drinkers.
The general consensus of opinion among Forum members is the definition of "binge drinking." The rapid consumption of more than 5 drinks on an empty stomach surely has different effects than the consumption of alcohol over several hours with food, such as during a prolonged dinner. The rate of consumption strongly affects the consequences of alcohol; the speed of drinking and context should constitute part of the definition of 'bingeing' and not just the total number of drinks.
The Forum concludes that "binge drinking," however defined, is not a healthy pattern of alcohol consumption. But the circumstances of consumption (rate of consumption, with or without food, etc.) may also be important in its definition and in judging its effects on health.
The Forum does not take the results of this single study to support binge drinking. What the Danish results suggest is that the occasional "excess" embedded in a moderate consumption pattern is not shown to be harmful in this study. As recognized in responsible drinking guidelines from Australia, Canada and the US, occasional episodes of consumption greater than the recommended daily levels do not necessarily change the classification of a normally moderate drinker into that of an abuser.
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