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Clouded in the murkiness of the debate surrounding the use of the PSA test is an increasing escalation of younger men (under the age of 50 years) being diagnosed with advanced prostate cancer. We know that there has been escalating incidence rate (IR) of prostate cancer PC noted in the last two decades. Many have attributed this IR to the more common use of PSA testing for early PC detection.

Researchers performed a study to compare the relative and absolute rates of detection of early and advanced PC in younger males under the age of 50 and to examine if early cancer was the only contributor to the change in this group.

They used frequency and rate sessions on demographics and PC characteristics comparing among Non-Hispanic White (NHW), African-American (AA), Hispanic (H), US Asian/Pacific Islanders (A/PI) and American Indians/Alaskan Natives (AI/AN) using SEER*Stat. They then used the IR and stage at diagnosis trends of subjects diagnosed under the age of 50 years.
They found that a total of 22,227 cases of PC were reported under the age of 50 years at diagnosis in SEER database from 1973-2010. About 77% were in NHW, 12% in AA, 6% in Hispanics, 4% in A/PI and less than 1% in AI/AN. Table below reflects our results.

They found that IR of PC increased significantly in men under the age of 50 years in the last decade. However stage breakdown did not change significantly. This implies that incidence of advanced stages prostate cancer escalated in parallel with early stages.
This increase can’t be fully explained by the use of PSA screening.

The question then becomes why have we seen this increase? Possibly there are some unknown epigenetic, environmental or socioeconomic factors contributing to this increased risk of advanced prostate cancer in younger men. . Relative increase in IR was especially high in S Asian/Pacific Islander population (by 125%) with a trend towards increase of advanced stage cancer share (by 3%). Further studies into PC risk factors are warranted.

J Clin Oncol 32, 2014 (suppl; abstr e16030); Uladzislau Naidzionak, Katsiaryna Ivanova, Akm Mosharraf Hossain

Joel T. Nowak, M.A., M.S.W.

 

It is known that Zoledronic acid (ZA) reduces the risk of developing skeletal-related events (SRE) which are caused by bone metastasis in prostate cancer (PCa). ZA also improves the quality of life (QOL).

ZA has become a standard supportive therapy for men with prostate cancer who have bone metastasis. The big unknown is when should a man start ZA treatment. In a recent study researchers investigated whether the combination of ZA and combined androgen blockade (CAB) could delay a PSA relapse of prostate cancer as well as prevent the development of SREs.

To look at this issue the researchers randomly sorted ithe subject men into two groups (combined androgen blockade (CAB) alone group and CAB + ZA treatment group).

In the CAB + ZA group, 4 mg ZA was intravenously administered every 4 weeks with the start of treatment. The first end point was a period to PSA relapse, and the secondary end point was SREs rate.

Untreated 60 men with prostate cancer  with bone metastasis were enrolled between 2006 and 2011.

Thirty one men were treated with CAB alone and 29 men were treated with CAB + ZA. There were no significant differences in the baseline characteristics in the both groups, and the mean observation period was 27.4 months and 32.1 months, respectively.

There was no significant difference in progression free survival (PFS) (p=0.073), tendency that CAB + ZA shows better PFS than CAB alone group was observed (time to 50% PFS was extended 11.6 months than CAB alone group). A sub-analysis using the men with a higher Gleason score over 7, CAB +ZA group showed significantly longer PFS than the CAB group (p=0.021). A significant difference was recognized in SRE rate between the two groups (p=0.019), ZA tended to delay the occurrence of SRE in men with prostate cancer.

This result indicates that the use of ZA at the beginning of hormonal therapy not only has a preventive effect on the occurrence of SREs but also a relapse-delaying effect, especially in men with high Gleason score and severe bone metastasis.

Through careful observation is essential, since the long-term use of ZA may increase the incidence of adverse effects, CAB-ZA treatment may be recommended for the treatment of PCa patients with bone metastasis.

J Clin Oncol 32, 2014 (suppl 4; abstr 207); Satoru Ueno, Atsushi Mizokami, Takashi Fukagai, Naohiro Fujimoto, Hitoshi Ohoka, Yukihiro Kondo, Gaku Arai, Hisamitsu Ide, Mikio Namiki.

 

 

Last April there was some preliminary data from the long-term Phase II STAND study presented at 29th Annual European Association of Urology (EAU) Congress that showed that sipuleucel-T (Provenge) when given after the start of androgen deprivation therapy (ADT) seemed to enhance and sustain the immune response in men with a biochemical failure (PSA only) of prostate cancer.

ADT remains the standard treatment option for men with biochemical failure after failure of local therapy. The STAND study is a Phase II randomized trial that consisted of two patient study groups, one completing Provenge two weeks before starting ADT and the second receiving Provenge three months after the start of ADT.

Preliminary results suggest enhanced cellular immune responses when Provenge was given after ADT. These responses were persistent for at least 12 months and robust in both patient groups.

According to Neal Shore, M.D., medical director at the Carolina Urologic Research Center and an occasional guest on the Malecare Teleconference page, “The STAND study results are encouraging as they provide additional evidence on how sipuleucel-T can be sequenced with other treatments which will assist clinician decision-making upon whether immune responses correlate with certain clinical parameters, such as prostate specific antigen (PSA) recurrence.”

I do not believe that the findings of this study are ready for translational clinical impact for us men with advanced prostate cancer given that Provenge, with a $124,000 price tag, is not approved for use prior to the prostate cancer becoming castrate resistant. It also adds a new complication to the decision making mix as a study released at the last annual ASCO meeting (see: http://advancedprostatecancer.net/?p=2238 and
http://advancedprostatecancer.net/?p=2221) showed that starting ADT immediately upon having a biochemical failure did not provide any survival advantage over waiting for some disease progression.

So, even if we forget the insurance issue are we better off with earlier ADT and then Provenge or are we better off delaying ADT and Provenge? We are going to need some additional studies to get at this answer.

(Also see: http://advancedprostatecancer.net/?p=3835)

Joel T. Nowak, M.A., M.S.W.

Aug
08
2014

Bone Metastases and Prostate Cancer

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The vast majority of men with advanced prostate cancer will eventually develop bone metastases. Given this fact it is important to understand what is meant by the term bone metastases.

Bones serve as the supporting framework of our bodies. Like the rest of us bones are constructed of cells. These cells compose a network or matrix of fibrous tissue which allow minerals such as calcium to become attached, giving our bones strength and hardness.

The bone contains two different types of cells, the osteoblast cells that form new bone and the osteoclast cells that dissolve old bone. Both of these cell types are in constant action, but they are normally in balance with each other. Osteoclast cells break down old bone while osteoblast cells work to replace the cells destroyed by the osteoclast cells. In the healthy body these two opposing forces work together in harmony, maintaining a perfect balance of healthy and strong bone.

Prostate cancer can spread to nearly all tissues of the body, however, bone is the most common site for prostate cancer spread. When this happens we have prostate cancer bone metastases, not bone cancer that is a different and unrelated disease that actually starts in the bone.

Prostate cancer metastases can occur in any bone in the body, but are most often found in bones near the central axis of the body. The spine is the most common site of bone metastasis, however other common sites are the hip-bone (pelvis), upper leg bone (femur), upper arm bone (humerus), ribs and the skull.

Once prostate cancer has spread to the bones or to other sites in the body it cannot be cured. However, it can still be treated with the goal oft shrinking, stopping, or slowing its growth.

This allows you to be able to live longer with a much improved quality of life.

Joel T. Nowak, M.A., M.S.W.

The following was written and posted by Paul Edwards to the Advanced Prostate Cancer Online Support Group:

The March 2014 issue of the Asia-Pacific Journal of Clinical Oncology published an article “Why do some cancer patients receiving chemotherapy choose to take complementary and alternative medicines and what are the risks?” by authors from University of Queensland School of Pharmacy and the Sunshine Coast Cancer Care Services.
The research found that
  • Complementary and alternative medicine (CAM) that is systemically absorbed is most likely to interfere with concurrent chemotherapy and potentially cause harm to cancer patients.
  • When tested in rigorous clinical trials, no CAM cancer treatments alone have shown benefit beyond placebo.
  • With the exception of ginger to treat chemotherapy-induced nausea, there is no compelling evidence overriding risk to take complementary medicines for supportive care during chemotherapy treatment.
  • There is, however, established evidence to use mind–body complementary therapies for supportive care during chemotherapy treatment.
The study listed mind–body therapies where benefit over standard care had been proven and which were safe to use as adjuvants with chemotherapy:

*Acupuncture Benefit for chemotherapy-induced acute vomiting

*Acupressure (acupuncture points stimulated by pressure) Benefit for chemotherapy-induced nausea and vomiting

*Moxibustion (acupuncture points stimulated by heat) Benefit for chemotherapy-induced acute vomiting

*Mild exercise Reduces fatigue and enhances life satisfaction. Yoga has been shown to be a useful practice for women recovering from breast cancer treatments to reduce stress, improve quality of life and well-being, and to reduce persistent post treatment fatigue

*Hypnosis Decreases chemotherapy-induced nausea and vomiting

*Imagery and relaxation (e.g. imagining immune cells as powerful medieval knights or big brooms dispatching cancer cells)  Modulates immune functioning during treatment

*Massage Decreases chemotherapy-induced nausea and vomiting

*Reflexology decreases anxiety during chemotherapy

*Meditation Shown to alter immune patterns by decreasing stress.  Decreases anxiety and depression

*Music  Reduces chemotherapy-induced anxiety

*Self-expression (includes written or verbal expression, artwork, humor and movement)  Written emotional expression has shown a positive effect on outlook and decreased dark feelings in patients with breast cancer

I agree that at all stages of treatment your medical specialists need to be aware of what supplements and alternative medications you are taking.