Test, Track, Treat - or Die!

Wow. This is a really downer of a tagline. I hope it will cause you to read further.

I attended an exposition yesterday on successful aging, sponsored the the Daily Breeze, our local South Bay newspaper (Los Angeles area). I was talking with vendors about participating in our prostate cancer / breast cancer awareness event November 9th, 2009 at the velodrome at the Home Deport Center in Carson, CA.

Speaking with one of the vendors, I heard another story about a man, aged 54, just diagnosed with Stage 4 prostate cancer, already metastasized to bone. This makes me wonder what it will take for men to come to grips with the self-induced fear about digital rectal examinations (DRE). Most of us played sports in our youth and experienced sprained joints, broken limbs, painful sunburns, jelly fish stings and possible a bouncing baseball to the tender private parts. A DRE isn’t as painful as any of these - nor are the needle biopsies if that should become necessary. Prostate cancer is the number two cancer killer of men, approximately 29,000 men each year, and the incidence of prostate cancer is rising. Despite massive investments in research, there is no effective cure for cancer. Ideally we will learn at some point the causes for cancer and be able to take preventative measure. Until that time, the best we can do is detect cancer sufficiently early that we can treat it where possible. Prostate cancer is highly treatable if cause early, prior to metastasis.

Here’s my personal prescription:

1. Test. Beginning at age 35, have an annual PSA test (until something better is developed).


2. Track. Track the change - hopefully there is none - and discuss it with your doctor. Track the data on your refrigerator door. Download and print one of simple PSA trackers from our website.


3. Treat. If you fall into the unfortunate group of about 200,000 men who are diagnosed each year, work with your doctor to determine your best course of treatment.


4. Live. If you’ve done all this, move to a healthy diet and exercise, and you’ve probably done all you can.

Finally, take a moment and encourage your friends to follow the same path.

New Blood Test

ScienceDaily (May 29, 2009) — A new blood test used in combination with a conventional prostate-specific antigen (PSA) screening sharply increases the accuracy of prostate cancer diagnosis, and could eliminate tens of thousands of unneeded, painful, and costly prostate biopsies annually, according to a study led by researchers at Dana-Farber Cancer Institute.

At the annual meeting of the American Society of Clinical Oncology in Orlando, Fla., William K. Oh, M.D., and Robert W. Ross, M.D., will report that the six-gene molecular diagnostic test, when combined with a PSA test, accurately detected prostate cancer more than 90 percent of the time. Earlier studies suggest that the conventional PSA test is 60-70 percent accurate in detecting cancer. The findings will be discussed at a poster session on May 31.

Men who are found to have elevated levels of PSA in routine screening tests are often referred for a biopsy of the gland to check for tumors. Nearly two-thirds of biopsies performed -- a painful procedure with some risk of complications -- do not find any cancerous cells. This high rate of "false positive" PSA test results underscores the need for a more accurate method for detecting prostate cancer, said Oh, who is the clinical director of the Lank Center for Genitourinary Oncology at Dana-Farber.

The two-year study involved 484 participants. The group comprised 204 men with known prostate cancer, 110 men with benign prostatic hypertrophy (BPH), and 170 healthy men in a control group. (BPH can elevate PSA levels in the blood, which often leads to a biopsy to rule out prostate cancer.) These groups were split into age-matched training and validation sets.

The researchers sought to measure the accuracy of a six-gene whole blood RNA transcript-based diagnostic test developed by Source MDx in Boulder, Colo., both in terms of its sensitivity (the ability to detect prostate cancer) and specificity (the ability to identify people who don't have prostate cancer).

Source MDx researchers developed the test after initially working with a set of 174 candidate genes whose activity was compared in the different study groups. They narrowed the pool down to just six genes that, as a group, were highly sensitive in predicting which patients had prostate cancer and which were normal.

The study found that "the six-gene model was more accurate than PSA alone at predicting cancer if you had it and no cancer if you didn't," said Oh. The test's accuracy improved even more when PSA measurements were added. Combined, the two tests achieved a diagnostic accuracy of more than 90 percent in specificity and sensitivity and eliminated most of the false-positives yielded by the PSA test.

Based on these findings, the researchers are planning to conduct a larger, multicenter clinical trial involving approximately 1,000 men to determine if the findings remain valid.

"These findings are very encouraging and suggest that this new test could spare tens of thousands of men from undergoing an unnecessary biopsy," Oh said. "However, until we can verify our findings, it is important to recognize that the PSA test, despite its limitations, is still the best test available for diagnosing prostate cancer at this time."

The study was funded in part by Source MDx and a Prostate Cancer SPORE grant at Dana-Farber/Harvard Cancer Center.

Adapted from materials provided by Dana-Farber Cancer Institute, via EurekAlert!, a service of AAAS.
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29000 Men Comment
This is really good news. A great deal of the current controversy over the value of PSA testing revolves around the false-positive issue. Anything that increases the probability of an accurate test outcome will be a welcome improvement. Until these tests are commonplace, however, the PSA remains the best available tool. A Free PSA test combined with a PSA test (which is total PSA) provides even more predictive power to the PSA test (visit http://www.prostatecancerawarenessproject.org, “early detection” tab, for a brief definition of the Free PSA test). I believe it is unfortunate that writers continue to focus on the “pain” associated with a biopsy. While men have different pain thresholds, my diagnosis required two separate needle biopsy sessions with 18 cores each, and I did not find either one particularly uncomfortable. According the American Cancer Society, fully 49% of men do not test annually for prostate cancer and much of this could be due to this focus on the “pain” of the DRE and the needle biopsy. Almost 29,000 men each year in the United States from prostate cancer. Wouldn’t it really be a shame if they are the ones that do not test because of this “pain” focus?

Pomegranate Juice May Help Prostate Cancer Patients

Jody A. Charnow
May 28, 2009

PSA doubling time was prolonged in men who had biochemical failure after surgery or radiotherapy
Pomegranate juice may help slow progression of prostate cancer in men who experience rising PSA levels following radical prostatectomy or radiotherapy, data suggest.
Researchers at the University of California at Los Angeles (UCLA) presented long-term data from a phase 2 trial involving 48 men who had rising PSA levels after prostate cancer treatment. To be eligible for the study, subjects had to have a PSA level greater than 0.2 ng/mL but less than 5. The men had a pretreatment Gleason score of 7 or less. Participants drank eight ounces of pomegranate juice daily (570 mg total polyphenol gallic acid equivalents).
Interim results previously published in Clinical Cancer Research (2006;12:4018-4026) showed a significant increase in the mean PSA doubling times after treatment with pomegranate juice: from 15 months at baseline to 54 months post-treatment. Following these positive results, the study was amended to allow subjects to continue treatment and undergo evaluation at three-month intervals until disease progression. At the end of six years, the mean PSA doubling time was 60 months post-treatment, according to investigators.
In the sixth year of treatment, 15 patients (31%) remained in the study, with a median follow-up of 30 months post-treatment (maximum 64 months). These patients had a significantly greater PSA doubling time and larger decline in median PSA slope than subjects no longer in the study.
“We are now in the seventh year of this study. This is quite unique in clinical research—to have such a long length of follow-up in a phase 2 study,” said lead investigator Allan Pantuck, MD, Associate Professor of Urology at the David Geffen School of Medicine at UCLA. “We have preclinical and clinical data that continue to suggest a slowing down of PSA doubling times in patients with prostate cancer.” The effect of pomegranate juice on PSA doubling times appears to be durable, he said.
Dr. Pantuck noted that the trial so far suggests that daily consumption of pomegranate juice for more than five years appears to be safe and to produce no untoward adverse effects. In addition, data show that some patients may be more sensitive than others to the effects of pomegranate juice.
He pointed out that promegranate juice is being studied for many medical indications— “everything from cancer to heart disease. However, it is still too early to say it is an elixir of life or that we have proven that there is a benefit. We currently have positive results that have justified the time and expense and effort to study the juice in a phase 3 study, and we hope to have these definitive results shortly.”
“This study suggests that pomegranate juice may effectively slow the progression of prostate cancer after unsuccessful treatment,” said AUA spokesperson Christopher Amling, MD, Division Chief of Surgery at Oregon Health & Science University in Portland. “This finding and other ongoing research might one day reveal that pomegranate juice is an effective prostate cancer preventative agent as well.”
29000 Men Comment
As a prostate cancer survivor, Class of 2003 (radical prostatectomy), I live with that “recurrence monkey” on my back, as many of us do. Being a former Army officer, I’m spring-loaded to make contingency plans for the worst possible outcome. Following my surgery, I adopted a modified vegetarian diet (fish and occasionally chicken) and continued to exercise (cycling, running, and walking with my wife). The result was that I dropped 12 pounds and have stabilized for the past five years at roughly 155 lb. (I’m 5’10“). Pomegranate juice has been part of my nutritional regime for the past two years, since I saw the first reference to the UCLA study.

ACS- Experimental Vaccine Offers Hope to Men with Advanced Prostate Cancer

Article date: 2009/05/06
By Rebecca Viksnins Snowden

Dendreon Corporation recently reported encouraging phase III study results for Provenge, a “vaccine” that uses a patient's own immune system to fight advanced prostate cancer. The results offer hope to men with advanced disease, though it may be some time before they see the vaccine, which has yet to be submitted to the FDA for approval.

Over 500 men with advanced prostate cancer that was no longer responding to hormone therapy were enrolled in the study. Two thirds of the men received 3 infusions of Provenge over the course of a month; the other third received a placebo.

The men who received Provenge infusions lived an average of 4 months longer than men who were getting the placebo. The 3-year survival rate for the men getting Provenge was 32%, compared to 23% for placebo.

"These results confirm the clinical value of Provenge to prolong survival in patients with advanced prostate cancer. Moreover, it validates the longstanding but elusive aspiration to harness a patient's own immune system to fight cancer," said one of the lead researchers, Philip Kantoff, MD, head of the prostate cancer program and chief of the division of solid tumor oncology at the Dana-Farber Cancer Institute and Harvard Medical School.

Patients receiving Provenge reported few side effects, and those they did report -- chills, fever, headache, fatigue, shortness of breath, vomiting, and tremor – usually went away within a few days. These initial study results were presented at a scientific meeting, but the full results have not yet been published in a peer-reviewed medical journal. However, the findings echo those of a previous, smaller study.

"Provenge suggests that we may in fact be able to stimulate our body's own defense mechanisms to aid our fight against cancer. This in itself is a truly remarkable accomplishment,” said Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. But, he says, there are some “potential pitfalls” of the study and says that a “more detailed analysis and publication of the results—not to mention review by the FDA—still must be done.”

For one, while Provenge improved survival, there was no evidence that the drug slows progression of the disease. "Usually, the situation is the other way around: the new drug delays progression of the disease, but may not increase survival. The normal way we think suggests that delay of progression is necessary before you see a survival benefit. That did not happen with Provenge. So, did the men who receive the placebo have something happen to them that may have shortened their lives compared to those who received Provenge? It isn't likely, but it is possible," said Lichtenfeld.

Dendreon plans to submit the drug for FDA approval later this year.

This won't be the first time the drug has crossed the FDA's desk. In 2007, the FDA refused to grant the drug accelerated approval, requesting more information about whether the drug prolongs survival.

"The sooner we can see all of the data from the study, the sooner we can move forward with getting this drug to men who need it if it indeed meets the expectations that have been set with the release of today’s results. That would be true progress,” said Lichtenfeld.
Men with advanced prostate cancer often have few treatment options available to them. Drugs that affect the body’s hormone levels are often effective for a time, but eventually the cancer stops responding to them. Chemotherapy helps some men at this point, but can have its own serious side effects.

Provenge is just one of several prostate cancer "vaccines" in development. Another, known as PROSTVAC-VF, uses a virus that has been genetically modified to contain prostate-specific antigen (PSA). The patient's immune system should respond to the virus and begin to recognize and destroy cancer cells containing PSA. The drug is still in early-stage clinical trials.

For more information about prostate cancer vaccines and other treatments, see the American Cancer Society’s Detailed Guide: Prostate Cancer, especially the section "What's New in Prostate Cancer Treatment?"

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Experimental_Vaccine_Offers_Hope_to_Men_with_Advanced_Prostate_Cancer.asp?sitearea=NWS&viewmode=print&

29000 Men Comment:
Every human life is precious, so anything that extends that gift is valuable. We continue to urge all men to establish a baseline PSA as early as possible and to watch for year-over-year changes. Any change of .75 or greater is of serious concern and you should check with your physician as soon as possible. Also, take a minute and ask your friends and colleagues if their track their PSA number. You’ll be surprised at how many do not. If you are bicyclist, consider joining us this August on the Tour de Skyline Drive (http://www.tourdeskylinedrive) this August or on the Tour de USA in 2010 (http://www.tourdeusa.org).

New Stem Cell Cancer Treatment Research

Here’s something really interesting forwarded to me from the University of Minnesota Academic Health Center. http://www.youtube.com/watch?v=kPpX1wyEC4g We need more of this!

Prostate Surgery Improves Younger Prostate Cancer Patients Survival

Results from the study done on the National SEER database show that the surgical procedure improves the 5-, 10-, 15- and 20-year survival for younger patients, when compared with other standard treatments such as radiotherapy or watchful waiting.

"When given the choice between surgery, watchful waiting or external beam radiotherapy, patients younger than 50 with moderately and poorly differentiated prostate cancers have better long-term overall and cancer-specific survival when they opt for surgery," says study author Naveen Pokala, M.D., an urologist with Henry Ford Hospital.

Based on findings from the study, Dr. Pokala and co-author Mani Menon, M.D., director of Henry Ford's Vattikuti Urology Institute, strongly recommend retropubic radical prostatectomy – a surgical procedure that removes the entire prostate gland plus some of the tissue around it – as the treatment of choice for prostate cancer patients under the age of 50.

Prostate cancer affects one in six men in the United States during his lifetime, but according to the American Cancer Society only one in 35 will die of it.

Although the majority of all prostate cancer are diagnosed in men older than 65, its prevalence is growing among men younger than 50. In fact, about one in 10,000 men under the age of 40 will be diagnosed this year with prostate cancer.

To determine which treatment option offers the best chance for long-term survival for younger prostate cancer patients, Pokala and Menon studied more than 8,200 men under age 50 with prostate cancer.

Among the study group, 73 percent were white and about 22 percent were black. The mean age was 46, and over 70 percent had moderately and 22 percent had poorly differentiated cancers. Of the patients, 1,065 were managed with no definitive treatment (watchful waiting); 6,614 (79.9 percent) with radical retropubic prostatectomy; and 600 with external beam radiotherapy.

The cancer-specific survival in the NDT group was 78 percent at 16 years, in the radiation group was 63 percent at 17 years; and 94 percent in the radical prostatectomy at 21 years. On a subset analysis the outcome was significantly better after radical prostatectomy in patients with moderately and poorly differentiated prostate cancer.

Overall, the study shows the 5-year, 10-year, 15-year and 20-year overall survival and cancer specific survival is significantly increased in patients who were less than 50 years of age with moderately and poorly differentiated cancers in the surgery group.

29000Men.org Comment
When I was diagnosed with prostate cancer in 2002, one of my first steps was to try and understand the long-term survival rates for the various treatment options. Definitive information was, and still is, difficult to locate. The above study provides some important insights, especially for men who are diagnosed at an early age.

Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation -- Smith et al., 10.1200/JCO.2008.20.8983 -- Journal of Clinical Oncology

By 2030, the United States’ population will increase to approximately 365 million, including 72
million older adults (age 􏰀 65 years) and 157 million minority individuals. Although cancer
incidence varies by age and race, the impact of demographic changes on cancer incidence has not
been fully characterized. We sought to estimate the number of cancer patients diagnosed in the
United States through 2030 by age and race.
Methods
Current demographic-specific cancer incidence rates were calculated using the Surveillance
Epidemiology and End Results database. Population projections from the Census Bureau were
used to project future cancer incidence through 2030.
Results
From 2010 to 2030, the total projected cancer incidence will increase by approximately 45%, from
1.6 million in 2010 to 2.3 million in 2030. This increase is driven by cancer diagnosed in older adults
and minorities. A 67% increase in cancer incidence is anticipated for older adults, compared with
an 11% increase for younger adults. A 99% increase is anticipated for minorities, compared with
a 31% increase for whites. From 2010 to 2030, the percentage of all cancers diagnosed in older
adults will increase from 61% to 70%, and the percentage of all cancers diagnosed in minorities
will increase from 21% to 28%.
Conclusion
Demographic changes in the United States will result in a marked increase in the number of cancer
diagnoses over the next 20 years. Continued efforts are needed to improve cancer care for older
adults and minorities.
J Clin Oncol 27. © 2009 by American Society of Clinical Oncology
Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation -- Smith et al., 10.1200/JCO.2008.20.8983 -- Journal of Clinical Oncology
http://jco.ascopubs.org/cgi/reprint/JCO.2008.20.8983v1?ijkey=ca529edc8ad547a1300f4c08bdd9354d30a94bc7