29000 Men

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2010-10-19T15:08:00.000-07:00

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Should You Save Some Tumor Tissue?

2010-05-13T08:58:00.000-07:00

29000 Men Comment
Lot’s of interesting things are happening in cancer research and the article below, suggesting that cancer patients retain a portion of their tumor for future use, is extremely interesting. Take a moment to read this piece.

Banking on Success: Keeping Tumor Tissue for Use in Cancer Treatment

May 13, 2010
by Heather Mayer, DOTmed Staff Reporter

Few Options
When Robert Gibbs, 41, was diagnosed with a Grade 2 brain tumor in 2004, he didn't have many treatment options other than the traditional chemotherapy, radiation and surgery. But unfortunately for Gibbs, his 2005 surgery didn't completely wipe out the cancer, and in 2008 it was back.

"I had everything going for me," he said. "And it all came to a screeching halt."

His second surgery left him legally blind and searching for a better treatment option. It was then he turned to a clinical trial testing a tumor vaccine called DCVax.

"Other than being legally blind due to the tumor, I'm going through no other treatment," Gibbs, now six years cancer-free, told DOTmed News. "[The vaccine] works."

The DCVax is a personalized cancer treatment that uses a patient's own tumor cells, after surgery, to fight off remaining cancers, working like any other vaccine, explained Linda Powers, chair of the Northwest Biotherapeutics board, which manufacturers the vaccine.

"We found, although heartbreaking, a lot of patients are getting in touch with Northwest after the tumor tissue was thrown away," Powers said of patients trying to participate in the company's third clinical trial, currently underway.

Gibbs and his wife, Barb, co-founded the Florida-based national organization, Miles for Hope, in order to raise money for brain cancer research and to help spread the word about banking tumor tissue, which can be used in a treatment vaccine. The organization also helps people access clinical trials, which could save their lives, as it did for Gibbs.

"If it wasn't for family or friends with frequent flyer miles, we may not have opted to participate [in the trial]," he said. "[Miles for Hope] makes sure people have access to cutting-edge treatment to save lives."

Personalized Therapy
Northwest Biotherapeutics, is not the first to come out with a personalized cancer vaccine. Dendreon was the first company to get FDA approval to commercially market a personalized vaccine for prostate cancer last month. But Northwest Biotherapeutics is following the trend of immune-system-based treatments.

Unlike Dendreon, Northwest Biotherapeutics uses individual patient tissue as opposed to a tumor-specific antigen, making DCVax even more personalized, explained Linda Liau, vice chair of neurosurgery at UCLA and the trial's lead researcher.

"Everyone has written off immune therapies," said Powers. "Finally, after all this time, the research community has continued to work on understanding the biology...Dendreon had FDA approval for immune therapy. There will be a flood of more immune therapies."

Read the full article at http://www.dotmed.com/news/story/12673.

Do You Think We Are Winning the War on Cancer?

2010-03-19T09:08:00.000-07:00

Just over 2,000,000 people die annually in the United States. Cancer account for just over 500,000 deaths each year. Almost 40 years after President Richard M. Nixon declared the War on Cancer in 1971, 25% of all deaths each year are from cancer.

A March 19, 2010 Gallup poll result shows that the number of Americans living with cancer increased by 0.3 percentage points in 2009, an increase in 690,000 adults diagnosed with cancer.

The American Cancer Society estimates that a full third of all cancers are related to poor eating habits and lack of exercise. It’s time for each of us to take responsibility for our health. What can we do? Just get outside and do something; walk, ride a bicycle, play with your children and grandchildren, coach a youth sports program. Just do something. If you play with the Internet at all, go to http://www.presidentschallenge.com and create a free activity tracking account and start earning points towards President’s Challenge awards. You can monitor your own activities and compare yourself to others of age and gender by location. You can also join the Prostate Cancer Prevention Group, Group ID number 59216, join a local group in your area, or create your own group.

Go to http://www.29000men.org, click on the “Events” tab, and join us on one of our cycling adventures.

Keep the rubber side down, have fun, and stay healthy!

A Hot New Italian to Help My Exercise Program

2010-03-11T09:04:00.000-08:00

As many of you know, The Prostate Cancer Awareness Project creates and supports bicycling events as a means of getting the word out about the importance of testing and early detection of prostate cancer. We also believe that exercise and lifestyle change help prevent prostate cancer from occurring and in preventing or delaying recurrence.

Following my surgery in May of 2003, I returned to bicycling and since then have ridden 16,362.6 miles and climbed 226,177 vertical feet of climb, including a climb up the fabled Alpe d’Huez in the summer of 2009.

After almost 21 years riding my 1988 Serotta Davis Phinney road bike, I’m headed for an upgrade!

I’m in discussions with the US distribution company for Formigli bicycles to become a sponsor of our bicycling events and provide discounts on their exquisite products in support of our programs. I will personally purchase the initial frame and it will be a Formigli Classic lugged steel frame in black, set up for road riding and climbing.

But how to select the frame size?
Formigli produces only made to order frames, so you need to provide them a complete set of specifications, such as seat tube length, head tube length, chain stay length, bottom bracket drop, etc. As you can see, at this point I’m well beyond simply fitting my body to an existing frame; I actually have the opportunity to create a frame with the riding geometry for my specific intended use, which will be hill climbing and long distance cruising - think century rides.

i’ve contacted a number of local bike shops and it looks like my first stop is going to be Veloworx in Santa Monica, California. The team there was trained in fitting by Paul Swift, who I’ve met several times at Interbike. I meet with them tomorrow afternoon. Check back for the report!

Are We Men Simply Too Cowardly to Talk About Prostate Cancer?

2010-03-08T09:35:00.000-08:00

29000 Men Comment

Read this provocative article by Stan Goldberg. Stan’s thesis is that men are afraid to talk about prostate cancer because it carries a stigma of impotence and incontinence. I think Stan is right. Do you?

Will the new American Cancer Society prostate cancer screening guidelines save your life?

2010-03-05T11:37:00.000-08:00

29000 Men Comment
Following is the link to the American Cancer Society’s recent recommendations about PSA testing.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_prostate_cancer_be_found_early_36.asp

As a 7-year prostate cancer survivor - I am not a physician and I do not provide medical advice - I continue to believe that men should begin PSA testing at age 35 and track their results year-to-year, since a rapid rate of increase is associated with a high possibility of prostate cancer.

We often hear comments such as “don’t worry about prostate cancer, it generally is slow growing and you most likely will die from some other cause.” If this is the case, why are almost 29,000 men perishing each year from prostate cancer? And why have over a million men died from prostate cancer since the War on Cancer was declared in 1971?

If you like to do research, just try and find detailed information about the cohort of men that die each year: at what age were they diagnosed?, at what cancer stage?, how were they diagnosed?, how were they treated?

If you want a sobering look at why we all should be testing, visit the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) website and dive into the statistics yourself. It’s pretty straight forward and you will be able to make your own decision about the value of PSA Testing. Here’s a quote from a recent NCI monograph on prostate cancer survival: “Survival for those diagnosed with distant disease and with poorly and undifferentiated tumors is poor, pointing to the benefit of earlier diagnosis.” “Poor” to the point that if a man is diagnosed with Stage IV prostate cancer he has a roughly 5% chance of living 10 additional years.!

If you are one of the unlucky men, like me, to have prostate cancer, would you rather be diagnosed early when there is the possibility of effective treatment or later, when there is none?

PSA testing isn’t perfect, but it is the best test currently available and can be done for as little at $26.00 dollars without a doctor visit (note: I am not advocating PSA testing without medical supervision, only noting that testing services are available).

Prostate cancer is the mirror image of breast cancer, yet men refuse to talk about the topic for fear of possible treatment side effects. At the same time, the business community, with a few exceptions, is afraid to engage on the issue, even while they rush to create breast cancer awareness programs.* This is even true for the most macho of all consumer brands, the Harley-Davidson Motor Company.

I will be riding across the US and back this summer (the Tour de USA 2010) to raise awareness of these issues. Full event details can be found at Tour de USA website, along with a listing to the cities where we will stop. I would love to have help in creating local media events at each stop.

* I applaud the companies that are supporting breast cancer initiatives and encourage them to continue these programs.

Ron Koster's Part 1 for Prostate Cancer Newcomers

2010-03-05T11:05:00.000-08:00

29000 Men Comment
As a six-year prostate cancer survivor, I have found that the two summaries written by Ron Koster, and reposted periodically by Nancy Peress, are particularly valuable reading for newly diagnosed survivors and their families. Following is a repost of Ron’s Part l. I posed Part ll the last time on February 5, 2010.

Date: Fri, 5 Mar 2010 09:36:08 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 1 of 2

Sent 3/5/2010

Several weeks before his death on August 11, 2005, Ron asked me to go
on sending out his weekly Welcome Newcomer message for him. It’s my
honor to continue posting his message each week as one small example
of his dedication to helping men with prostate cancer. As Ron often
signed his emails, “Sometimes, it takes just one person to work a
miracle.” Ron was one of the miracle workers.

Revised and updated December 1, 2009 by Mike Scott (with we hope
Rons complete approval).
=====

In spite of the fact that almost everything about prostate cancer
(PCa) is controversial, you’ve found an excellent source of
information. Be patient, and don’t give up just because this resource
may frequently be dominated by irrelevant, repetitious, or esoteric
notes which may not be particularly helpful to the newcomer!

Risk for PCa is assessed primarily through a combination of two widely
used tests: the prostate specific antigen (PSA) test and the digital
rectal exam (DRE).

A normal PSA for a 50-year-old man is usually less than 2.5 ng/ml,
but there is no specific PSA value that is predictive of risk for
prostate cancer. A higher PSA level by itself does not necessarily
mean that you have PCa, and a lower PSA level does not necessarily
mean that you don’t have PCa.

The DRE enables your doctor to feel the size, shape, and texture of
your prostate to determine if you have a clinically normal or abnormal
prostate. However, you can have PCa without having a palpable
(feelable) tumor, and palpable nodules or abnormalities are not always PCa.

Even though much of the testing is extremely controversial, most PCa
survivors prefer and recommend that all men of about 40 be tested
early and regularly in the hope that early diagnosis will give greater
choice of treatment and cure with fewer side or after effects. Men
with a family history of prostate cancer or other risk factors may
want to get a first (baseline) PSA test at an even younger age.

High PSA levels may be cause by PCa, by benign prostatic hyperplasia
(BPH), or by a urinary tract infection such as prostatitis. However,
NO PSA ASSAY IS PERFECT and no specific PSA level is diagnostic for
prostate cancer! At 58 years of age, when I was diagnosed, my own PSA
was 3.6 ng/ml, my Gleason score was 7, and I was subsequently shown to
be pathological stage T2a (after surgery).

Other tests which your doctor may want to perform on a blood or urine
sample (or which you can ask him to carry out) include the PSA II or
Free PSA test, which can be used to rule out prostatitis and/or benign
prostatic hyperplasia (BPH) and the so-called PCA3 test, which can
help to predict risk for more aggressive forms of prostate cancer.
Older tests that are less commonly used today include the serum acid
phosphate test, the alkaline phosphatase test, and the prostatic acid
phosphatase (PAP) test.

The results of a PSA test and a DRE (and the PCA3 test) can be used,
in combination with information about your family history of prostate
cancer and other medical information, to assess your risk for PCa
using the Risk of Biopsy-Detectable Risk Calculator, which you can find at
http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

The results of these tests, including a suspicious DRE, may give you
and your doctor good cause to decide you need a prostate biopsy. An
initial biopsy, today, usually consists of the removal of 8 to 12
biopsy cores using a specialized procedure under ultrasound biopsy.

If PCa is found in the tissue removed at biopsy, the pathologist who
examines the biopsy cores will assign what is known as a Gleason
score. It will be someplace between 6 and 10, the higher number
indicating a more aggressive form of PCa. The Gleason score has two
components, the GRADE and the SUM or SCORE. The GRADE is based on how
the individual cells look under the microscope. The Gleason grades
used to range from 1 to 5, with 1 being the closest to normal and 5
being bad. However, today, it is normal for all Gleason grades to
range only from 3 to 5 if cancer is thought to be present because
Gleason grades of 1 or 2 are considered not to be cancer. There are
both general and specific guidelines for each grade, but examining
prostate biopsy cores to establish the presence of cancer and the
Gleason grades of that cancer is difficult. The experience of the
pathologist is key -- which is why a second opinion on the biopsied
tissue is often a good approach.

When the pathologist reads a specimen, s/he looks at it to determine
the most common grade of tumor seen: that is the first number of the
SUM. Then the pathologist determines the next most common tumor area
and assigns a Gleason grade to it. This is the second number of the
Gleason SUM or SCORE. The two numbers, when added together, give the
SUM. Close reading of the pathology report, will often indicate both
the Gleason grades and the percentage of each grade, which may make
you feel better or worse than knowing the Gleason SUM or SCORE) -- but
the Gleason SCORE is what is reported in most of the medical
literature and used for comparisons. So a Gleason score of 3 + 4 = 7
means more grade 3 than grade 4 and a Gleason score of 4 + 3 = 7 is
just the opposite, meaning more grade 4 than grade 3.

It is VERY IMPORTANT, however, to understand that a “clean” or
negative pathology report of the prostatic tissue taken at a normal
8- or 12-core biopsy is no guarantee at all that PCa doesn’t exist in
your prostate.

If you are diagnosed with prostate cancer, BEFORE treatment, your
doctor will also assign a CLINICAL STAGE for your cancer. This
clinical stage will be based on the so-called TNM staging system,
where T refers to the primary tumor (in your prostate), N refers to
the evidence that there may be cancer that has extended to your lymph
nodes, and M refers to the evidence that the cancer has metastasized
(spread) to other areas in your body (usually, at first, bones like
your hips and your spine).

The following is the standard (AJCC) CLINICAL staging nomenclature for
prostate cancer, last updated in 2002:

Primary Tumor (T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

T1 Clinically inapparent tumor not palpable nor visible by imaging

T1a Tumor incidental histologic finding in 5% or less of tissue
resected by TURP.

T1b Tumor incidental histologic finding in more than 5% of tissue
resected by TURP.

T1c Tumor identified by needle biopsy (e.g. because of elevated PSA)

T2 Palpable tumor but confined within the prostate

T2a Tumor involves one half of one lobe or less.

T2b Tumor involves more than half one lobe, but not both lobes.

T2c The tumor involves both lobes.

T3 Tumor extends through the prostatic capsule

T3a Extracapsular extension on one or both sides of the prostate

T3b Tumor invades one or both the seminal vesicles

T4 Tumor is fixed to or invades adjacent structures other than
seminal vesicles

Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single lymph node, 2 cm or smaller

N2 Metastasis to one or more lymph nodes 2 cm or larger, but none
larger than 5 cm in greatest diameter

N3 Metastasis to a lymph node greater than 5 cm in greatest diameter.

Distant Metastasis (M)

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis to any site

M1a Distant metastasis to non-regional lymph nodes

M1b Distant metastasis to the bone(s)

You should know that if you decide to have a surgical treatment for
your prostate cancer, then it will be possible for your surgeon to
obtain a post-surgical PATHOLOGICAL stage for your prostate cancer
which will usually be slightly different that the CLINICAL stage.
Pathological staging is only possibly after surgical treatment.

If you initially shown to have prostate cancer on a biopsy, your
doctor may want you to have one or more imaging tests to try to
identify whether your cancer has escaped from the prostate
(metastasized) to other parts of your pelvic region or even to other
organs. These imaging tests can include color Doppler ultrasound
scans, computerized tomography (CT) scans, magnetic resonance imaging
(MRI) scans, bone scans, and the ProstaScint test. Some of these tests
involve injecting a radioisotope into the blood-stream. Absolutely
none of these tests or procedures is 100% accurate.

Stay Active to Reduce Your Risk of Prostate Cancer

2010-02-09T09:03:00.000-08:00

29000 Men Comment
The article below is more evidence that lifestyle has a direct impact on our risk of prostate cancer and, by extension, possibly the risk of recurrence. Read this article and then get active, and consider participating in one of our cycling events: http://www.29000men.org, Events Tab.

Begin Article
Can an active lifestyle protect a man from prostate cancer? Research reported in the journal Cancer Causes and Control (Volume 19, page 107) suggests that it might ...

Much effort has been devoted to searching for lifestyle or environmental factors that might serve as promoters for prostate cancer. The incidence of microscopic prostate cancer (cancers too small to be seen except under a microscope) is similar among men in the United States and in all other countries that have been examined. However, the mortality rates from prostate cancer differ from one country to another and even within different regions of the United States.

These differences suggest that factors such as diet, exercise, body weight, or exposure to certain substances or forces influence prostate cancer's progression from microscopic tumors to clinically significant ones. Some factors are believed to encourage the growth of prostate cancer, whereas others may have a protective effect.

A long-term study of men working in the aerospace industry suggests that having a physically active job may reduce the risk of prostate cancer by nearly half.

Researchers studied the effects of occupational physical activity on prostate cancer risk among 2,167 men who had worked at a nuclear and rocket engine testing facility in Southern California between the 1950s and 1990s. Over a 10-year period between January 1988 and December 1999, 362 of the men developed prostate cancer.

Compared with men who did not develop the prostate cancer, these men were more likely to have had sedentary jobs that mainly involved sitting. Sedentary jobs included positions such as managers, data analysts, inspectors, administrators, and senior engineers. Jobs requiring high levels of continuous activity included positions like junior mechanics, patrolmen, firemen, electricians, janitors, truck-lift operators, and welders.

Bottom line: The researchers speculated that men who are continually active during the day may have lower levels of androgens (male hormones), which can be altered with physical activity. If you have a sedentary job, try to compensate by engaging in regular exercise and physically challenging sports or hobbies. It's good for your heart and could help your prostate as well.
Source: Johns Hopkins Health Alerts.

Can We Prevent Cancer Recurrence?

2010-02-08T20:19:00.000-08:00

The threat of recurrence is something every cancer survivor lives with daily. Dan Butttner’s recent TED presentation, How to live to be 100+, offers some interesting insights. Thoughts?

Nitroglycerine a Possible Treatment Protocol for Prostate Cancer

2010-02-08T18:50:00.000-08:00

Advanced Prostate Cancer 2/6/10 10:31 AM Joel Clinical Trials Drugs and Treatments On The Horizon Uncategorized Joel T Nowak Malecare nitroglycerin PSA recurrence Comments

In a clinical trial conducted at Queen’s University, Canada, researchers, Robert Siemens, Jeremy Heaton, Michael Adams, Jun Kawakami and Charles Graham, have found that nitroglycerin, the widely used explosive which is also commonly used to treat angina, can treat prostate cancer. The researchers found that very low doses of nitroglycerin slow the growth or even stop the progression of prostate cancer without the severe side effects we experience from current treatments.
The researchers based the trial on pre-clinical research carried out at Queen’s where they found that nitric oxide plays an important role in prostate tumor progression and low-dose nitroglycerin is capable of controlling this process.
The researchers used low doses of nitroglycerin in a 24-month, phase II study, involving 29 men who had increasing levels of prostate-specific antigen (PSA) following prostate surgery or radiation (PSA only recurrences). The men in the trial were treated with a low-dose, slow-release nitroglycerin skin patches known as NOVade. The pharmaceutical company, Nometics Inc. of Canada, developed the skin patches.
Of the 17 men who completed the study, all but one showed a stabilization or decrease in the rate of cancer progression, as measured by their PSA Doubling Time. There wasn’t any information presented about why 7 of the subject men failed to complete the study.
The trial results appeared in a recent issue of the journal Urology. In the journal they stated that, “We were very excited to see a significant slowing in the progression of the disease as evidenced by the men’s PSA levels, and to see this result in many of the men who completed the study.”
The potential for these findings could be significant and far reaching as nitroglycerin is inexpensive, has already demonstrated that it is safe and has already approved by the FDA. After additional confirmation studies, nitroglycerin patches could easily be prescribed as an “off label” and relatively benign treatment for recurrent prostate cancer. Nitroglycerin, perhaps a treatment on the horizon.
Joel T Nowak, MA, MSW

A New Strategy in the War On Cancer

2010-02-08T16:45:00.000-08:00

I just viewed a very interesting podcast by Dr. David Agus. TED is a very interesting organization. You can access the podcasts through iTunes or directly at their website, TED.com. This particular presentation was given at TED MED. It gives some insights into possible new directions in cancer treatment and mentions zoledronic acid, which prevented cancer recurrence for three years in the cited case. One distressing note, however, the overall rate of cancer in the US is not decreasing.

Ken Koster's Part 2 for Prostate Cancer Survivor Newcomers

2010-02-05T19:14:00.000-08:00

Date: Fri, 5 Feb 2010 06:11:25 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 2 of 2

PCa is generally treated by three kinds of doctors: You probably saw a
UROLOGIST first. If the diagnosis indicates that the cancer has not
escaped the gland, it would be wise for you to see a RADIATION
ONCOLOGIST for a second opinion. If the cancer has escaped the gland,
a MEDICAL ONCOLOGIST might be the source of a second opinion. Some
patients seek a medical oncologist for another opinion even though the
cancer has not escaped the gland -- sort of a “neutral,” professional opinion.

You’re lucky to have found this source of information before you, your
friend or your relative has submitted to therapy. Even though you may
be “anxious” to “get on with it”, you can postpone treatment for a
brief period until you have done your home work, because you need to
know everything you can about each of the possible PCa treatment modalities.

The first group of treatments is used most commonly for men with
so-called localized prostate cancer that is confined to the prostate
itself or possibly to the prostate and the immediately nearby tissues:

- Active surveillance or watchful waiting (sometimes called expectant
management)

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (potentially including acupuncture, nutritional
and/or herbal supplements, Essiac and green teas, positive mental
attitude, meditation, visualization, spiritual healing, humor, and prayer)

- Proton Beam Radiation therapy or PBRT

- Brachytherapy using either permanent radioactive implants (often
referred to as “seed implants”, or “SI”), or temporary radioactive
implants (often referred to as “high dose radiation”, or HDR”)

- Various other types of photon-based external beam radiation,
including Intensity Modulated Radiation Therapy (IMRT), Image-Guided
Radiation Therapy (IGRT), CyberKnife therapy, and others

- The different types of surgical treatment (radical prostatectomy),
which come in four basic categories: radical retropubic prostatectomy
(RRP), radical perineal prostatectomy (RPP), laparoscopic radical
prostatectomy (LRP), and robot-assisted laparoscopic prostatectomy (RALP)

- Cryosurgery (also known as cryoablation)

- High-intensity focused ultrasound (which has not yet been approved
for use in the USA but is available in other countries from
American-based physicians)

- Limited forms of hormone therapy using drugs like LHRH agonists,
antiandrogens, and 5 -reductase inhibitors either alone or in
combination with other types of therapy, often for limited periods of time

The second group of treatments is more customary for men with more
advanced forms of prostate cancer:

- Long-term or intermittent hormone therapies of various types,
including single-drug androgen deprivation therapy (ADT) and more
complex forms of ADT based on combinations of two or three hormonal drugs

- Chemotherapy, initially and usually using a docetaxel-based
(Taxotere-based) drug regimen

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (see above)

- True watchful waiting in which therapy is avoided until symptoms
need to be treated

- Investigational drugs and drug combinations that are being tested in
clinical trials

We can help you learn more about this disease we call our hobby. The
diagnosis of PCa (like the diagnosis of many other cancers) is almost
always accompanied by the FUD factor -- FEAR, UNCERTAINTY, and DOUBT!
You can get rid of the FUD factor by taking charge; learn all you can
learn, so that YOU can decide which therapy YOU want.

A whole slew of good PCa books have been published. I have yet to
find the “perfect” book. I suggest you read at least these two for a
“more balanced” view:

- Guide to Surviving Prostate Cancer by Patrick C. Walsh, MD, and
Janet Farrar Worthington

- Prostate Cancer: A Non-Surgical Perspective by Dr. Kent Wallner.

The Patient’s Guide to Prostate Cancer by Dr. Mark B. Garnick is a
fast read, but there are now many, many other books available -- some
of which you’ll want to avoid -- some include misinformation; others
are scary enough to make you want to “take the pipe” rather than treatment.

After you’ve decided on the therapy of YOUR choice, you should seek
the most skilled, experienced practitioner available. Most survivors
agree that no matter what therapy YOU choose, you should do your
homework and be assured that the contemplated practitioner has done
several hundred successful procedures. There are individual
physicians who are highly specialized in all of the techniques listed
above, and other survivors will be happy to give you specific
recommendations, but ALWAYS remember that what worked for other
individuals may not work for or even be appropriate for you.

A listing of PCa SUPPORT GROUPS is available at several PCa Internet
sites. Most of the groups can be very helpful. Like doctors, you’ll
be more comfortable with some groups than others. In addition, there
are now several on line chat rooms and related support systems that
use interactive Web-based technology where you can meet with
survivors, physicians, and others willing to share their expertise.

When you are aware of all the PCa treatment options, the chances for
cure, recurrence, survival; their side/after effects; and you’ve
confirmed that information with other doctors, and men in support
groups; you may be ready to proceed. If not, don’t be bashful, come
back, share more of your concerns and ask us more questions.
Don’t waste a good opportunity to listen and ask questions when you’re
talking with a medical professional. Use a good tape recorder to take
notes every time you meet with a doctor, so that both you and your
partner are not pre-occupied with note-taking. Participate in the
discussion, and be sure you understand everything being said. You’ll
be glad for the opportunity to review the consultation -- probably
several times -- before you determine your treatment strategy.

Ron Koster, from the foothills of the Catskills

A Great Summary of Prostate Issues

2010-02-03T21:14:00.000-08:00

29000 Men Comment
I’m now going into my 6th year as a prostate cancer survivor, and I have done a great deal of research over those years. Following is Part I of a three part series that I believe is some of the best information I have found. I will follow with Parts II and III in later posts. I can’t recommend the source enough: LISTSERV@LISTSERV.ACOR.ORG.

Date: Fri, 29 Jan 2010 07:01:15 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 1 of 2

Sent 1/29/2010

Several weeks before his death on August 11, 2005, Ron asked me to go
on sending out his weekly Welcome Newcomer message for him. It’s my
honor to continue posting his message each week as one small example
of his dedication to helping men with prostate cancer. As Ron often
signed his emails, “Sometimes, it takes just one person to work a
miracle.” Ron was one of the miracle workers.

Revised and updated December 1, 2009 by Mike Scott (with we hope
Ron’s complete approval).
=====

In spite of the fact that almost everything about prostate cancer
(PCa) is controversial, you’ve found an excellent source of
information. Be patient, and don’t give up just because this resource
may frequently be dominated by irrelevant, repetitious, or esoteric
notes which may not be particularly helpful to the newcomer!

Risk for PCa is assessed primarily through a combination of two widely
used tests: the prostate specific antigen (PSA) test and the digital
rectal exam (DRE).

A normal PSA for a 50-year-old man is usually less than 2.5 ng/ml,
but there is no specific PSA value that is predictive of risk for
prostate cancer. A higher PSA level by itself does not necessarily
mean that you have PCa, and a lower PSA level does not necessarily
mean that you don’t have PCa.

The DRE enables your doctor to feel the size, shape, and texture of
your prostate to determine if you have a clinically normal or abnormal
prostate. However, you can have PCa without having a palpable
(feelable) tumor, and palpable nodules or abnormalities are not always PCa.

Even though much of the testing is extremely controversial, most PCa
survivors prefer and recommend that all men of about 40 be tested
early and regularly in the hope that early diagnosis will give greater
choice of treatment and cure with fewer side or after effects. Men
with a family history of prostate cancer or other risk factors may
want to get a first (baseline) PSA test at an even younger age.

High PSA levels may be cause by PCa, by benign prostatic hyperplasia
(BPH), or by a urinary tract infection such as prostatitis. However,
NO PSA ASSAY IS PERFECT and no specific PSA level is diagnostic for
prostate cancer! At 58 years of age, when I was diagnosed, my own PSA
was 3.6 ng/ml, my Gleason score was 7, and I was subsequently shown to
be pathological stage T2a (after surgery).

Other tests which your doctor may want to perform on a blood or urine
sample (or which you can ask him to carry out) include the PSA II or
Free PSA test, which can be used to rule out prostatitis and/or benign
prostatic hyperplasia (BPH) and the so-called PCA3 test, which can
help to predict risk for more aggressive forms of prostate cancer.
Older tests that are less commonly used today include the serum acid
phosphate test, the alkaline phosphatase test, and the prostatic acid
phosphatase (PAP) test.

The results of a PSA test and a DRE (and the PCA3 test) can be used,
in combination with information about your family history of prostate
cancer and other medical information, to assess your risk for PCa
using the Risk of Biopsy-Detectable Risk Calculator, which you can find at
http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

The results of these tests, including a suspicious DRE, may give you
and your doctor good cause to decide you need a prostate biopsy. An
initial biopsy, today, usually consists of the removal of 8 to 12
biopsy cores using a specialized procedure under ultrasound biopsy.

If PCa is found in the tissue removed at biopsy, the pathologist who
examines the biopsy cores will assign what is known as a Gleason
score. It will be someplace between 6 and 10, the higher number
indicating a more aggressive form of PCa. The Gleason score has two
components, the GRADE and the SUM or SCORE. The GRADE is based on how
the individual cells look under the microscope. The Gleason grades
used to range from 1 to 5, with 1 being the closest to normal and 5
being bad. However, today, it is normal for all Gleason grades to
range only from 3 to 5 if cancer is thought to be present because
Gleason grades of 1 or 2 are considered not to be cancer. There are
both general and specific guidelines for each grade, but examining
prostate biopsy cores to establish the presence of cancer and the
Gleason grades of that cancer is difficult. The experience of the
pathologist is key -- which is why a second opinion on the biopsied
tissue is often a good approach.

When the pathologist reads a specimen, s/he looks at it to determine
the most common grade of tumor seen: that is the first number of the
SUM. Then the pathologist determines the next most common tumor area
and assigns a Gleason grade to it. This is the second number of the
Gleason SUM or SCORE. The two numbers, when added together, give the
SUM. Close reading of the pathology report, will often indicate both
the Gleason grades and the percentage of each grade, which may make
you feel better or worse than knowing the Gleason SUM or SCORE) -- but
the Gleason SCORE is what is reported in most of the medical
literature and used for comparisons. So a Gleason score of 3 + 4 = 7
means more grade 3 than grade 4 and a Gleason score of 4 + 3 = 7 is
just the opposite, meaning more grade 4 than grade 3.

It is VERY IMPORTANT, however, to understand that a “clean” or
negative pathology report of the prostatic tissue taken at a normal
8- or 12-core biopsy is no guarantee at all that PCa doesn’t exist in
your prostate.

If you are diagnosed with prostate cancer, BEFORE treatment, your
doctor will also assign a CLINICAL STAGE for your cancer. This
clinical stage will be based on the so-called TNM staging system,
where T refers to the primary tumor (in your prostate), N refers to
the evidence that there may be cancer that has extended to your lymph
nodes, and M refers to the evidence that the cancer has metastasized
(spread) to other areas in your body (usually, at first, bones like
your hips and your spine).

The following is the standard (AJCC) CLINICAL staging nomenclature for
prostate cancer, last updated in 2002:

Primary Tumor (T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

T1 Clinically inapparent tumor not palpable nor visible by imaging

T1a Tumor incidental histologic finding in 5% or less of tissue
resected by TURP.

T1b Tumor incidental histologic finding in more than 5% of tissue
resected by TURP.

T1c Tumor identified by needle biopsy (e.g. because of elevated PSA)

T2 Palpable tumor but confined within the prostate

T2a Tumor involves one half of one lobe or less.

T2b Tumor involves more than half one lobe, but not both lobes.

T2c The tumor involves both lobes.

T3 Tumor extends through the prostatic capsule

T3a Extracapsular extension on one or both sides of the prostate

T3b Tumor invades one or both the seminal vesicles

T4 Tumor is fixed to or invades adjacent structures other than
seminal vesicles

Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single lymph node, 2 cm or smaller

N2 Metastasis to one or more lymph nodes 2 cm or larger, but none
larger than 5 cm in greatest diameter

N3 Metastasis to a lymph node greater than 5 cm in greatest diameter.

Distant Metastasis (M)

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis to any site

M1a Distant metastasis to non-regional lymph nodes

M1b Distant metastasis to the bone(s)

You should know that if you decide to have a surgical treatment for
your prostate cancer, then it will be possible for your surgeon to
obtain a post-surgical PATHOLOGICAL stage for your prostate cancer
which will usually be slightly different that the CLINICAL stage.
Pathological staging is only possibly after surgical treatment.

If you initially shown to have prostate cancer on a biopsy, your
doctor may want you to have one or more imaging tests to try to
identify whether your cancer has escaped from the prostate
(metastasized) to other parts of your pelvic region or even to other
organs. These imaging tests can include color Doppler ultrasound
scans, computerized tomography (CT) scans, magnetic resonance imaging
(MRI) scans, bone scans, and the ProstaScint test. Some of these tests
involve injecting a radioisotope into the blood-stream. Absolutely
none of these tests or procedures is 100% accurate.

(please see part 2)

=====================================================
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Prostate Cancer Survivor Documentary Movie

2010-01-30T17:50:00.000-08:00

I’m going to be making a documentary about prostate cancer survivors and their families during this summer’s Tour de USA. The city schedule (46 cities) is posted on the event site. If you would like to be interviewed and tell your story, just visit the website, join the mailing list and send us email. This is a story that really needs to be told.

January 20, 2010 Weight In - Biggest Loser Potential?

2010-01-20T10:07:00.000-08:00

In my post last week, I was at 154 determined to drop back to 149 as my ideal weight - I’m 5“10”, and 149 still places me above my ideal BMI. I’m struggling a bit, though. The kids are still in the house and that ‘kid food’ is so tempting. Hello carrots and veggies! Check back and see how I’ve done next week. I’m also getting back on the back and hitting the weights in the gym. I’m also going to explore some weight programs for 65+, since I just hit that mark. What programs are you other survivors using to control your weight?

Where to Get Really Good Information from Prostate Cancer Survivors

2010-01-20T09:48:00.000-08:00

Finding really good information about prostate cancer is a challenge. The ACOR LISTSERV provides an ongoing dialogue between prostate cancer survivors about their conditions, the treatments they are following and the treatment outcomes. if you are recently diagnosed or in your survivor period, I highly recommend subscribing to the LISTSERV. If you find it useful and have the resources, consider making a donation to support their operations.

Gene Mutation Tied to Increased Risk of Aggressive Prostate Cancer

2010-01-13T18:38:00.000-08:00

January 12, 2010

A new gene mutation has been discovered that may explain why some men are especially prone to developing prostate cancer
Boston (DbTechNo) - A new gene mutation has been discovered that may explain why some men are especially prone to developing prostate cancer.

Prostate cancer is one of the more tricky forms of the disease, as it can either present as an aggressive tumor or a slow growing tumor which determines the appropriate form of treatment.

It is one of the more common types of cancer diagnosed in men, and the aggressive form of the disease is the second leading cancer killer for men in America.

Researchers have discovered a gene mutation dubbed “rs4054823″ which puts a man at a 25% increased risk of being diagnosed with the aggressive form of the disease.

“This finding addresses one of the most important clinical questions of prostate cancer — the ability at an early stage to distinguish between aggressive and slow-growing disease,” said the study’s lead author Jianfeng Xu, cancer expert at Wake Forest University Baptist Medical Center in North Carolina.

“Although the genetic marker currently has limited clinical utility, we believe it has the potential to one day be used in combination with other clinical variables and genetic markers to predict which men have aggressive prostate cancer at a stage when the disease is still curable.”

The study can be found in the upcoming addition of the Proceedings of the National Academy of Sciences.

Source: dbtechno.com

Obesity Responsible for 100,000 Cancer Cases Annually

2010-01-11T21:03:00.000-08:00

Research is beginning to quantify that old saying that “we are our own worst enemy.”

A recent report from the American Institute of Cancer Research (AICR) states that excess body fat is a major cause of cancer. The AICR research looked at seven cancers know to have correlations with cancer and calculated the actual case counts that were likely to have been caused by obesity. The numbers in the study are shocking: 49% of endometrial cancers, 24% of kidney cancers, 28% of pancreatic cancers, 17% of breast cancers, and 9% of colorectal cancers.

Dr. Laurence Kolonel, Deputy Director of the Cancer Research Center of Hawaii and AICR/WCRF expert panel member, presented the new preventability estimates and noted that “We now know that carrying excess body fat plays a central role in many of the most common cancers,” and “it’s clearer than ever that obesity’s impact is felt before, during, and after cancer - it increases risk, makes treatment more difficult and shortens survival.”

29000 Men Comment
I am now going into my 7th year as a prostate cancer survivor and I’m watching my PSA bounce around at the .02, .06, .04 range. My doctors keep telling me not to worry, but I don’t believe I’m cured, and I still have that monkey on my back. Following my surgery in 2003, I went on a strict vegetarian diet and my weight dropped to 144 pounds, just 2 pounds more that when I graduated from college and went in the Army. Over the past two years, I gradually relaxed my diet and my weight increased to 154. My goal for 2010 is to return to my survival eating regime and lose that weight. After all, if the cancer returns, wouldn’t I be greatly to blame? In my business life I talk frequently about accountability. Well, this is pretty much the ultimate in personal accountability. My weight today was 154. Check my as I track my progress. If you want to begin exercising, consider bicycling. It’s a great sport.

Prostate Cancer TRAP

2010-01-11T13:54:00.000-08:00

Prostate cancer cells are often resistant to cell death. Researchers led by Dr. Dario C. Altieri of the University of Massachusetts Medical School, therefore, explored the role of TRAP-1, a protein thought to regulate cell death, in prostate cancer survival. TRAP-1 was highly expressed in both high-grade human prostate cancer lesions and mouse models of prostate cancer, but not in benign or normal prostate tissue. In addition, TRAP-1 over expression in non-cancer prostate cells inhibited cell death, whereas TRAP-1-deficient prostate cancer cells had enhanced levels of cell death. Moreover, treatment with Gamitrinib, which inhibits TRAP-1, resulted in prostate cancer cell death, but not death of non-cancerous prostate cells. Therefore, targeting TRAP-1 via Gamitrinib treatment may be a viable therapeutic strategy for patients with advanced prostate cancer.

Leav et al suggest that "TRAP-1 [is] a novel marker of localized and metastatic prostate cancer, but not normal glands, required for prostate cancer cell viability, in vivo. Taken together with the preliminary safety of Gamitrinibs in preclinical studies, these data suggest that targeting mitochondrial TRAP-1 may provide a novel therapeutic approach for patients with advanced and metastatic prostate cancer" A similar approach may be also suitable for other types of cancer, as TRAP-1 is broadly expressed in disparate human malignancies. In future studies, Dr. Altieri and colleagues plan to "further dissect the biology of TRAP-1 cytoprotection in cancer cells, and test whether disabling its function may overcome drug resistance, the most common reason of treatment failure and dismal outcome in patients with advanced prostate cancer.”

Source: American Journal of Pathology

Sacramento HOG Joins the Tour de USA!

2009-12-15T08:27:00.000-08:00

Sacramento HOG Chapter #295 is the first HOG Chapter to officially join the 2010 Tour de USA for Prostate Cancer. The Tour de USA is the longest motorcycle charity rally in history. Visit the Tour de USA website for ride and registration information. Go HOGs!

How a daily walk wards off prostate cancer

2009-12-02T10:51:00.000-08:00

29000 Men Comment
Below is a short article from the Daily Mail in the UK that echoes what research here is the US is revealing, that lifestyle - exercise and nutritional choices - have a significant impact on cancer prevention. Visit the Prostate Cancer Awareness Project website and participated in one of our bicycling-related programs. Read on!
From our colleagues across the water
By Daily Mail Reporter
A daily walk lowers the risk of prostate cancer, say researchers reporting in the latest issue of the journal Urology. Men who walked around three to six hours a week were two-thirds less likely to be diagnosed with the disease than couch potato counterparts. Men who did one to three hours a week were also 86 per cent less likely to have an aggressive, fast-growing tumour, the study found.
Previous research has shown exercise lowers blood levels of testosterone and other hormones linked to the growth of prostate tumours. Activity is also known to boost the immune system and reduce the risk of cancer.
Read more: http://www.dailymail.co.uk/health/article-1232209/Fitness-news-How-daily-walk-wards-prostate-cancer-colds-bay.html#ixzz0YUBr15JA

7 Reasons PSA Testing Still Matters

2009-11-14T16:09:00.000-08:00

29000 Men Comment
As I have stated before in this blog, it is my fervent belief that PSA testing currently is the only effective means of preventing prostate cancer deaths. It’s not knowing you have prostate cancer that causes over treatment, it is faulty patient decisions. I say patient decisions because ultimately each of us is responsible for the treatment we undergo. We cannot, and should not, place that responsibility on the medical community.

If you are interested in a balanced view of the current PSA testing controversy, read the following article by Dr. Ford Vox on his blog at

Begin Dr. Vox’s Blog Post:

The PSA Test: 7 Reasons It Still Matters
November 13, 2009 03:55 PM ET | Ford Vox | Permanent Link | Print

The U.S. Preventive Services Task Force asked doctors last year to stop checking PSA levels in elderly men—the very men who are most likely to have prostate cancer. By age 75, the officials reasoned, doctors are more likely to keep tinkering with their patients until they die of treatment side effects or something other than prostate cancer altogether. This spring, the New England Journal of Medicine published two long-term studies that questioned whether knowing a man's PSA level actually helps men survive. Healthcare commentators say that PSAs set off a cascade of overtreatment, endangering patients and tolerating wasteful medicine, and that patients should be wary.

You might expect that the surgical specialists at the center of prostate cancer treatment would have reined in their PSA testing, but they haven't. The American Urological Association actually lowered its recommendation for the age at which doctors should start offering patients the PSA test from 50 to 40. It was the first revision of the guidelines in nearly a decade. The next one, says Kirsten Greene, a urologist who worked on the committee, should take just a year, in light of the accelerating data and heightened public debate.

"The key change is how we react to abnormal tests and to a cancer diagnosis, which is generally less aggressively for some men than in the past," says Gerald Andriole, chief of urologic surgery at Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis. Andriole says that men shouldn't be afraid to get diagnosed; good urologists avoid overtreating less-dangerous cancers. Active surveillance or targeted attacks on very small tumors that spare healthy prostate tissue are both popular options.

From the latest research, here are seven reasons why urologists are encouraging men of any age who expect to live at least another 10 years to think hard about getting a PSA test, even if they have to pay out of pocket:

1. Keeping tabs on PSA saves lives. Many urologists flat out reject a large study published in the New England Journal of Medicine earlier this year that found men who got the PSA test did worse than men who didn't. The dissenters say the results weren't trustworthy—many of the men who weren't supposed to get tested actually did, thanks to their proactive primary-care docs. Another recent large NEJM study found that nine years after entering the study, men who got regular PSA screening were 20 percent less likely to die of prostate cancer. One model suggests the PSA test has contributed to much of the 30 percent decline in prostate cancer deaths seen in recent decades.

2. There's no magic PSA number. In the urologists' latest recommendations, it is clear that there's no one-size-fits-all age at which to be tested or bad PSA number. For many years, a particular reading of 4 or above was a battle cry that called for a biopsy or aggressive treatment. In reality, any reading is suspect. Without knowing much more about him, studies give a middle-aged man a 10 percent chance of having visible cancer on biopsy even if his PSA level is zero. Today, doctors consider a single PSA number in the context of your specific health background, race, and family history (it may also help diagnose benign enlargement or an infection), and then suggest when to be tested next. If you do get a biopsy, the criteria for serious concern are stricter, and there are more conservative treatment options.

3. Velocity matters. Your first PSA test is neither your last nor your most important. Depending on your age and your current PSA number, the question is how much, and how fast, subsequent test numbers increase. Researchers are busy determining just how much velocity is normal. (Some researchers say a speed bump of more than 0.25 in one year for a 40-year-old man should prompt concern.) Every man generates a history of data points his doctors can interpret in light of the research.

4. There ' s more than one kind of PSA to measure . Enlarged but noncancerous prostates usually release "free" PSA that circulates through the body, while PSA produced by cancer cells tends to attach itself to proteins in your blood. By considering the ratio of the types of PSA, as is done by looking at the ratio of bad to good cholesterol for heart disease, doctors can offer you better advice about your risk and what you should do next.

5. The younger you are, the more meaningful the PSA test. Older prostates tend to get bigger and put out more PSA, complicating interpretation. Higher PSA levels at a younger age are an indicator of elevated risk and call for closer monitoring of factors like your PSA velocity. At the same time, prostate cancer therapies are most effective and sparing of function when the cancer is at an early stage.

6. PSA numbers reveal your prognosis and are critical in follow-up. If you do develop a serious form of prostate cancer that requires aggressive treatment, your PSA levels prior to treatment will help your medical team determine the risk of recurrence. It's one factor among many others, such as how the tumor looked under the microscope after surgery, but the latest studies show it's of real value. After surgery to remove the prostate, the PSA test is even more critical: Detection of extremely minute levels can signal cancer recurrence. The earlier doctors know the cancer is back, the earlier patients can decide about secondary treatments like radiation and hormonal therapy.

7. For now, PSA is the best we've got. Scientists are looking hard for a better "biomarker" than the PSA, ideally one that doesn't require so much deliberation. Candidates are surfacing, but they require more proof. Physical measures like the prostate's size can be misleading, as Mayo Clinic researchers reminded us this week. Studies show that a digital rectal exam plus a PSA test is the surest way to pick up prostate cancer. But if you've got to pick only one test, PSA is still the best.

So Easy a Caveman Can Do It!

2009-11-12T16:17:00.000-08:00

We’ve all heard the Geico car insurance ad a million times, at least if we watch sports. So what does this saying have to do with prostate cancer? The answer is nothing and everything.

The research has just about reached the overwhelming stage that the Western diet, especially our American version - heavy on meat and dairy with their associated fat and toxic loads, is a major factor in prostate cancer development.

As a prostate cancer survivor, I’m pretty interested in ensuring that mine does not recur, so I started looking at the recurrence risk elements that are within my control. Basically, these factors are what I eat (my diet), what I do (exercise - or lack thereof), and what I think - laughter is great medicine.

On the food front, I decided to see how easily I could adopt a diet with no meat and dairy. But, I reasoned, it needs to be really EASY - there’s the caveman angle - because we guys (at least most of us) tend to graze on the first thing we see and things that are easy. Below is my first shot at doing green, the easy way.

I created what I think is a pretty passable salad using pre-washed vegetables - minimum preparation time. The ingredients: 1) pre-washed spinach; 2) pre-washed broccoli and romaine lettuce; 3) I peeled and diced some raw onions - it did require some peeling; and 4) I chopped in red peppers. Full disclosure; I did wash the red bell pepper. I drizzled extra virgin olive oil over the top along with some coarse sea salt, as I have a salt tooth. Et voila! A pretty good salad - very healthy - with almost no preparation. Make it as big as you like, there aren’t many calories but lots of great vitamins, minerals, phytonutrients, etc. A caveman really could do this because they had that all important opposable thumb. And all in about 11.5 minutes. Got brocolli?

Letter to the Editor, LA Times, on PSA Testing

2009-10-27T09:59:00.000-07:00

29000 Men Comment
Below is a copy of my letter to the editor that was published in the LA Times on 10/27/2009. It was slightly shortened to conform to the 150 word limit. Eliminated was my comment that the annual prostate cancer death rate has dropped from the 40,000 men per year in the pre-PSA test era to the approximately 29,000 deaths per year today. If the current debate is successful in convincing men they do need to test and track their PSA, we very likely will see a return to the 40,000 per year death rate. This would mean that an additional 100,000 men would die unnecessarily from prostate cancer each decade.

I believe that we need to focus more on prostate cancer prevention and methods to effectively determine which cancers are the aggressive killers. See the Times letter below.

LA Times Opinion Section, October 27, 2009
Cancer risks and diagnoses

Re “With cancer, it’s always personal,” Oct. 25

Thank you for running Paul Lieberman's Op-Ed article on prostate and breast-cancer screening.

I would, however, retitle his article, "With Cancer, it's never real until it's personal. " My point is that one only comes to terms with cancer after we, personally, are diagnosed. The danger with the current discussion over prostate cancer testing is that the continual focus on possible post-treatment problems may drive the annual PSA testing rate below the current meager rate.

The principal issue with PSA testing is not with the number of men tested but with the treatment decisions made by cancer patients and their physicians. What men need is better information about prostate cancer risk and treatment options, but with real statistics about post-treatment side effects attached.

And, of course, the ability of physicians to be able to reliably differentiate between benign and aggressive forms of prostate cancer.

Robert W. Hess
Manhattan Beach

http://www.latimes.com/news/opinion/letters/

Mayo researchers find few side effects from radiation treatment given after prostate cancer surgery

2009-10-26T16:45:00.000-07:00

29000 Men Comment
The following article came from by Cancer Weekly, a leading research newsletter for biotech and pharmaceutical professionals. For more information, go to http://www.newsrx.com/publication.php?pubID=74.

If correct, the results of the study detailed below should be reviewed by all men preparing to undergo prostate cancer surgery. In my case, the option was never mentioned. I’m now 5 1/2 years into my survivorship and recurrence is something I think about often.

“Mayo researchers find few side effects from radiation treatment given after prostate cancer surgery

The largest single-institution study of its kind has found few complications in prostate cancer patients treated with radiotherapy after surgery to remove the prostate. Men in this study received radiotherapy after a prostate-specific antigen (PSA) test following surgery indicated their cancer had recurred.

Researchers say the findings from Mayo Clinic's campuses in Florida and Minnesota suggest that patients and their physicians should not overly worry about toxicity and side effects from the treatment, known as salvage external beam radiotherapy. The study findings will be published in the October issue of Radiotherapy and Oncology.

"There is a general fear of this kind of radiation treatment on the part of some patients and their physicians, but this study shows that it not only effectively eradicates the recurrent cancer in a substantial number of patients, but that there are few serious side effects," says the study's lead investigator, Jennifer Peterson, M.D., from the Department of Radiation Oncology at Mayo Clinic in Florida.

"It is really important that patients and their doctors watch PSA levels after a radical prostatectomy, which is a complete removal of the prostate," she says. In men who have an intact prostate, a PSA test can indicate either an enlarged prostate gland or development of cancer in the prostate, says Dr. Peterson. "But in men without a prostate, a rising PSA level indicates that cancer has recurred. After a recurrence is detected, there is only a narrow window of time during which radiotherapy will be beneficial in controlling their cancer."

"No other therapy besides salvage external beam radiotherapy has been shown to cure these patients," she adds.

In 2009, an estimated 192,000 American men will have newly diagnosed prostate cancer. Approximately one-third (about 64,000 men) will choose radical prostatectomy as their primary treatment, according to the National Cancer Institute. Large studies have shown that one-third of those men, about 21,000 patients, will experience a rising PSA - a recurrence of their cancer - within five to 10 years, says Dr. Peterson. "Two-thirds of these men, if left untreated, will have metastatic disease within 10 years, but the chances of that occurring are greatly reduced in patients given salvage radiotherapy," she says.

Lingering uncertainty about the effectiveness of salvage radiotherapy and its side effects have led many urologists not to recommend the treatment, says co-author Steven Buskirk, M.D., from Mayo Clinic in Florida.

This study, which lasted two decades, was undertaken to specifically document those side effects. It studied 308 patients with a median follow-up of 60 months after salvage external beam radiotherapy. Only one patient had a serious (grade 4) complication and three patients had a less serious (grade 3) side effect. None of these effects were fatal, and all were treated. Milder side effects were seen in an additional 37 patients, the researchers say, and all were successfully treated for these complications. Urinary leakage, a concern of many patients who choose not to use radiation, was not a common side effect of treatment.”

What We Eat and Do May be the Real Strategy for Beating Cancer

2009-10-24T12:14:00.000-07:00

29000 Men Comment
“No matter how strange something is, if you give it enough time it becomes normal. American’s have now accepted heart disease, cancer, and other degenerative diseases as a normal part of American life.” (1)

Now approaching six years as a prostate cancer survivor and amateur student of wellness and cancer recurrence prevention, I have arrived at the conclusion that our best chance at avoiding or defeating this disease rests with our own habits.

I’ve been looking at this issue for five years now, and I recently read books by David Servan-Schreier, MD, PhD, Anti Cancer: A New Way of Life, and the RAVE Diet and Lifestyle by Mike Anderson.

I’ll be summarizing what my key takeaways from these books over the next series of posts, and I encourage your feedback - even “pushback.” I’ll also be posting some of my personal recipes for “quick eats that are so easy "Even a Guy can do them!”

Best regards, Robert

Anderson, Mike, The RAVE Diet, RAVEDIET.com, August, 2004.

Mild Incontinence

2009-10-22T11:11:00.000-07:00

In case you have just a small bit of incontinence following surgery or radiation therapy, consider using women's panty liners. They are smaller than men's products, work really well, and are absolutely undetectable. If you are a numbers guys, you can get a small postal scale and track the degree of incontinence and watch as your kegel exercises begin to work.

To PSA or Not to PSA. Is that the Question?

2009-10-22T10:45:00.000-07:00

29000 Men Comment
Below is a good description of some of the history of PSA testing and accepted PSA values for specific age ranges. The problem with guidelines is that there are the general rule and don’t cover the statistical outliers. For example, I am an accidental prostate cancer survivor. I was diagnosed at age 57 with a PSA value of 3.2, well within the acceptable range according to the standard. I also had a negative DRE, which was misleading because my tumors were sitting on top of the prostate where they could not be felt. My post treatment diagnosis was Stage 2, with a Gleason Score of 3+3. I am only here writing this blog because my urologist was super diligent and ordered a Free PSA test that came back with a very low ratio (.09; 9%).

Prostate cancer kills almost 29,000 men each year. It is up to each man individually to monitor his PSA, track the changes, and then get the facts. I am not suggesting a rush to treatment, but I do believe it is vitally important for men to know if they have prostate cancer as soon as possible. If you are unlucky and are one of the 1 in 6 men that is diagnosed, the next step is to work with the doctor to determine if you have an aggressive form of the disease.

Please visit us at 29000Men.org and participate in one of our prostate cancer awareness events.

Begin Quote of Referenced Material
The PSA Test

Understanding the PSA Test and Results

Prostate Specific Antigen (PSA) is a protein made in the prostate. Normally, very little should be found in the blood. Rising levels of PSA in the blood indicate a problem with the prostate, which could be cancer but could also be an enlarged prostate (BPH).

Annual screening should start at age 45 for the general population, but the right age to start PSA testing depends on your level of risk.

Doctors usually recommend further testing for men with a total PSA level of 2.5 or more nanograms of PSA per milliliter of blood (ng/ml). This cut-off level has been set by the National Comprehensive Cancer Network, a large network of cancer experts who establish industry wide standards.

As PSA levels increase, so do the odds that it’s due to prostate cancer. About 25 percent of men with a PSA level from 4 to 10 have prostate cancer. About 67 percent of men with a PSA above 10 have the disease.

The change in your PSA level over time, PSA velocity, is very important. Even if your PSA is 4.0 ng/ml or below, an increase of 50 percent or more in one year may indicate prostate cancer. If your PSA is above 4.0 ng/ml, an increase of 75 percent or more in one year could indicate an aggressive case of the disease.

There are some factors that you and your doctor may want to consider when it comes to interpreting your score:

* Your age. Doctors may use age-adjusted PSA ranges to account for the natural increase in PSA with age when considering further testing.
* The size of your prostate. PSA Density is a measure that relates your PSA level to the size of your prostate, to account for the increase in PSA caused by prostate enlargement.
* Your weight. Body Mass Index, a measure of obesity, may also be a factor. The relationship between obesity and lower PSA levels may cause doctors to miss early prostate cancer cases in overweight men.
* Ejaculation within 48 hours before taking a PSA test can also cause a higher reading of your PSA level.

Some doctors recommend the following PSA cut-off levels adjusted by age and ethnicity:

Age Caucasian or Hispanic African American Asian

40 to 49 2.5 2.0 2.0

50 to 59 3.5 4.0 3.0

60 to 69 4.5 4.5 4.0

70 to 79 6.5 5.5 5.0

PSA Test Standards

Today, because there are two standards for PSA tests, the same cutoff should not be used across all PSA tests. It is important for you and your physician to know which type of test your clinic’s lab uses and how to correctly interpret the results.

The Hybritech PSA test established 4.0 ng/mL as the cutoff for a normal test. This means men with a score above 4.0 should be referred for further testing, such as a biopsy. Men with a result lower than 4.0 may not be referred for biopsy, depending on their physician’s instructions. As other manufactures developed PSA tests, they aligned their tests to the same standard, which became known as the "Hybritech standard," and other manufacturers used the same recommended cutoff of 4.0.

By the mid-1990s, some researchers began to recognize that test results from different test manufacturers could be slightly different and joined together to create a common calibration standard to better align results from different PSA tests. This standard was accepted by the World Health Organization (WHO) and soon became known in the medical community as the “WHO standard” PSA test. To establish this new standard, a different scientific process to measure molecular weight of PSA was used and found that weight to be 20 percent higher than was used for the Hybritech test. Because of the way this is calculated, a WHO test would show a proportionately lower PSA concentration level than would a Hybritech test for the same sample. As a result, the cutoff point at which men are referred for further testing would more appropriately be set about 20 percent lower than the 4.0 used for the Hybritech test.

To find out which type of test you have received, your physician should contact his or her lab to determine which brand of test was used for their PSA testing and whether it is WHO or Hybritech calibrated.

Types of PSA Tests

Some of the PSA in the blood is bound to enzymes (complexed) while some is freely circulating (free). Unless otherwise noted, the PSA levels generally refer to total PSA (or tPSA), a combination of complexed and free PSA.

Free-PSA or fPSA refers to the percentage of PSA in the blood that is not bound to enzymes. Doctors are now recommending further testing for men with a free-PSA of less than 25 percent. This is a helpful indicator for men who may be uncertain whether to get a biopsy, such as those with PSA levels between 4 and 10, and negative DRE results.

Complexed PSA or cPSA refers to the measure of one type of bound or complexed PSA. This measure is as accurate as total PSA and may be better at ruling out some people from further testing. Cut-off levels are different for cPSA, so make sure you know whether your PSA test is complexed or total. For example, a cPSA level of 2.2 is equivalent to the cut-off level of tPSA at 2.5.

PSA and Recurring Prostate Cancer

The PSA test is also used to detect and monitor recurrence of prostate cancer after initial treatment. PSA levels should drop dramatically after initial treatment. If they rise again, they are a good indicator that the initial treatment did not catch all the cancer cells.

Source: Zero: The Project to End Prostate Cancer http://www.zerocancer.org/site/PageNavigator/PSA_Test

What Ritalin and Prostate Cancer Have in Common

2009-10-13T13:22:00.000-07:00

29000 Men Comment

There is an excellent article in the current edition of Bicycling Magazine, Riding with Ritalin, that really does pertain to prostate cancer prevention and survival. The article, which is available at the link above and is a quick and interesting read, describes how cycling made a significant improvement in the live of a child and young person with ADHD, significantly lowering the amount of medication required.

The article notes that, "Research has shown that vigorous exercise is so effective at quelling anxiety and depression that some patients have been able to reduce or eliminate the use of medications such as

Prozac

and Zoloft. In a study at the University of Southern

Mississippi

, participants who suffered from generalized

anxiety disorder

and exercised at 60 to 90 percent of their maximum heart rates for three 20-minute sessions per week saw significant decreases in anxiety sensitivity and fear after just two workouts. Further research has shown that people who get regular vigorous exercise are less likely to develop

anxiety disorders

and depression."

Separate research shows that a third of all cancers are the direct result of what we eat and a lack of exercise. In the coming weeks, I'll be reviewing the book "Anti Cancer: A New Way of Life" by David Servan-Schreier, MD, PhD.

Making a decision to adopt a different nutritional style and implementing a regular exercise program can have a major impact on your body's ability to prevent cancer or its recurrence. I happen to believe that bicycling is an ideal exercise program component. You can ride a beach cruiser, a mountain, in a velodrome, or on the road. Every town in America probably has at least one bicycle shop and cycling club. To find the one nearest you, simply pose the question in your favorite Internet browser.

If you like to travel, there literally are dozens of touring groups with trip opportunities all around the globe. If you are married, take a family trip or do family rides. If you like a challenge, consider getting your USA Cycling license and participating in a local amateur competitive event.

Finally, we would love to have you be part of our Prostate Cancer Awareness Project Black Tire Affair ® program. We currently have events at the Encino Velodrome here in California, along the Skyline Drive in Virginia, in Las Vegas, Nevada, and at Reddish Knob in Virginia beginning in October 2010.

"PSA Testing - A Failed Medical Experiment"

2009-10-12T12:11:00.000-07:00

29000 Men Comment
My thanks to Dr. Dach for commenting on my post concerning the PSA testing controversy, and I encourage everyone to read his excellent article at http://www.jeffreydach.com/2009/10/01/psa-testing-the-failed-medical-experiment-by-jeffrey-dach-md.aspx.

Dr. Dach concludes his article as follows:
"In conclusion, PSA screening for prostate cancer has been a failed medical experiment leaving behind 1 million male victims treated unnecessarily for a type of prostate cancer that was clinically insignificant, providing little or no benefit in terms of lives saved. Leaders in the field are now alerting us to the pitfalls, harms and limitations involved in PSA cancer screening.

Recognizing that there are 30,000 prostate cancer deaths per year, the urgent challenge is to identify and treat the aggressive cancers destined to kill the host, and avoid harming the other 7 million men representing a silent reservoir of biologically insignificant disease. Hopefully, this will be the subject of future NIH funded research, so that another one million men in the future will be spared needless overdiagnosis and overtreatment."

29000 Men Comment
As a prostate cancer survivor who is alive today because of PSA and Free PSA testing and a determined urologist, it is my deeply held opinion [please note that I am not a physician and can not and do not offer medical advice] that the issue is not with too much diagnosis, as approximately 29,000 men continue to die each year from prostate cancer, but with the treatment decisions made following diagnosis. If the current controversy is successful in convincing men that prostate cancer testing is unnecessary and that men that to do seek treatment are destined to have quality of life degradation, will we not in the future see an increase in prostate cancer deaths? I look forward to a lively discussion on this important issue.

PLU Codes - Organic or Genetically Modified?

2009-10-08T13:08:00.000-07:00

Do you ever wonder about the meaning of those annoying (at least to me they are) little stickers we find on our produce? Well, here’s some interesting information, especially if you are trying to eat organically or simply trying to avoid “engineered” food.

PLU stands for “Price Look Up” standards, which are published by the International Federation for Produce Standards (IFPS) Board of Directors. You can find the full directory at plucodes.com.

What can be really important is the first digit, if the PLU code sticker on your produce contains five (5) digits. If it has only four (4) digits, it is “normally grown,” whatever that means in the country of origin.

If the first digit of a five (5) digit code is “9,” the produce is organically grown - again, meaning whatever standard that entails in the country of production.

But, if the first digit of a five (5) digit code is “8,” it means that the produce is genetically modified. Caveat emptor.

Tour de USA 2010 for Prostate Cancer Awareness

2009-10-08T07:02:00.000-07:00

29000 Men Comment

We are moving forward on our planning for our cross country (and back) motorcycle trip to raise awareness for prostate cancer. If you ride a motorcycle and are interested in the ride of a lifetime, pop on over to the TourdeUSA website and watch our TourdeUSA blog for details.

The PSA Testing Controversy

2009-10-08T06:45:00.000-07:00

29000 Men Comment

The medical and medical journalistic community continue to struggle with the issue of PSA testing for prostate cancer. The issue is the treatment of prostate cancer that is slow-growing and not a major threat. The difficulty is that is extremely difficult to determine which prostate cancers are “benign” and which are aggressive and life threatening. It seems a bit ironic that we have this major focus on over testing for prostate cancer but no similar debate about testing for breast cancer, when the two cancers are virtual mirror images in terms of annual new cases and death rates.

The issue, I believe, is not in over testing for prostate cancer, since early detection is essential for effective treatment of aggressive prostate cancer, but with the level of knowledge men have about prostate cancer and the various forms of treatment. Current American Cancer Society statistics show that only 54% of men test annually for prostate cancer and that almost 29,000 men die each year from the disease. My conclusion is that we are undertesting the male population as a whole, and possibly over treating those are identified. I would love to have a dialogue on this issue.

Dr. Mark Scholz, head of the Prostate Cancer Research Institute in Los Angeles, published the following statement that, I believe, succinctly summarizes the dilemma. My suggestion would be to follow Dr. Scholz’s advice; test, but take the time and steps necessary to ensure you have a form of prostate cancer that requires treatment.

Best regards, Robert

Re: Letter to the Editor Regarding a Wall Street Journal Article titled:  Two Big Studies Tackle Debate on Prostate Test published on Thursday March 19, 2009

 The Wall Street Journal recently published a letter to the editor under the heading, “Lifestyle Is Fine, but Cancer Needs Effective Treatment.” The physician writing the letter vilified the idea of using anything but surgery to treat his prostate cancer. Unfortunately, his uninformed convictions are prevalent throughout the medical community. Now definitive, well-performed studies unequivocally prove that overtreatment is the norm (New England Journal of Medicine 2009;360:1310-9 and 1320-8) .

 As has been the case for years, the a priori assumption that “all cancer needs treatment” has confused the expert commentators who are interpreting these crystal-clear study results as being part of an ongoing unresolved controversy about PSA testing. The reality is that huge amounts of precious research dollars are being spent to answer a foolish question. Whether or not to do PSA testing is not the issue. The issue is deciding what to do with the information the PSA provides.

 Right now the nation is in the grip of 8-billion dollar industry hell-bent on administering treatment to every kind of prostate cancer whether it is life-threatening or not. The solution to the problem of over-treating prostate cancer is not less PSA testing. The solution is educating physicians to forgo recommending immediate surgery or radiation to every last man who gets a diagnosis of prostate cancer.
 Newly-diagnosed patients need to research all their options before agreeing to irreversible radical treatment. PSA testing (in conjunction with other means) has a useful role in determining which men harbor the more aggressive types of prostate cancer. Only with a “go slow” approach, ongoing monitoring known as Active Surveillance, can we distinguish men with aggressive disease who need treatment from men with indolent disease who don’t need treatment.

 Mark Scholz, M.D.  Prostate Cancer Research Institute Los Angeles, California

Male Sling for Incontinence

2009-10-06T08:06:00.000-07:00

29000 Men Comment

Often when I talk with men about prostate cancer it quickly becomes clear that the fear of incontinence following treatment is one of the key concerns that prevent men from testing for prostate cancer. While some degree of incontinence is a possible outcome of treatment, it certainly is not an inevitable outcome of treatment. There are numerous methods of dealing with incontinence when it occurs. If this is a concern, take a quick read of the following article or click the link to visit the parent page.

http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-male-sling.html

The Male Sling for Incontinence

The male sling is a relatively new procedure to treat men with incontinence as a result of prostate cancer treatment. In most cases this treatment can be done on an outpatient basis or with one overnight stay. The procedure can take less than half hour to one hour and requires a two-inch incision between the scrotum and the rectum.

The male sling is a minimally invasive procedure where a strip of abdominal or synthetic tissue is placed in the pelvis to compress the urethra and prevent urine leakage during stress maneuvers. Six titanium bone screws are placed into the pubic bone after exposing the pelvic bone on each side. Three screws are placed on each side. A permanent suture is attached to each bone screw. The sutures are then passed through the material used to create the sling. On one side of the pubic bone three sutures are passed through one edge of the sling and tied tightly and on the other side three sutures are then passed through the sling and tied to create the closure of the urethra. The incision is then closed. A catheter is usually left in place for a period of 24 hours. Immediately after the catheter is removed most men are able to urinate with better control.

Not all medical establishments have the male sling available. Initial studies have reported 80% incontinence improvement of the men treated. Although still in its infancy, the male sling has become a significant advance in how we treat incontinence, allowing many men to regain their urinary control and improve their quality of life. Patients should consult their physician to determine whether the male sling would benefit them.

Prostate Cancer Research Institute Annual Conference

2009-09-14T15:13:00.000-07:00

Over the weekend I attended PCRI’s annual convention on prostate cancer research and treatment. I was particularly struck by Dr. David Heber’s presentation on nutrition and prostate cancer. I’ll be posting more information over the next few days, but PCRI is a very good source of information and support for prostate cancer survivors and those newly diagnosed.

MyBikeInfo iPhone and iPod Touch Application

2009-09-14T15:10:00.000-07:00

If you are a cyclist and use MyBikeInfo for iPhone/iPod Touch, just click the link below to receive infrequent updates about improvements and new functionality to MyBikeInfo iPhone/iPod Touch application. You may unsubscribe at any time. By the way, you can use MyBikeInfo to track information on your motorcycle, as well. Plus, with MyBikeInfo’s RSS functionality, you can have real-time feeds from all of your favorite websites in one handy place on your iPhone. Proceeds go to prostate cancer awareness and prevention.

http://29000men.us1.list-manage.com/subscribe?u=95aaf73102f9fd5323096e57f&id=819e716571

TSG, Inc. Releases MyBikeInfo iPhone Application

2009-08-26T05:33:00.000-07:00

In these difficult economic times, it’s especially difficult for non-profit entities to raise funds to support their charitable missions. As a result, Robert Hess, CEO of TSG, Inc., and Founder and President of the Prostate Cancer Awareness Project (PCaAP), embarked on a program to create a self-funding mechanism for the PCaAP.

Because the PCaAP uses bicycling events to disseminate it’s “Early Detection, Early Treatment” message and to drive healthy lifestyle activities, the logical choice was something related to cycling. The result, after 9 months of technical development led by Mr. Prem Sundaram, is the MyBikeInfo iPhone application.

The application stores all of the information necessary for a proper positioning fit for an unlimited number of bicycles and includes the ability to create RSS feeds within the application. It’s available now in the iTunes application store. Full details are at http://www.mybikeinfo.com. Proceeds go to prostate cancer awareness and testing for men without medical insurance.

TSG, Inc. is pleased to pleased to support the Prostate Cancer Awareness Project.

Initial reviews look pretty good. See velogirlscoaching in San Francisco.

2009 Tour de Skyline Drive Completed

2009-08-24T06:33:00.000-07:00

We just completed the 2009 edition of the Tour de Skyline Drive. Our annual two-day event from Front Royal, VIrginia to Luray, Virginia and back along the beautiful Skyline Drive in the Shenandoah National Park. Pictures will be on the event website - TourdeSkyLineDrive.org - in a few days. Click the following link to see the Channel 3, Winchester, Virginia report on the event. Cyclist Tour Raises Prostate Cancer Awareness

Keep the rubber side down and Test-Track-Treat-Live.

Best regards, Robert

Alpe d'Huez for Prostate Cancer Awareness

2009-08-18T05:54:00.000-07:00

As part of our prostate cancer awareness program, I rented a bicycle during my July visit to Italy and France and climbed the Alpe d'Huez in our current bicycling kit - although it's a bit difficult to see the logo in the picture. I learned that the Dutch cancer foundation does an annual fundraiser on the Alpe d'Huez that raised 5 million Euros on June 6, 2009. I've got an idea for a similar event here in the US.

To my dismay, however, I had forgotten to take my bicycle fit dimensions with me, so I made the climb with a less than optimal bicycle adjustment. But, I'll never need to suffer like that again. My firm, TSG, has just released an iPhone application, MyBikeInfo, that records every possible dimension of a bicycle adjustment for all types of bicycles: road, time trial, track, mountain, etc.

The application is available now from the iTunes application store, and 50% of all proceeds are going to the Prostate Cancer Awareness Project to support awareness and annual testing for men without health insurance. Give it try! You should be able to access the app from the MyBikeInfo website, but if that does not work, just open your iTunes application and search for MyBikeInfo.

And watch this blog for information on our new project. PS. This picture was taken at Turn 4 and I was more than ready for the climb to be over!

Dietary fat from red meat and dairy linked to pancreatic cancer

2009-07-02T09:09:00.000-07:00

29000 Men Comment
There seems to be a growing body of research clearly pointing to the relationship between dietary habits and cancers of all types. There is similar research concerning prostate cancer. These insights give each of us a means of affecting our current and future susceptibility to cancer. There currently are over 2 million prostate cancer survivors in the United States. A change in dietary intake could potentially have an important effect on longetivity.

Report Summary
High intake of dietary fats from red meat and dairy products was associated with an increased risk of pancreatic cancer, revealed by researchers. This study was undertaken because research relating fat intake to pancreatic cancer was inconclusive.

The new study is published online June 26 in the Journal of the National Cancer Institute.

To examine the association, Rachael Z. Stolzenberg-Solomon, Ph.D., of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Bethesda, Md., and colleagues analyzed a cohort of over 500,000 people from the National Institutes of Health – AARP Diet and Health Study.

Participants completed a food frequency questionnaire in 1995 and 1996 and were followed prospectively for an average of 6 years to track a variety of health outcomes, including pancreatic cancer.

Men and women who consumed high amounts of total fats had 53% and 23% higher relative rates of pancreatic cancer, respectively, compared with men and women who had the lowest fat consumption. Participants who consumed high amounts of saturated fats had 36% higher relative rates of pancreatic cancer compared with those who consumed low amounts.

"We observed positive associations between pancreatic cancer and intakes of total, saturated, and monounsaturated fat overall, particularly from red meat and dairy food sources. We did not observe any consistent association with polyunsaturated or fat from plant food sources," the authors write. "Altogether, these results suggest a role for animal fat in pancreatic carcinogenesis."

In an accompanying editorial, Brian M. Wolpin, M.D., MPH, of the Dana Farber Cancer Institute in Boston and Meir J. Stampfer, M.D., DrPH, of the Harvard School of Public Health, call the study well-performed and a good addition to the understanding of pancreatic cancer.

They do note, however, that there is insufficient epidemiological and laboratory evidence to confirm the importance of animal fats or even that meat is the important factor, as opposed to other dietary or lifestyle preferences associated with meat consumption.

"With further investigation, this work has the potential to provide interesting clues to the mechanisms underlying pancreatic tumorigenesis," the editorialists write.

15 Pounds in 15 Months. Will They Kill Me?

2009-06-25T10:02:00.000-07:00

29000Men Comment
I just finished watching Mike Anderson’s movie, Healing Cancer, and I must say that it made a major impact on my thinking.

If you have read my short bio on the blog, you know my prostate cancer background. After my treatment, I searched for ways that I could affect the potential future recurrence of my prostate cancer. The only options I found were diet and exercise, because I wasn’t in the position to change my environment either by lowering work stress or by physically moving to a new location (I live in Manhattan Beach, CA).

I adopted a vegetarian diet and got back on my bicycle. Within 6 months I had dropped to 142 pounds, my weight at the time I graduated from college and entered the US Army. I felt great, although I looked a bit thin to most people (that’s why you see me sporting a beard - it makes my face look a bit fuller).

However, over the past year I relaxed my diet to include chicken, turkey, and an occasional fling with red meat, but also more non-vegetable carbohydrates and, of course, the cheese that I love. The result? My weight has increased to 158 pounds (my normal weight at surgery was 162 pounds - I stand 5’10“).

Yesterday, I reverted to my vegetarian regime and I’ll follow my progress on this blog. I would be very interested in hearing from other PCa survivors about their reflections on Mike Anderson’s research.

Best regards, Robert.
Test.Track.Treat.Live.™

PS: If you are a motorcyclist, check out http://www.tourdeusa.org. I'll be riding across the US and back in 2010 to get guys thinking about prostate cancer. I would love to have company along the way.

How Long Do I Have?

2009-06-25T08:37:00.000-07:00

29000 Men Comment
Below is a link to a prostate cancer nomogram developed at Memorial Sloan-Kettering Cancer Center. I was provided this link by the moderator at The Cancer Forums. This can be a useful tool in developing your post-diagnosis cancer “battle plan.”

Having spent a career in the military, and now with my own management consulting firm, I was trained to proactively plan for various possible outcomes. The logical question that came to my mind at the time of my diagnosis was simply, “What can I do personally to improve my long-term survival probability.” More on this in my next post.

Sloan-Kettering - Prediction Tools: Prostate Cancer

“Our Prostate Nomogram helps physicians and patients decide which treatment will result in the greatest benefit. It is recommended that patients using the tool consult with a physician or other professional healthcare provider prior to making any treatment decisions.”

PREDICTION TOOL

UroToday - Excellent Prostate Cancer Resource Center

2009-06-07T10:56:00.000-07:00

29000Men Comment
This is an excellent resource for those of us who like to look at actual research being done in the medical community. This is very informative if you take the time to educate yourself. There is an excellent summary of new work being done in prognostic nomograms.

UroToday
UroToday's Prostate Cancer section is a repository of the clinical publications, clinical trials and investigative science pertaining to the diagnosis and treatment of prostate cancer. Also available are conference coverage for all timely prostate cancer science, streaming media presentations, audio podcasts and downloadable slides from UroToday's slide library.

http://www.urotoday.com/browse_categories/prostate_cancer/1014/

New Cancer Tests Could Sell Over the Counter : Discovery News

2009-06-04T13:35:00.000-07:00

29000men Comment:
The article below about over the counter cancer screening tests is really intriguing for all cancers and would be very good for prostate cancer. The key to surviving prostate cancer is detecting it when is still is treatable. A simple test like the one described below could go a long way toward dramatically increasing the prostate cancer test rate - currently an abysmal 52%.

New Cancer Tests Could Sell Over the Counter
Eric Bland, Discovery News

May 22, 2009 -- Over-the-counter tests for lung, colon, prostate and other cancers could soon be available at your local pharmacy, say scientists from the University of Central Florida.

The tests, which scientists compare to over-the-counter pregnancy tests, would detect seven to 10 different kinds of common cancers using a single drop of blood, and take a few minutes to complete.

"We want to use this as a screening tool, not a diagnostic tool," said Qun Huo, a professor at the University of Central Florida who developed the testing system and announced it at a recent conference in Houston. "If people are willing to do more screening, then they can catch any unusual changes due to cancer sooner, and the survival rates should increase."
The tests could reach the market in as little as two years, Quo says.

WATCH VIDEO: Is nanotechnology safe? Jorge Ribas investigates.

When a normal, properly functioning cell suddenly turns cancerous, it releases unusual chemicals, known as biomarkers, into the blood stream.

Doctors can already detect several of these biomarkers. The problem with existing methods is that they are fairly expensive, take several hours to complete, need several syringes of blood, and can only detect large numbers of biomarkers. When there are enough biomarkers to detect cancer using existing tests, it often means that the cancer is large or in more advanced stages, when treatment options can be limited.

By contrast, the over-the-counter cancer test would be quick, relatively painless, and more sensitive than existing methods.

To accomplish this, the new test will use a variety of gold nanoparticles, some as small as nine nanometers and ranging up to over 100 nanometers, to detect cancer biomarkers.

When the gold nanoparticles detect a chemical produced by a cancerous cell, two of the nanoparticles sandwich the cancer particle in a bear hug. Waves of light then bounce off the suddenly larger particles to detect the cancer molecules and alert the patient to their existence.

If the test finds cancer biomarkers, Huo says patients shouldn't panic. Instead, it should be a sign that they should see a doctor for further testing and to monitor the progression of the disease.

"We use assays to monitor cholesterol levels as well," said Huo. "But that doesn't necessarily mean that a person with high cholesterol will have a heart attack."

"This test could certainly come in handy," said Cheryl Baker, a physician at M. D. Anderson Cancer Center Orlando. "If you pick up rising biomarker levels, then we can start treatment and increase the survival rate. Hopefully this will help separate a cancer diagnosis from a death sentence."

New Cancer Tests Could Sell Over the Counter : Discovery News
http://dsc.discovery.com/news/2009/05/22/cancer-test-otc-print.html

An Annual PSA Test - It's the Manly Thing to Do!

2009-06-03T11:14:00.000-07:00

29000men Comment
Below is a good summary of the continuing controversy over the utility of the annual PSA test for prostate cancer detection. Despite the differing perspectives and the double negatives, one very encouraging recommendation is that men have a baseline PSA test at age 40. This is a step in the right direction, but single point data isn’t very useful since the key goal is to see if a rising trend existing. Can you imagine making an investment decision without looking at the trend of that investment over time? Similarly, it doesn’t make much sense to me to make a potentially life ending decision on the based on one test. [Remember, ~29,000 men die each year in the US from prostate cancer and there is no cure for metastasized prostate cancer.]
Here’s my thought (and recommendation): have your initial test at age 40 and a second test at age 41. This allows you to determine if there is any change that warrants a detailed discussion with your doctor.

By Ed Edelson
HealthDay Reporter
MONDAY, April 27 (HealthDay News) -- New guidelines on prostate cancer screening suggest that annual PSA blood tests might not be necessary for many men, but the same guidelines call for a "baseline" PSA test at the age of 40, rather than 50.

A prostate-specific antigen (PSA) test to detect early signs of prostate cancer should be offered to "well-informed men aged 40 and older who have a life expectancy of 10 years," state clinical guidelines issued Monday by the American Urological Association at its annual meeting in Chicago.

Noting that the issue of PSA testing and how it should be used to guide treatment "is highly controversial," the association still stated that the test, "when offered and interpreted appropriately, may provide important information for the diagnosis, pre-treatment staging or risk assessment or post-treatment monitoring of prostate cancer."

But it's important that "the risks and benefits of PSA screening be discussed with men before the test is done," said Dr. Peter Carroll, chairman of the department of urology at the University of California, San Francisco, who headed the committee that drew up the new guidelines.
Those risks can include impotence and incontinence caused by unnecessary surgery.

The recommendation that a first PSA test be offered to men at 40 should help doctors spot high-risk patients more readily, however. "PSA at that age is strongly predictive of the future risk of prostate cancer," Carroll said. "Later detection in the 50s, when the cancer would be more advanced, could be avoided."

The guidelines also recognize that many prostate cancers grow so slowly that they are of no risk, he said. Further steps after detection of an elevated level of PSA, a protein produced by the prostate, should require consideration of "other risk factors, such as family history and ethnicity," Carroll said.

Another major change is that the guidelines set no specific PSA blood level as an indicator of danger, he said. The danger level for an individual man will depend on other risk factors.

And yearly PSA tests might not be needed for many men, the guidelines note. "Screening less frequently may be a less costly way to screen," Carroll said. No specific timetable for less frequent screening is set in the guidelines, but they might be recommended as more information becomes available, he said.

The new guidelines did take into account two recent studies, one in Europe which found that regular PSA screening reduced prostate cancer deaths, and one in the United States which found no effect of screening, Carroll said. The U.S. study was flawed in several ways, he noted. For example, it permitted men who were not assigned to the group for screening to go have PSA tests on their own.
"Both studies do not suggest that PSA screening should not be undertaken," Carroll said.

New information on PSA testing has been a major focus at this year's AUA meeting. One study by urologists at the University of Colorado focused on the timing of PSA tests. The study, which followed more than 76,000 men for at least five years, found that the PSA levels of nearly 99% of men with very low readings on an initial test would remain low for at least five years. That suggests that limiting tests to every five years for men at that low level, and to every two years for men with slightly higher readings, would lower the overall need for PSA tests by 70%, reducing testing costs by $1 billion a year, the researchers reported.

On the other hand, a Swedish study found that PSA readings at age 60 were strong indicators of increased prostate cancer death risk. But "60 -year-old men with PSA at or below 1 nanogram per milliliter [a low reading] can be told that although they harbor prostate cancer, it is very unlikely to become life-threatening," the researchers wrote.

A third report at the meeting took issue with the recommendation of the U.S. Preventive Task Force that men aged 75 and older should not have PSA tests at all.

Dr. Judd W. Moul said that when he read that recommendation, he did a poll of 340 older men at the Duke University Prostate Center, which he heads. "My immediate reaction was that it was age discrimination," he said.

The survey, done by Duke medical students, found that 78.2% of the men were upset by the recommendation, said Moul, an outspoken proponent of PSA testing.

Moul acknowledged that the report had been refused publication by a medical journal on the grounds that it was biased. But he said the advice to stop PSA testing after 75 "was supported neither by public opinion nor by our outcomes data."

SOURCES: Peter Carroll, chairman, department of urology, University of California, San Francisco; Judd W. Moul, M.D., director, Duke University Prostate Center, Durham, N.C.; April 27, 2009, presentation, American Urological Association annual meeting, Chicago
Copyright © 2009 ScoutNews, LLC. All rights reserved.

Health - Healthy lifestyle is on decline in US

2009-06-01T13:40:00.000-07:00

Healthy lifestyle is on decline in US

Despite the well-known benefits of having a lifestyle that includes physical activity, eating a diet high in fruits and vegetables, maintaining a healthy weight, moderate alcohol use and not smoking, only a small proportion of adults follow this healthy lifestyle pattern, and in fact, the numbers are declining, according to an article published in the June 2009 issue of The American Journal of Medicine.

Lifestyle choices are associated with the risk of cardiovascular disease as well as diabetes.

Investigators from the Department of Family Medicine, Medical University of South Carolina, Charleston compared the results of two large-scale studies of the US population in 1988-1994 and in 2001-2006. In the intervening 18 years, the percentage of adults aged 40-74 years with a body mass index greater than 30 has increased from 28% to 36%; physical activity 12 times a month or more has decreased from 53% to 43%; smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26%; and moderate alcohol use has increased from 40% to 51%. The number of people adhering to all 5 healthy habits has decreased from 15% to 8%.

The National Health and Nutrition Examination Survey (NHANES) is a national survey of non-institutionalized persons in the US conducted regularly by the National Center for Health Statistics. The researchers used data from a sub sample of the NHANES surveys of 1988-1994 and 2001-2006, adults aged 40-74 years, because this age span is the primary time for initial diagnosis of cardiovascular risk factors and disease. In the NHANES 1988-1994, the number of respondents 40-74 years old was 7340, representing a weighted sample size of 78,794,217. For NHANES 2001-2006, the number of respondents was 7811, for a weighted sample size of 65,476,573.

Since people with diagnosed health conditions such as cardiovascular disease, diabetes, hypertension, or high cholesterol were part of the samples, the researchers sought to determine whether such individuals were adhering to the healthy habits to a greater or lesser degree than people without those conditions, and whether adherence had changed over time. The study also concluded that people with cardiovascular disease, diabetes, high blood pressure or high cholesterol, or risk factors for those conditions, were no more likely to adhere to a healthy lifestyle pattern than people without such risk factors.

Writing in the article, Dana E. King, MD, MS, states, "The potential public health benefits from promoting a healthier lifestyle at all ages, and especially ages 40-74 years, are substantial. Regular physical activity and a prudent diet can reduce the risk of premature death and disability from a variety of conditions including coronary heart disease, and are strongly related to the incidence of obesity. In the US, medical costs due to physical inactivity and its consequences are estimated at $76 billion in 2000 dollars. Research indicates that individuals are capable of adopting healthy habits in middle age, and making an impact on cardiovascular risk."

The article is "Adherence to Healthy Lifestyle Habits in US Adults, 1988-2006" by Dana E. King, MD, MS, Arch G. Mainous III, PhD, Mark Carnemolla, BS, and Charles J. Everett, PhD". It appears in The American Journal of Medicine, Volume 122, Issue 6 (June 2009) published by Elsevier.

(Healthy lifestyle is on decline in US published at Health News Track on May 27, 2009)Health - Healthy lifestyle is on decline in US
http://www.healthnewstrack.com/health-news-1442.html

Test, Track, Treat - or Die!

2009-05-31T09:16:00.000-07:00

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:

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

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.

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.

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

2009-05-29T13:27:00.000-07:00

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

2009-05-15T11:11:00.000-07:00

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

2009-05-14T19:14:00.000-07:00

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

2009-05-13T22:49:00.000-07:00

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

2009-05-13T13:34:00.000-07:00

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

2009-05-02T12:22:00.000-07:00

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

Do You Have a Personal Health Record?

2009-04-30T15:39:00.000-07:00

As an "accidental prostate cancer survivor," I'm now a big fan of personal health records (PHR) and annually reviewing what's contained in those records. A movement toward creating PHR's is underway. Microsoft has their Health Vault and Google has released the beta version of Google Health. I've just started to test them so I can't provide an evaluation, but it's a step in the right direction. The Robert Woods Johnson Foundation has an innovation program underway to move the PHP movement forward. Just visit the Project HealthDesign, a RWJF program, to see program details. Send us a note with your experiences if you are using a PHR.

New AUA Prostate Cancer Screening Guidelines

2009-04-28T15:51:00.000-07:00

We are happy to provide a link to the AUA's (American Urologic Association) latest prostate cancer screening guidelines. Just visit the site and you can download a copy of their guidelines brochure.

I would like to note that the guidelines recommend an annual PSA for men beginning at 40, along with a DRE (digital rectal exam). Although I am not a physician and do not provide medical advice, I suggest that men have a Free PSA test if their PSA test comes back positive. I say this because in my case my two tumors were located on top of the prostate where they could not be felt by DRE. Fortunately, my urologist requested a Free PSA test (your Free PSA value should be equal to or greater than .25 (25%) of your total PSA, and the tumors were detection prior to metastasis. If your Free PSA/total PSA is less than .25, it is an indication that a tumor may be present and you should consult your physician. If you do not have a physician (and you should!), you can obtain these tests on your own from an independent laboratory.

Remember, it is not the absolute PSA value that matters most, but the change from year-to-year. Should your PSA value change approximately .75 or more from one year to the next, you should see a physician immediately.

Want a little adventure in your life? Join us for all or part of the 2010 Tour de USA for prostate cancer awareness or join us on the Tour de Skyline Drive this August 22-24.

Virgin Tour de USA?

2009-04-28T10:51:00.000-07:00

Hello All: I'm still working on generating some interest in the Prostate Cancer Tour de USA in 2010. The good news is that we have received our formal "Tour de USA" trademark registration from the US Patent Office. The bad news is that we still are challenged in getting men to think about testing annually for the Number Two cancer killer of men, and in getting companies interesting in engaging with us. That said, we continue to save lives one man at a time as we talk to men about the disease.

I just submitted the Tour de USA for consideration as one of the Virgin Group's "Virgin Unite" charity initiatives. It would be great to have Richard Branson ride a segment with us.

The 2010 ride will go from statehouse-to-statehouse and we need volunteers to make arrangements for those stops. So, it you have a few minutes and the desire to help, check out the route in our previous post and send us an email to see how you can help.

Tour de USA Route

2009-04-21T05:48:00.000-07:00

The inaugural Tour de USA for prostate cancer awareness will take place in June, 1010. The ride begins in Sacramento and the tentative routing is as follows: Nevada, Idaho, Wyoming, Colorado, Nebraska, Iowa, Wisconsin (H-D headquarters), Missouri, Illinois, Ohio, West Virginia, Washington, DC, Virginia, North Carolina, Tennessee, Arkansas, Oklahoma, Texas (panhandle), New Mexico, Arizona, California.

We are looking for assistance coordinating PR stops at Harley-Davidson dealerships along the way. There also are a few spots on the core group who can ride the entire distance.

If you are interested in riding or would like to help, send an email to TourdeUSA@29000men.org.

"Just Do It" Seems to Hold True for Prostate Cancer Prevention

2009-04-18T08:29:00.000-07:00

Rather than just surviving prostate cancer, wouldn't it be better to simply prevent it in the first place? You bet! But how can we do that when we don't know precisely what causes cancer?

Research is beginning to demonstrate a connection between lifestyle habits - exercise levels and nutritional patterns - that seem to have an effect on cancer occurrence. For example, a 2008 report cited in the Daily Mail in the United Kingdom revealed that men working in office jobs experienced a higher rate of prostate cancer than men that moved around during their workday. These results are in line with an American Cancer Society study that estimates that a third of all cancers can be traced to inactivity and nutritional shortcomings.

I'm not a physician, but it seems to me that "Just Doing It" - to paraphrase the Nike slogan - is a free and easy way to prevent yourself from becoming one of the one-in-six men who will experience prostate cancer. So, if you work in an office, it's time to get moving!

If you like to bicycle, consider joining us in August 2009 at the Tour of Skyline Drive in Virginia. We'll spend two days riding along the Skyline Drive in the Shenandoah National Park.

Remember to "Test. Track. Treat. Live." Track your PSA annually and look for a change of .75 or more, and ask your colleagues (35 and older) if they are testing.

Best regards, Robert

What About Prostate Cancer Recurrence?

2009-04-09T10:10:00.000-07:00

This is the opening post in my personal process of determining if my prostate cancer is recurring. As is the case with PSA testing, there are differing views concerning when recurrence can be detected. Most PSA testing is done at the one decimal sensitivity level, i.e., at a sensitivity of ".1". Newer ultrasensitive tests can detect PSA levels at a sensitivity of ".01," which is an order of magnitude more sensitive. The Clinical Practice Guidelines in Oncology for prostate cancer (according to the National Comprehensive Cancer Network) indicate additional treatment for men who have had a radical prostatectomy (I had an RP in 2003) if they have a detectable PSA level of >.3 ng/ml that increases in two or more subsequent measurements following a period of no detectable PSA. I fall into that category, expect that I my PSA measures over the past 18 months have risen from undetectable, to .01, to .08 with the most recent test at .06. Having spent a career in the military, I'm always focused on proactive response, so I am in the process of meeting with a physician that believes in early detection and treatment. My current task is getting my medical records sent from my surgeon (who believes I am 'cured') to my new physician. So far, my written request has been lost twice. If you are reading this post and are in a similar situation, I would enjoy hearing from you. Test. Track. Treat. Live.(TM)

Due Your Own Due Diligence!

2009-04-09T10:07:00.000-07:00

The controversy over the utility of the PSA for lowering the prostate cancer continues, which is a good thing because it hopefully will draw men's attention (better yet, draw women's attention) to the critical importance of annual testing.
While some members of the medical community continue to comment about "over treating" prostate cancer, approximately 29,000 men die each year in the US from the disease, and the incidence rate for prostate cancer in the 20-49 year cohort is increasing. Spend a few minutes at the National Cancer Institute's online database (Surveillance Epidemiology and End Results) at http:/seer.cancer.gov/faststats and you will see how much we do not know about this disease - the most current data set is three years old. What I believe it shows is that early detection (note that the PSA test came into use in the early 1990s) has increased the rate of detection and lowered the death rate. The worrying aspect is the continuing rise in PCa incidence in young adult males.
You can find an interesting article about the PSA testing controversy in the online version of the San Francisco Chronicle on this issue at . The author, himself a prostate cancer survivor and the CEO of Soar BioDynamics Ltd., makes the point that rather than discarding the PSA test perhaps we should be using it as part of a more comprehensive diagnostic process. Prostate cancer is still the most common male cancer is the US and is the number two cancer killer in men. Prostate cancer is not the harmless, indolent disease that it is often portrayed. One in every six men will be stricken with disease - perhaps more if the trends in the SEER continue. If you read this post, I like to hear your comments. If you know a man who is 35 or older and not testing, encourage them to begin. Test. Track. Treat. Live.(TM)

The AUA Weighs in on the PSA Testing Discussion

2009-03-31T10:20:00.001-07:00

The AUA released the following statement on March 26, 2009. As noted, the statement is attributal to Dr. John Barry, AUA president. As a prostate cancer survivor focused on early detection and treatment, this seems a very balanced statement. Your comments?

AUA STATEMENT ABOUT PROSTATE-SPECIFIC ANTIGEN TESTING

The statement below is attributable to Dr. John Barry, president of the American Urological Association. This statement is being issued in response to two studies recently published in the New England Journal of Medicine about prostate-specific antigen (PSA) testing.

The American Urological Association has read with great interest the coverage surrounding the two studies about prostate-specific antigen (PSA) testing recently published in the New England Journal of Medicine, and is concerned about the alarm these two studies have raised with patients. The decision to screen for prostate cancer is a personal one that a man should make in conjunction with his physician or urologist. Because most cancers need to be caught in their earliest stages to achieve the best outcome for the patient, disparaging the PSA test puts men — particularly with certain risk profiles — at risk for life-threatening disease. Prior to the use of the PSA test, tumors were found mostly in advanced — and less treatable — stages, giving patients far fewer options for treatment. These studies, as well as the 2008 United States Preventive Services Task Force recommendation that men stop PSA testing after the age of 75, have potential for harm if they are not explained clearly to patients or reviewed in the context of the full debate on PSA. It is the opinion of the AUA that the PSA test is a valuable screening tool that saves lives — and men with concerns about elevated PSA scores should consult their urologists about next steps.

These two studies do not clearly assert that PSA testing causes more harm than benefit. In one of the two studies, 52 percent of men in the “non-screened” arm had recent PSA tests, thus enriching the non-screened arm with men who had normal PSA levels and reducing the chance for prostate cancer death in this arm of the study. This means that more than half of the men in the non-screening arm of the study were screened, making it difficult to demonstrate a difference. In the other study, there was actually a 20 percent reduction in death from prostate cancer with a relatively short follow-up of only nine years. This is an important point. The benefit of screening may not be demonstrable until significantly longer follow up is reached for both trials. These studies therefore do not lead to the conclusion that PSA screening should be abandoned.

Men who are concerned about these studies should talk with their urologists about their particular risk profile and whether regular PSA testing is best for them.

The AUA is presently finalizing a new Best Practice Statement about prostate-specific antigen testing that will be unveiled during our upcoming Annual Meeting. These studies are being addressed in more detail in the Statement, but do not change the AUA’s position that PSA is a valuable screening tool and should be appropriately offered to men. This document will be made available to the public in April.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 15,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc.

PCA3. Another Potential Tool?

2009-03-31T09:16:00.000-07:00

The ongoing debate over the value and validity of the PSA test continues. The following article comes from a respected source in the United Kingdom. From the prostate cancer survivor side of the issue, we read many, many accounts of lives saved through detection by PSA testing. We still don't know how many of the approximately 29,000 men who die each year from prostate cancer did or did not have a PSA test and what stage they were at when diagnosed. Until there are significantly improved testing protocols that can identify prostate cancer and predict which will be aggressive, it is important that we continue to educate men about this dangerous disease and to provide them with the knowledge and tools to intelligently participate in their individual prostate cancer risk management program. The original article can be found at http://www.prostateuk.org/prostatenews/20090305_article_pca3.rsk.htm.

PROSTATE CANCER DIAGNOSIS: STRENGTHS AND WEAKNESSES OF PROSTATE-SPECIFIC ANTIGEN AND THE DISCOVERY AND CLINICAL EVALUATION OF PROSTATE CANCER GENE 3 (PCA3)

Article by: Professor Roger Kirby, Chairman, Prostate UK
Summary
Prostate biopsy decisions are traditionally guided by digital rectal examination and measurement of serum total prostate specific antigen (tPSA). However, both techniques are subject to inherent weaknesses. Prostate cancer gene 3 (PCA3), a gene-based marker, specific for prostate cancer, supplements the predictive power of tPSA to improve diagnosis of disease. Inclusion of this new marker in the standard of care for men at risk for prostate cancer should be considered as it presents marked potential for better prostate biopsy decision making and for improving overall patient care.
Certainty - freedom from doubt; a total security from error.
What if clinicians were able to make diagnostic and treatment decisions in a state of complete certainty? Patients would no longer face the risks of unnecessary invasive techniques, with their own inherent risks, or of adverse events related to avoidable treatment. In diagnosis of prostate cancer (pCA), the urologist would make prostate biopsy decisions based on non-invasive or minimally-invasive indicators indicating the presence of the disease. No patient would undergo biopsy who did not have prostate cancer. No patient would risk the anxiety and co-morbidities of biopsy without good cause. Further, what if those non-invasive or minimally-invasive indicators quantified tumour aggressiveness? The urologist could then determine the urgency of biopsy and treatment in light of patient desires and life expectancy based on other health status indicators.
Unfortunately, today’s urologists and their patients enjoy no such security in diagnosis and management of the most prevalent disease that they manage.
On the other hand, biopsy decisions have not been uninformed. In addition to clinical variables, demographics, and the presence or absence of other risk factors, digital rectal examination (DRE) of the prostate and measurement of serum total prostate-specific antigen (tPSA) have traditionally been used to assist in biopsy decision-making. Use of these techniques in combination has improved the detection and treatment of pCA over the last few decades. But, the improvement has been limited due to intrinsic weaknesses in both methods. DRE is subjective and displays marginal predictive value[1-3], while PSA is subject to various inherent flaws primarily driven by non-specificity for pCA. Thus, poor survival in prostate cancer results from a current lack of specific, highly predictive methods for early detection and for differentiation of aggressive and indolent cancers.
Recently, a non-invasive urinary test for prostate cancer gene 3 (PCA3) has been developed. PCA3 is an emerging gene-based marker that is highly specific for pCA. This review examines the current diagnostic dilemmas, the weaknesses of traditional testing, and the potential of PCA3 to complement existing diagnostic methodologies.
The dilemma
Let us illustrate the current clinical dilemma with an example: a fifty-five year-old Caucasian man sees his urologist for an initial appointment following referral from primary care. He reports a family history of pCA in second-degree relatives, he complains of frequent urination, and his latest annual physical indicated a serum prostate specific antigen (tPSA) concentration of 2.7 ng/ml. The urologist performs a digital rectal examination (DRE), which reveals no suspicious nodule, and subsequently confirms the tPSA value. Should the urologist recommend prostate biopsy at this time? Despite more than two decades of research on PSA, clinical experience, and establishment of institutional procedures, urologists still cannot make this decision with great confidence.
This example is neither unrealistic nor uncommon[4]. While patients present with more obvious risk for prostate cancer, still others present with more apparently benign indications who are subsequently found to harbour pCA (the prostate cancer rate is ~20% in the range of 2.5-4 ng/ml tPSA, inclusive of indolent and clinically relevant cancers[5]. Even taking a more compelling example wherein the hypothetical patient presents with tPSA between 4 and 10 ng/ml, there is still no certainty that prostate cancer will be detected upon biopsy. In fact, up to 60% of men with tPSA in this range will have a negative biopsy.
PSA: contemporary use and inherent flaws
Beginning at approximately age 50[6], men with a life expectancy of at least ten years undergo annual measurement of serum tPSA. If tPSA results are elevated in comparison to previous results but no other symptoms indicate a risk for pCA, DRE or tPSA testing may be repeated at appropriate intervals to observe and confirm any trends. If tPSA continues to increase or subsequent DRE results are suspicious, the clinician may attempt to rule out various benign conditions using imaging techniques, cystoscopy, and determination of percent free PSA (%fPSA). If the results of these analyses indicate a sufficient risk for pCA, biopsy will be recommended. Of course, the definition of “sufficient risk” will depend on the physician, their interpretation of the data, and established institutional procedures.
Characterizing risk based solely on serum tPSA findings presents inherent difficulties. PSA is specific for prostate tissue but not for prostate cancer. Elevated values of serum tPSA are observed in multiple benign conditions involving enlargement of the prostate [7-11] including prostatic hypertrophy (BPH)[7], and acute prostatitis[8]. Conversely, high body mass index (BMI) erroneously lowers tPSA values as a result of hemodilution[12]. Thus, the interpretation of tPSA values is prone to error arising from non-specific sources.
Furthermore, serum tPSA values have been demonstrated to be poor indicators of pCA aggressiveness regardless of the cutpoint chosen[13]. Because PSA does not correlate well with aggressiveness, there is a trend in clinical practice toward overdiagnosis and consequent overtreatment of prostate cancer[14].
In light of these inherent weaknesses of serum tPSA testing, it is clear that complementary indicators are needed to better inform the decisions to biopsy or perform radical treatments. Preferably, these new indicators would be insensitive to the non-specific factors that affect serum tPSA results. Furthermore, emerging indicators would ideally correlate with tumour aggressiveness and provide information independent of and complementary to serum tPSA.
Identification of PCA3 and early studies
PCA3, also referred to as PCA3DD3 or DD3PCA3 in the literature, was first identified in 1999 via differential display analysis in healthy, hyperplastic, and cancerous tissue from patients undergoing radical prostatectomy[15]. PCA3 exhibited a high level of expression in prostate tumours and was apparently absent in benign tissue. Further analyses demonstrated low but quantifiable expression in benign prostate tissue but undetectable levels of expression in normal tissues from all major organs. Additionally, no expression could be detected in tumours from breast, cervix, endometrium, ovary, or testis, and cancer cell lines from bladder, breast, kidney, and ovaries.
Subsequent studies using quantitative research tests for PCA3 demonstrated a median 66-fold upregulation in prostate malignancies and a high sensitivity and specificity for detection of pCA[16]. The PROGENSA™ PCA3 test was developed soon thereafter. The test employs Transcription-Mediated Amplification (TMA™) technology to quantify PCA3 and PSA messenger RNA (mRNA) in urine samples collected following DRE. The DRE is required to release prostate cells into the urine and the quantification of PSA mRNA is required to normalize for the total mRNA present in a sample (PSA mRNA levels in prostate cells released into urine are completely unrelated to PSA protein levels in blood and are essentially unchanged in pCA[17]). Thus, the method measures both PCA3 mRNA and PSA mRNA and the results are represented as a ratio of the two mRNAs referred to as the “PCA3 Score.” Similar to other gene-based tests, the PCA3 Assay is comparable in cost and complexity. Samples must be sent to an accredited laboratory experienced in performing molecular testing and PCA3 Scores are reported back to the urologist.
Sample collection and specimen stability are robust. Informative rates (percentage of urine samples yielding accurately quantifiable mRNAs for assay) have been demonstrated to exceed 99%[18] and the assays demonstrate good reproducibility with intra- and inter-assay coefficients of variation of <13%>
Clinical Application of the PROGENSA™ PCA3 Assay
Utility of PCA3 testing
Determination of a PCA3 Score may be useful in several clinical scenarios. First, the Score may be used to increase confidence in an initial biopsy decision where serum tPSA results are uncertain (2.5-10 ng/ml). Second, PCA3 testing may be used to increase confidence in a re-biopsy decision wherein DRE and serum tPSA results are suspicious and/or family history and other factors indicate increased risk for pCA. Lastly, when biopsy results are positive but tumour aggressiveness is unknown, PCA3 may be useful in comparing risks and benefits of radical prostatectomy versus active surveillance management. Thus, the availability of a PCA3 Score alone or in combination with existing methods may better guide biopsy decision-making than current methods and may also be useful as an indicator of clinical stage and disease significance.
PCA3 clinical performance in comparison to serum tPSA
Comparative research studies have consistently demonstrated better prostate cancer predictive value of PCA3 versus serum tPSA. Marks and colleagues[20] studied 233 men with a prior negative prostate biopsy but with evidence of serum tPSA persistently above 2.5 ng/ml. Applying receiver-operating characteristic (ROC) curve analysis to PCA3 and serum tPSA results obtained after a re-biopsy of these men yielded significantly higher area under the curve (AUC) for PCA3 versus serum tPSA (Table 1).
In a separate study, Groskopf, et al.[21] compared PCA3 and tPSA in 70 men who received prostate biopsy based on pre-existing risk factors in comparison with 52 apparently healthy men with no known risk factors. At a PCA3 Score cutpoint of 50, sensitivity was 69% and specificity was 79%. For serum tPSA at the established cutpoint of 2.5 ng/ml and with sensitivity held constant at 69%, specificity for tPSA was 60%.
The foregoing results have been recently confirmed using a time-resolved fluorescence-based variant of the PCA3 test by van Gils, et al.[22] In their multicenter study of 583 men with serum tPSA between 3 and 15 ng/ml, the AUC for prediction of positive biopsy was higher for PCA3 than for serum tPSA testing (Table 1). Also, a correlation of increasing PCA3 Score with increasing probability of positive repeat biopsy was demonstrated [22].
Associations with prostate volume and tumour volume/tumour aggressiveness
An association of a marker with prostate volume regardless of the presence or absence of prostate cancer is an undesirable characteristic as it indicates non-specificity of the marker. Whereas serum tPSA shows such associations, PCA3 has not in an initial study by Deras, et al.[23] In this study, the associations of both markers with prostate volume were evaluated in a cohort of 570 men scheduled for initial or repeat prostate biopsy. Serum tPSA values increased demonstrably and significantly (p<0.0001) p="0.54)." r="0.27," p="0.008)," p="0.007)">
Most recently, a study by Haese et al.[18] has supported the findings of Nakanishi, Deras and Marks. In this multicenter, multinational European study, 463 men with one or more previous negative biopsies were re-biopsied following DRE and urine collections. The re-biopsy yielded 128 cancers (28%). Detected cancers were classified as indolent if they were stage T1c, had PSA density <0.15 p="0.0059)." p="0.0401)" p="0.005).">
PCA3 performance versus serum total PSA range
It is desirable for any new indicator of pCA to maintain its predictive value across the entire range of population serum tPSA values. To address the performance of PCA3 in this regard, Deras, et al.[23] categorised their study cohort into patients with serum tPSA <4>10 ng/ml and determined sensitivity and specificity of PCA3 for detection of positive biopsy within each category. Across all categories, sensitivity was 54% at a specificity of 74%. These parameters varied <10% p="0.7282)">
Complementarity to serum total PSA
If PSA and PCA3 are destined to be complementary in clinical management and treatment decisions, there must be evidence that the utility of both markers is enhanced when data are analyzed as covarying predictors of biopsy outcomes. In the Deras study[23], urinary PCA3 and serum tPSA were evaluated in univariate and multivariate logistic regression models. Predictive probability relative to biopsy outcome was determined. For tPSA alone, PCA3 alone, and the combination of tPSA + PCA3, the areas under the curve from ROC were 0.547, 0.686, and 0.752, respectively (Figure 1). The increase in AUC observed in the multivariate model was strongly significant (p=0.0002), demonstrating the complementarity of the methods.
Furthermore, the incorporation of PCA3 information into the Prostate Cancer Prevention Trial (PCPT) risk calculator demonstrated additional benefit[25]. Although it was not possible to measure directly urinary PCA3 Scores in the PCPT study population, statistical methods to incorporate data from external populations were developed [25]. PCA3, serum tPSA, and DRE data from a cohort of 521 men undergoing prostate biopsy were included in the original PCPT risk calculator, serum tPSA by itself, urinary PCA3 by itself, and an updated PCPT risk calculator incorporating PCA3. AUC for the PCPT calculator incorporating PCA3 was 0.703, which was statistically superior to the PCPT calculator without PCA3 (AUC=0.618, p<0.025).>
The recent Haese study[18] again supports these earlier findings. In a multivariate logistic regression model for prediction of pCA at repeat biopsy, PCA3 score was an independent predictor (p=0.006) of outcome following adjustment for age, serum tPSA, %fPSA, DRE, and prostate volume. Inclusion of PCA3 in the base model containing the other terms improved accuracy of the model by 4.2%, which was significant at p<0.001.>
Avoidance of unnecessary biopsies
The effectiveness of PSA screening on prostate cancer mortality is still a matter for debate, however an increasing number of men undergo PSA testing annually. For example, data from the National Cancer Institute indicates that an additional 1.8 million U.S. men age 40-69 and 1.2 million men over 70 would have an abnormal PSA value if the threshold for PSA was decreased from 4.0 ng/ml to 2.5 ng/ml [26]. This results in an additional 3.0 million men with an elevated PSA that would be candidates for biopsy. Such trends demonstrate a need for other cancer specific markers to improve diagnostic and treatment decision-making.
The Haese study[18] provides some insights regarding identification of patients for whom biopsy is unwarranted. At a PCA3 Score cut-off of 20, repeat biopsies would have been reduced by 44% while missing only 9% of cancers. This finding suggests the potential of PCA3 to reduce the incidence of overdiagnosis and further studies are ongoing.
Conclusion
Over the past two decades, serum tPSA, together with other indicators, has guided biopsy decisions for urologists. While research during this period has characterized the strengths of tPSA testing, many weaknesses have also been revealed. The discovery and clinical evaluation of PCA3 has demonstrated that the marker supplements tPSA in diagnosis and is insensitive to the non-specific factors that can affect circulating tPSA levels. The addition of PCA3 to the urologist’s diagnostic toolset will not result in a state of certainty; however, diagnostic sensitivity, specificity, and predictive value are incrementally improved by its inclusion. In turn, biopsy and management decisions may be better informed. This has the potential to improve the overall level of patient care.

Should Men Be Screened For Prostate Cancer?

2009-03-24T14:07:00.000-07:00

Just last week, two major studies on the usefulness of screening men for prostate cancer were released; one was a US study and the other was done in Europe. You can find a good summary article written by Tara Parker-Pope at this link at http://well.blogs.nytimes.com/2009/03/23/for-men-to-screen-or-not-to-screen/#comment-261739.

Prostate Cancer Survivor Preaches Testing

2009-03-15T19:27:00.001-07:00

Convincing men to test for prostate cancer is an ongoing challenge. A recent article in the South Florida Times provides a great example. A 46 year old man recently diagnosed with prostate cancer organized a free seminar attended by 80 men. Of the 80, only 33 took a blood test (41%) and only 27 (34%) agreed to a digital rectal exam. We guys are a macho bunch, but there is a very real danger here. The 10-year survival rate for treatment prior to metastasis is 97%; for post-metatastic treatment the 10-year survival rate is only 17%. If we survivors can gently remind our colleagues about the need for testing and tracking the annual change - if any, we can make some significant inroads into late diagnoses. The Prostate Cancer Awareness Project is sending a rider across the US by bicycle in 2010 to raise funds for awareness events. Visit http://www.TourdeUSA.org and join the team.

Prostate Cancer Screening. Doing More Harm Than Good?

2009-03-15T09:10:00.000-07:00

Following is a link to a recent Reader's Digest article on cancer screening. (http://today.msnbc.msn.com/id2942490/) The article summarizes some current thinking that too much screening causes unnecessary treatment of cancers that will never become life threatening. The author cites the views of a Veterans Affairs doctor that takes this view concerning prostate cancer. While I am not a physician, I am a five year prostate cancer survivor who is still here because of an accidental diagnosis of Stage 2 prostate cancer. Since 29,000 men die annually in the US from prostate cancer (that is almost 300,000 men each decade), I find the argument that there is too much screening difficult to accept. What is leads me to believe is that our screening programs and regimes are not sufficiently widespread and effective. I have yet to find any database that shows the following minimal data for each annual cohort of prostate cancer deaths: 1) age at diagnosis; 2) state at diagnosis; 3) method of diagnosis; 4) treatment regime; 5) age at mortality; 6) % experiencing erectile or incontinence issues. Until we have that data, it would seem to be difficult to argue on either side of the screening controversy. As a prostate cancer survivor, though, I think I would argue for a more widespread screening program (only 51% of men currently test). Personally, I would prefer to live an additional 5 - 10 years even if I did so with some degree of incontinence or erectile dysfunction, and I know my wife feels the same. I would love to hear your comments.

First Post

2009-03-03T18:37:00.000-08:00

This blog will chronicle my journey through life with prostate cancer as my wingman. I was diagnosed with prostate cancer in December 2002, and underwent radical prostatectomy in May 2003. Since then, I have continued my business life and created a small non-profit, the Prostate Cancer Awareness Project, to get men to test annually. The past five years have been interesting ones, and I have decided to create this blog to post my thoughts for those that are following in my footsteps and those of the men who have preceded me. The blog name, 29,000 Men, refers to the approximate number of men that die each year in the United States from prostate cancer. I look forward to engaging with you.