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Tag Archives: Prostate Cancer

Could Milk Raise a Man’s Odds for Prostate Cancer?

Denise Mann wrote . . . . . . . . .

Men who drink lots of milk may be more likely to develop prostate cancer than men who don’t, new research finds.

When compared to men who consumed just 1 or 2 tablespoons of milk every day, men who drank about 1-3/4 cups of milk daily were about 27% more likely to develop prostate cancer, a new study showed.

What’s more, they had about a 60% increased risk for developing prostate cancer compared with men who steered clear of dairy altogether.

The new study wasn’t designed to say how, or even if, milk consumption ups the risk for prostate cancer, but researchers have their theories.

“Insulin-like growth factor-1 is known to be a risk factor for prostate and breast cancer, and it turns out that dairy consumption raises the level of this hormone,” said study author Dr. Gary Fraser. He is a professor of preventive medicine at Loma Linda University School of Medicine and School of Public Health in California.

Prostate cancer needs hormones to grow, and there are other hormones found in cow’s milk, too, he said. Fraser and colleagues previously published similar findings linking dairy to breast cancer.

“This issue needs a little more clarity before we conclude that there is a causal link, but there could be, and if you had a bad family history of prostate cancer, I would be inclined to go on a plant-based diet now,” Fraser said.

Plant-based alternatives to cow’s milk include soy, oat, almond, cashew and other nondairy milks. These nondairy calcium sources did not increase prostate cancer risk in the new study.

For the study, the researchers asked more than 28,700 men about their diets. A handful of men were also asked to recall all the food and drinks that they consumed in the previous 24 hours.

None of the men had prostate cancer when the study began, but 1,254 men developed prostate cancer after about eight years of follow-up. Researchers created a statistical model to control for other factors that could affect the results, including family history of prostate cancer, race or age.

Milk consumption increased the risk for all types of prostate cancer, including the more aggressive form.

The increase in risk for prostate cancer was directly tied to low- or regular-fat milk, not yogurt or cheese, and this increase plateaued after about two-thirds of a cup of milk each day, Fraser said.

The study did have its share of limitations. Asking people to recall what they ate isn’t always the most reliable method of gathering information.

The research is published in the American Journal of Clinical Nutrition.

Outside experts aren’t ready to say that milk increases prostate cancer risk.

It’s too early to draw that conclusion, said Dr. Otis Brawley, a professor of oncology at the Johns Hopkins University School of Medicine in Baltimore.

“We do know that obesity, consuming too many calories, and not getting enough exercise increases the risk of aggressive prostate cancer,” Brawley said.

The best way to stay one step ahead of prostate cancer is to maintain a normal body weight, exercise regularly, and eat a balanced diet with five to nine servings of fruits and vegetables each day, he said.

Dr. Andrew Laccetti, a medical oncologist at Memorial Sloan Kettering Cancer Center in Montvale, N.J., agreed.

“Although this study does not definitely suggest that dairy directly causes an increase in prostate cancer risk, it does fit with the broader understanding that prostate cancer is a disease of Western nations,” he said.

“A Western lifestyle, including diets rich in saturated fats, sedentary behavior and obesity, exhibits convincing evidence to support an association with the development of prostate cancer,” Laccetti noted.

Source: HealthDay

Cause of Metastasis in Prostate Cancer Discovered

Prostate cancers remain localised in the majority of cases, giving affected individuals a good chance of survival. However, about 20% of patients develop incurable metastatic prostate cancer, resulting in approximately 5,000 deaths each year in Austria alone. Medical research has not yet adequately explained why metastases occur in some people and not in others. A research team at MedUni Vienna has now discovered specific changes in a protein that drive the growth and spread of prostate cancer. The study was recently published in the journal Molecular Cancer.

In the study, the researchers broke new ground and investigated the role of the protein KMT2C in prostate cancer. KMT2C is a genetic component that essentially functions as a regulator of central cellular processes. If KMT2C loses this regulatory ability due to typical cancer-related mutations, this encourages the proliferation of the cancer gene MYC. This in turn causes cells to divide at an increased rate, driving both growth and spread of the cancer.

New insights into the transition to metastasis

“Our study provides new insights into the previously poorly understood transition from localised prostate cancer to terminal metastatic prostate cancer,” says study leader Lukas Kenner (Department of Pathology at MedUni Vienna, Comprehensive Cancer Center of MedUni Vienna and University Hospital Vienna, Department of Laboratory Animal Pathology at Vetmeduni Vienna and the K1 Center CBmed), underlining the significance of the research work. In addition, the knowledge gained about the effects of KMT2C mutations may also generate new momentum for the diagnosis and treatment of prostate cancer.

Diagnosing aggressive progression at an early stage

KMT2C mutation status can be measured via a blood test, allowing early diagnosis of potentially aggressive progression in prostate cancers. In addition, MYC inhibitors could be used to prevent increased cell division, and hence metastasis, and it is hoped that further scientific studies will substantiate this. MYC inhibitors are essentially new cancer treatment drugs that have already been tested in clinical trials and – if further studies confirm this – could also be used in metastatic prostate cancer in the next few years. “Since a high level of KMT2C mutation characterises many types of cancer, such as breast, lung, colorectal, bladder and even skin cancer, our study results have a great deal of potential in the research, diagnosis and treatment of malignant cancers in general,” says Lukas Kenner.

Source: Medial University of Vienna

Newer Hormone Treatments for Prostate Cancer May Raise Risk of Depression

Dennis Thompson wrote . . . . . . . . .

Advanced forms of hormone therapy are very effective at keeping prostate cancer in check, but they also can double a man’s risk of falling into depression, researchers have found.

Prostate cancer patients treated with the latest forms of hormone blockers were twice as likely to develop depression compared with men treated with older forms of hormone therapy or those who received no such medication at all, results from a new study show.

It’s a risk that cancer doctors will need to keep in mind when prescribing these drugs to patients, said lead researcher Dr. Kevin Nead, an assistant professor of epidemiology at the University of Texas MD Anderson Cancer Center in Houston.

“Our study does not suggest that any men who are eligible for these medications should not be on them because of the risk of depression,” he said. “What it does reinforce is that we have people who we know, because they have cancer, are already at increased risk for depression.”

Putting them on these medications is potentially doubling their risk, and Nead said, depression in cancer patients is associated with worse survival.

“These are patients we need to pay a lot of attention to and try to have early interventions to prevent or treat their depression, because it will impact their overall outcomes,” he said.

Prostate cancer feeds on male hormones like testosterone, which are also known as androgens. Doctors have long treated prostate cancer in part by blocking androgen, depriving cancer cells of their fuel.

They now have second-generation anti-androgen drugs like abiraterone and apalutamide that are even better at blocking testosterone than earlier medications, researchers said.

But a lack of testosterone increases a man’s overall risk of depression, whether or not he has prostate cancer.

“Men with low testosterone are at an increased risk of depression,” Nead said. “In men who have low testosterone, if you give them testosterone back, it actually improves their mood and decreases the risk of depression.”

Cancer patients are at increased risk of depression anyway, given their battle with a deadly disease. Worse, depression tends to profoundly impact the outlook for cancer patients.

“We know depression in cancer patients is particularly bad in that it’s associated with patients having worse cancer outcomes, including worse overall survival,” Nead said.

Depression “might impact people’s interest in being aggressive” with their cancer treatment, he added. “It might affect their overall health and how they can tolerate different therapies. It might affect their decisions on how they pursue their cancer care or how often they see their doctor.”

To see how much additional risk of depression comes with the newer androgen blockers, Nead’s team analyzed data from nearly 30,100 prostate cancer patients.

They broke the men into three groups — those who received no hormone therapy, those who got the more established medications, and those treated with second-generation anti-androgen drugs.

“If you look across all three of these groups, the men that received second-generation anti-androgens had an increased risk of depression,” Nead said.

The risk likely increases so dramatically because the second-generation drugs are so much more better at their job, said Dr. Bobby Liaw, clinical director of genitourinary oncology for the Mount Sinai Health System in New York City.

The older drugs “do very well in bringing your testosterone levels down, but they only stop testosterone production at the main factory of testosterone, which is the testes,” Liaw explained.

“In reality, you do have some small amounts of androgen production from other places in the body that traditional hormone therapy would not shut down,” he added. For example, the adrenal gland produces a small amount of male hormone, as do fat cells.

“You come along with a much more potent androgen receptor antagonist, it will further deprive cells already kind of starved for testosterone of even more of it,” Liaw said. “It’s not a big surprise it could worsen moods and depression.”

Neither Nead nor Liaw felt that the depression risk from the newer drugs outweighs their benefits for prostate cancer patients, however.

“It’s not to say that just because there’s that risk of depression that we should entirely shy away from an otherwise very efficacious treatment, but I think it definitely warrants us being a little bit more cognizant,” Liaw said. “We do need to be much more cognizant of these long-term side effects. We need to be more prepared to catch early signs of depression.”

Family members and friends of prostate cancer patients can help by watching their loved ones as they undergo hormone therapy for signs of depression, the doctors said.

“Often times the patient themselves may not always be the best judge of it. From day to day, if it’s a small change, they might not notice it,” Liaw said.

The new study was recently published in JAMA Network Open.

Source: HealthDay

Adding MRI to Screening Can Cut Prostate Cancer Overdiagnosis in Half

Ernie Mundell and Robert Preidt wrote . . . . . . . . .

One of the big issues in prostate cancer care is overdiagnosis — men who are treated for low-risk, slow-growing tumors that might be better left monitored and untreated.

Now, research out of Sweden suggests that having patients undergo MRI screening, along with targeted biopsies, could reduce the number of prostate cancer overdiagnoses by half.

The new approach can detect just as many clinically significant tumors as current methods, but reduces unnecessary biopsies and the identification of minor low-risk tumors, according to the study presented recently at the European Association of Urology Congress. The findings were published simultaneously in the New England Journal of Medicine.

The findings show that “modern methods for prostate cancer screening maintain the benefits of screening, while decreasing the harms substantially,” said study co-leader Tobias Nordström. He is associate professor of urology at Danderyd Hospital at the Karolinska Institute.

“This addresses the greatest barrier to the introduction of nationwide screening,” Nordström explained in an institute news release.

One expert in the United States said the research holds real promise.

“For the past 20 years, urologists and researchers have been striving to improve prostate cancer screening to target men with clinically significant prostate cancer and avoid overdiagnosis in men with low-risk prostate cancer,” said Dr. Manish Vira, system chief of urology at Northwell Health Cancer Institute in New Hyde Park, N.Y.

The Swedish findings show how the use of highly targeted MRI “has moved our field closer to the goal,” said Vira, who wasn’t involved in the new study.

As the Stockholm team explained, most countries no longer have nationwide prostate-cancer screening programs in place because current methods — PSA (prostate-specific antigen) blood testing plus traditional biopsies — often result in overdiagnosis and unnecessary biopsies, meaning the risks of screening can outweigh the benefits.

In too many cases, so-called “indolent” prostate tumors grow at such a slow pace that treating them brings harms (such as urinary issues and impotence) that exceed any real risk from the tumor to the patient’s health.

But is there a better way to spot those higher-risk tumors that do need treatment?

In the new study, the Karolinska team tracked outcomes for 12,750 Swedish men between 2018 and 2021. Blood samples were collected from the men for PSA analysis, as well as analysis by the new Stockholm3 test, developed by institute researchers.

Men whose tests revealed elevated PSA levels were then randomly selected to undergo either traditional biopsies or they underwent MRI.

In the MRI group, biopsies were conducted only on suspected tumors identified by MRI.

The new approach can detect just as many clinically significant tumors as current methods, the researchers said, but it reduces unnecessary biopsies and the identification of minor low-risk tumors.

Vira explained that “by incorporating MRI into the prostate cancer screening process, we can better recommend biopsy in those men who are at high risk, and perhaps just as importantly, avoid unnecessary biopsies in men who don’t have prostate cancer or have indolent/insignificant disease.”

Dr. Art R. Rastinehad is associate professor of urology and radiology and vice chair of urology at Lenox Hill Hospital in New York City. He wasn’t involved in the Swedish research, but called it “another great study supporting the use of MRI before a prostate biopsy in men at risk of prostate cancer.”

He pointed out that “prostate cancer was the last solid organ malignancy that was diagnosed without imaging, so we are very excited to continue to use advanced imaging technologies to help our patients.”

The potential benefits to patients are clear, he added.

“It is estimated that up to 51% of patients having their prostate removed may be candidates for a less invasive, outpatient treatment that helps them get back to their normal lives with a lower risk of urinary incontinence and/or erectile dysfunction,” Rastinehad said.

Source: HealthDay

Targeted Radiotherapy Might Help Men Battling Advanced Prostate Cancer

Cara Murez wrote . . . . . . . . .

Patients with advanced prostate cancers may have newfound hope: Researchers identified a new potential treatment for men with metastatic castration-resistant prostate cancer, which has no cure.

Metastatic castration-resistant prostate cancer means the disease continues to spread despite therapies that deplete male hormones (androgens) such as testosterone, which are thought to “feed” tumors.

When added to standard care, this novel targeted radiotherapy improved survival for these cancer patients, researchers report.

The study “offers the treatment possibility where there was really very little for the most advanced patient, but it opens a doorway for exploring the benefits of this drug in multiple earlier patient populations,” said Dr. Michael Morris, head of the Prostate Cancer Section at Memorial Sloan Kettering Cancer Center in New York City.

In about 80% of prostate cancers, there is a protein on the surface of the cancer cell that is called prostate-specific membrane antigen (PSMA). It is also distributed on prostate cancer that has spread to the bone, lymph nodes or soft tissues. Yet, PSMA is not on normal tissues, so it was a good target for both diagnostics and therapeutics, Morris explained.

The new drug has two components, a targeting molecule and a payload delivers radiation. It is given intravenously.

“Each of the molecules of drug is seeking to bind with the cells containing PSMA, which generally are the prostate cancer cell. As the drug binds to it, the cell brings the drug into the interior of the cell. The radiation, which is attached to the drug, it’s the payload of the drug, is also brought into the interior of the cell. And there, it irradiates the cell and kills it as well as the cells that are neighboring to it,” Morris said.

To be a part of the trial, the patients had to have disease that had progressed through testosterone-lowering therapy, which has been the standard for decades, Morris said. They also had to have progressed through another class of drugs known as androgen-receptor pathway inhibitors and through chemotherapy.

“What happens when you go on to treatment with prostate cancer is that if you respond, you stay on that therapy or stay on that regimen until either side effects preclude continuing the therapy or it no longer works because the disease has become resistant to it,” Morris explained.

The trial included 831 participants. Patients were randomized two-to-one to receive the new treatment, called lutetium-labeled PSMA-617, plus standard care or just standard care between June 2018 and October 2019.

The new treatment increased overall median survival to 15.3 months versus 11.3 months for these patients who had very advanced disease. It also increased a measure called radiographic progression-free survival, which reflects disease control while on the drug, from a median of 3.4 months to 8.7 months.

The study is being presented online at the American Society of Clinical Oncology annual meeting, which will be held June 4-8. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal. Drug maker Novartis funded the study and plans to submit the data to regulatory authorities for review and potential approval.

Prostate cancer is both the most common cancer in American men and the second leading cause of cancer-related death. The study’s positive results mean that patients who have very advanced disease might have a new treatment option.

“It also means that, usually in prostate cancer as well as other diseases, what you develop and discover as a new therapy for the most advanced patients usually benefits earlier patients and frequently we’ll see those benefits amplified in less sick patients who have less-resistant disease,” Morris said.

Current studies are now looking at the therapy for patients who have earlier disease who have not yet received chemotherapy, as well as those who are just beginning treatments for prostate cancer.

Dr. Ash Tewari, system chair in the Milton and Carroll Petrie Department of Urology at Mount Sinai Health System in New York City, said the study offers a lot of promise for patients, giving those with advanced prostate cancer new hope. It also has a reasonable side effect profile, said Tewari, who was not involved in the study.

“Androgen deprivation is the mainstay of therapy of advanced prostate cancer, but the cure rate is low and patients eventually become castrate-resistant,” Tewari said. “There is a need to more closely tailor therapies to individual patient profiles.”

Noting the median results for overall survival that the study found, Tewari said that extra four months of life can be very meaningful for someone who lives to see an important family milestone, such as a grandchild’s wedding.

“This is a good example of when a well-conducted clinical trial backed by scientific data can make an impact in patient’s life. And we should always be curiously, cautiously looking at these options,” he said.

Source: HealthDay

Thousands of Men to Trial Prostate Cancer Home Testing Kit

Thousands of men worldwide are to receive a home test kit for prostate cancer – thanks to pioneering research from the University of East Anglia and the Norfolk and Norwich University Hospital (NNUH).

The research team are trialling a new home-testing ‘Prostate Screening Box’ to collect men’s urine samples at-home. The urine samples will be used to analyse the health of the prostate in 2,000 men in the UK, Europe and Canada.

This simple urine test is intended to diagnose aggressive prostate cancer and in a pilot study predicted which patients required treatment up to five years earlier than standard clinical methods.

The Prostate Screening Box has been developed in collaboration with REAL Digital International Limited to create a kit that fits through a standard letterbox.

It means that men can provide a urine sample in the comfort of their own home, instead of going into a clinic or having to undergo an uncomfortable rectal examination. The research team hope that it could revolutionise diagnosis of the disease.

Lead researcher Dr Jeremy Clark, from UEA’s Norwich Medical School, said: “Prostate cancer is the most common cancer in men in the UK. However it usually develops slowly and the majority of cancers will not require treatment in a man’s lifetime. It is not a simple matter to predict which tumours will become aggressive, making it hard to decide on treatment for many men”.

“The most commonly used tests for prostate cancer include blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan or a biopsy”.

“We have developed the PUR (Prostate Urine Risk) test, which looks at gene expression in urine samples and provides vital information about whether a cancer is aggressive or ‘low risk’.

“The Prostate Screening Box part sounds like quite a small innovation, but it means that in future the monitoring of cancer in men could be so much less stressful for them and reduce the number of expensive trips to the hospital.

“The prostate lies just below the bladder. It constantly produces secretions which naturally flow into the urethra – the tube through which urine passes from the bladder. The prostatic secretions carry cells and molecules from all over the prostate which are flushed out of the body on urination. We collect these and examine them. It’s a way of sampling the whole prostate in one go.

“As the prostate is constantly secreting, the levels of biomarkers in the urethra will build up with time. Collecting from the first wee of the day means that overnight secretions can be collected which makes the analysis more sensitive.”

The team have previously trialled the kit with a small group of participants, but in the next phase of the research study are rolling it out to thousands.

Men taking part in the trial will receive a home urine-sampling kit and will be asked to provide two urine samples – one to be taken first thing in the morning and the second an hour later. The samples will then be sent back to the lab for analysis.

Dr Clark said: “Feedback from early participants showed that the at-home collection was much preferred over sample collection in a hospital.

“We hope that using our Prostate Screening Box could in future revolutionise how those on ‘active surveillance’ are monitored for disease progression, with men only having to visit the clinic after a positive urine result.

“This is in contrast to the current situation where men are recalled to the clinic every six to 12 months for a range of tests including DRE, PSA tests, painful and expensive biopsies and MRI. We are working to develop the test to help patients in three years’ time.

“A negative test could enable men to only be retested every two to three years, relieving stress to the patient and reducing hospital workload,” he added.

Robert Mills, Consultant Clinical Director in Urology at NNUH, said: “This simple, non-invasive urine test has the potential to significantly change how we diagnose and manage early prostate cancer for the benefit of patients and health care systems. It may enable us to avoid unnecessary diagnosis of low risk disease as well as managing patients more appropriately with surveillance for those with low risk of progression and early curative treatment for those at high risk of progression.”

Paul Villanti, executive director of programs at Movember, said: “The PUR test has great potential to transform the way prostate cancer is managed. Not only can it accurately predict when a man’s disease will become aggressive and require treatment, but it has the added advantage of allowing men to complete it at home.

“We are proud to have supported the development of the PUR test from its early stages as part of our Global Action Plan on Biomarkers, through to this trial involving thousands of men across the world.

“Through our Global Action Plan on active surveillance, we have been able to identify hundreds of men from the UK, Germany, Italy and Canada who are suitable to take part in this trial.

“We hope it will speed up the trial’s progress and get this test included as part of clinical care for men as quickly as possible.”

Source: University of East Anglia