Prostate Cancer

• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
• Treatment

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Prostate Cancer

NHS - Prostate cancer (Video)

NHS - Prostate cancer “Diagnosing prostate cancer Prostate-specific antigen (PSA) testing The main test for prostate cancer is the PSA (prostate-specific antigen) test, which looks for raised levels of PSA in the blood. Prostate cancer increases the production of PSA, so the test may be able to detect prostate cancer in its early stages. However, the test is problematic: • Up to 20% of men who do have prostate cancer will not have a raised PSA level; • Over 65% of men with a raised PSA level will not have cancer. PSA levels tend to rise in all men as they get older. Digital rectal examination The next step to confirming a diagnosis of prostate cancer is a digital rectal examination (DRE). This can be done by your GP. During a DRE, your GP will insert a finger into your rectum (back passage). The rectum is close to your prostate gland, so your GP is able to check to see if the surface of the gland has changed. This will feel a little uncomfortable but it should not cause you pain. Prostate cancer can cause the gland to become hard and bumpy. However, in some cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer. DRE is also useful in ruling out benign prostatic hyperplasia, as this causes the gland to feel firm and smooth. Biopsy Your GP will assess the risk of you possibly having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE and associated risk factors such as age, family history and ethnic group. If it is felt that the risk is significant you will be referred to a hospital to discuss the options of further tests. The most commonly used test is known as a transrectal ultrasound-guided biopsy (TRUS). During a TRUS biopsy, an ultrasound scanner (a machine that uses sound waves to build up a picture of the inside of your body) is used to study your prostate. This also allows the doctor to guide a needle through your rectum which is then used to take small samples of tissue from your prostate (biopsy). The procedure can be uncomfortable and sometimes painful. You may be given a local anaesthetic to minimize any discomfort. The biopsy may also cause complications such as bleeding and infection. Although it is much more reliable than a PSA test, a biopsy may miss up to 20% of cancers. Therefore, you may need to undergo another biopsy if your symptoms persist, or your PSA level continues to rise. Gleason score The samples of tissue from the biopsy are then studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This is done by giving the samples a grade, known as a Gleason score. The lower the score, the less likely the cancer will spread. • a Gleason score of 6 or less means the cancer is unlikely to spread, • a Gleason score of 7 means that there is a moderate chance of the cancer spreading, and • a Gleason score of 8 or above means that there is a significant chance that the cancer will spread. Further testing If it is felt that there is a significant chance that the cancer has spread from your prostate to other parts of the body, further tests may be recommended. Two tests that are commonly used are: • A magnetic resonance imaging (MRI ) scan - which uses magnetic waves to build up a detailed picture of the inside of your body. A MRI scan can tell if the cancer has spread beyond the prostate to the surrounding tissue. • An isotope bone scan - this test uses radiation to detect any abnormalities in your bones. An isotope bone scan can tell if the cancer has spread to your bones. “

NIH - Prostate cancer (Medical Encyclopedia) "The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. … Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40. … Men at higher risk include black men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest incidence occurs in Japanese men and vegetarians. Prostate cancers are classified or staged based on their aggressiveness and how different they are from the surrounding prostate tissue. There are several different ways to stage tumors, a common one being the A-B-C-D staging system, also known as the Whitmore-Jewett system: A: Tumor is not palpable (not felt on physical examination), and is usually detected by accident after prostate surgery done for other reasons. B: Tumor is confined to the prostate and usually detected by physical examination or PSA testing. C: Tumor extends beyond the prostate capsule without spread to lymph nodes. D: Cancer has spread (metastasized) to regional lymph nodes or other parts of the body (bone and lungs, for example)

Highlighted Articles

Doctors Urged Not to Screen Elderly Men for Prostate Cancer (2008) “In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group is causing more harm than good.”

Body Mass Index, Weight Change, and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort (Cancer Epidemiology Biomarkers & Prevention 2007) "Conclusion: Obesity increases the risk of more aggressive prostate cancer and may decrease either the occurrence or the likelihood of diagnosis of less-aggressive tumors. Men who lose weight may reduce their risk of prostate cancer."

Meat Consumption among Black and White Men and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort (Cancer Epidemiol Biomarkers Prev 2006) "No measure of meat consumption was associated with risk of prostate cancer among White men. Among Black men, total red meat intake (processed plus unprocessed red meat) was associated with higher risk of prostate cancer … this increase in risk was mainly due to risk associated with consumption of cooked processed meats (sausages, bacon, and hot dogs … This study suggests that high consumption of cooked processed meats may contribute to prostate cancer risk among Black men in the United States."

Highlighted Internet Sites

NCI - Prostate Cancer

NCI – What You Need To Know About Prostate Cancer

NIH - Prostate Cancer

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Prostate Cancer

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Anaemia following initiation of androgen deprivation therapy for metastatic prostate cancer: A retrospective chart review. (Aging Male. 2008)

Drugs

Androgen deprivation therapy for advanced prostate cancer: why does it fail and can its effects be prolonged? (Can J Urol. 2008)

Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer (JAMA. 2008) “Context Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer. … Conclusion Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management.”

The postchemotherapy PSA surge syndrome (Annals of Oncology 2008)

Hormone therapy for prostate cancer - immediate initiation. (Front Radiat Ther Oncol. 2008)

Chemotherapy for Advanced Prostate Cancer: 25 Years Later

Hormone Therapy Only Helps Some Older Men With Prostate Cancer "Adding hormone therapy to radiation treatment for fast-moving prostate cancer can save lives, but the benefit often doesn't apply to men who have other serious medical problems, a new study shows. "The new message from this study is that there definitely is a difference in outcome, depending on the gentleman's health," said Dr. Anthony V. D'Amico, chief of genitourinary oncology at Brigham and Women's Hospital in Boston. His report is published in the Jan. 23 issue of the Journal of the American Medical Association. The old message, reported in 2004 on the five-year point of the study, was that treatment to suppress the activity of male hormones known as androgens improved survival of older men with aggressive prostate cancer, D'Amico said. But the new report showed the benefit was limited to men without other serious medical problems. Adding hormone therapy to radiation treatment in the 206-man study decreased the rate of death significantly, but the benefit was confined to men without other health issues."

Exercise

General Information

Nomogram Predicting the Probability of Early Recurrence After Radical Prostatectomy for Prostate Cancer. (J Urol. 2008)

[Nocturia and benign prostatic hyperplasia] (Vojnosanit Pregl. 2008)

Why a common treatment for prostate cancer ultimately fails “Understanding the effects of the androgen receptor gives physicians a toehold in efforts to develop more effective treatments for men with prostate cancer. That would be welcome news for the one of every six men who will get the disease during his lifetime. More than 28,000 men die from the disease in the United States each year, according to the American Cancer Society. Men's risk from prostate cancer is about equal to women's risk from breast cancer: Each year, about the same number of men get prostate cancer as women get breast cancer, and their risk of dying from the diseases is about equal, according to ACS. Chang's findings are most relevant for patients with advanced prostate cancer, who typically receive hormone therapy after other treatments such as surgery or radiation. With hormone therapy, physicians blunt the effects of male hormones like testosterone to bring the disease in the prostate to a halt. One form of hormone therapy works by blocking the androgen receptor. Androgen deprivation therapy is generally very effective for a year or two, but for reasons that no one has understood, the cancer ultimately returns. "When a man receives hormone therapy, initially the treatment works well, and his PSA (prostate specific antigen) level goes down," said Edward Messing, M.D., a urologist and an author of the paper. "But inevitably, the PSA will start climbing again, and that is usually the first sign that the treatment is beginning to fail. It's a sign that the cancer in the prostate is making a comeback." “

Treating Prostate Cancer: A Guide for Men with Localized Prostate Cancer

Statin Use and Risk of Prostate Cancer: Results from a Population-based Epidemiologic Study (American Journal of Epidemiology 2008)

[High PSA and total prostatectomy: Specific and overall 10-year survival.] (Prog Urol. 2008)

How advanced prostate cancer becomes resistant to androgen-deprivation therapy

Current treatment options in the management of chronic prostatitis. (Ther Clin Risk Manag. 2007)

Understanding differences between high and low volume hospitals for radical prostatectomy. (Urol Oncol. 2008)

Each Therapy for Prostate Cancer Has a Distinct Pattern of Adverse Effects

Saturated fat intake predicts biochemical failure after prostatectomy. (Int J Cancer. 2008) "Men who were both obese and consumed HSF diets had the shortest biochemical-failure-free-survival (19 months), and nonobese men who consumed LSF diets had the longest biochemical-failure-free-survival (46 months, p < 0.001). Understanding the interplay between modifiable factors, such as diet and obesity, and disease characteristics may lead to the development of behavioral and/or targeted interventions for patients at increased risk of progression."

Each Therapy for Prostate Cancer Has a Distinct Pattern of Adverse Effects Outcomes related to treatment of prostate cancer usually affect urinary and bowel functions and sexual activity. Treatment-related symptoms, including sexual, urinary, bowel, and hormone functions, were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age."

Systematic Review: Comparative Effectiveness and Harms of Treatments for Clinically Localized Prostate Cancer (Annals 2008)

Guidelines

A Critical Review of Clinical Practice Guidelines for the Management of Clinically Localized Prostate Cancer. (J Urol. 2008)

NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer (2008)

New Prostate Cancer Guidelines Add Intensity-Modulated Radiotherapy

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

NCI - Dictionary of Cancer Terms

NCI - Drug Dictionary

NCI - Overview of Nutrition in Cancer Care

NCI - Prostate Cancer (PDQ®): Treatment

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Dietary n-3 Polyunsaturated Fatty Acids Enhance Hormone Ablation Therapy in Androgen-Dependent Prostate Cancer. (Am J Pathol. 2008) “In conclusion, dietary n-3 PUFA may enhance the response of prostate cancer to ablation therapy and retard progression to androgen-independent growth by altering tumor PUFA content.”

Diet High In Saturated Fat Contributes To Prostate Cancer Treatment Failure, Study Suggests “Saturated fats were most commonly consumed as beef steaks, cheese and cheese spreads, hamburgers and cheeseburgers, eggs, ice cream and salad dressings.”

Other

Radiation-Chemotherapy

Other Treatments

Radiation With ADT Halves Deaths in Older Men With Prostate Cancer

[Brachytherapy of the prostate cancer.] (Urologe A. 2008)

Results of concomitant chemoradiation for cervical cancer using high dose rate intracavitary brachytherapy: Study of JROSG (Japan Radiation Oncology Study Group). (Acta Oncol. 2008)

Experimental

The dietary bioflavonoid, quercetin, selectively induces apoptosis of prostate cancer cells by down-regulating the expression of heat shock protein 90. (Prostate. 2008)

Radiotherapy

Radiation therapy cuts prostate cancer death: study “It is easily cured in early stages with surgery or radiation. For prostate cancer that has spread, drugs that interfere with cancer-fueling hormones are prescribed. In the United States, adding radiation therapy is already standard, said Dr. Howard Sandler, chair of Radiation Oncology at Cedars-Sinai Medical Center in Los Angeles and a spokesman for the American Society of Clinical Oncology. He said health agencies in Europe did not always provide radiation as the standard of care. "A 50 percent reduction in the risk of prostate cancer death is a real clinical benefit," Sandler said in a telephone interview.“

Increased risk of colon cancer after external radiation therapy for prostate cancer. (Int J Cancer. 2008)

Radiotherapy as primary treatment modality. (Front Radiat Ther Oncol. 2008)

Supplements-Vitamins-CAM

Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery. (Cancer Epidemiol Biomarkers Prev. 2008)

The use of complementary therapy by men with prostate cancer in the UK. (Eur J Cancer Care (Engl). 2008)

Surgery

[Effect of transurethral resection of prostate on quality of life in aged patients with benign prostatic hyperplasia.] (Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2008) Conclusion TURP may alleviate BPH clinical symptoms and improve quality of life,but may not be helpful to the recovery of sexual function in aged patients with BPH.”

Radical Prostatectomy Reduces Prostate Cancer Mortality and Distant Metastases

Radical prostatectomy for low risk carcinoma of the prostate (World Journal of Urology 2008)

Combined radiotherapy and hormonal therapy in the treatment of prostate cancer. (Front Radiat Ther Oncol. 2008)

Radical prostatectomy in the 21st century - the gold standard for localized and locally advanced prostate cancer. (Front Radiat Ther Oncol. 2008)

Understanding differences between high and low volume hospitals for radical prostatectomy. (Urol Oncol. 2008)

Progression after radical prostatectomy for men in their thirties compared to older men. (BJU Int. 2008)

Transplantation

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