“A prostate-specific antigen (PSA) nadir (the lowest level a PSA drops following treatment) greater than 0.5 ng/mL following radiation and androgen deprivation therapy seems to identify men prior to PSA failure who are at high-risk for death, and would thus require more aggressive treatment for their prostate cancer, according to the results of a recent study in JAMA Oncology.
“The study looked at data from a randomized trial of 206 men treated with either radiation or radiation plus 6 months of hormonal therapy and compared early markers of prostate cancer death to identify men at risk of dying early.”
“Giving men with suspected prostate cancer an MRI scan could improve diagnosis and save those who do not have aggressive cancers from having an unnecessary biopsy, according to a study published in The Lancet.
“The study estimates that adding the extra test could help one in four (27%) men avoid an unnecessary biopsy and reduce the number of men who are over-diagnosed – diagnosed with a cancer that does not go on to cause any harm during their lifetime – by 5%.”
“About a dozen new medical tests are coming to market that aim to more accurately diagnose prostate cancer and go well beyond the standard PSA (prostate-specific antigen) blood screenings used today. Several of them may even allow men to forego getting a biopsy that more than 1 million men diagnosed with prostate cancer undergo each year. That’s because these new tests will help doctors distinguish between aggressive disease and slow-growing tumors.”
“Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the rise in aggressive management of men with high-risk prostate cancer. Cooperberg says the proportion of men who are receiving hormonal therapy alone had been rising consistently over the course of a 15 year period, up until 2010, to about 50%. Since then, Cooperberg says that number has dropped to about half of what it was, or 25%, which is attributed to more aggressive treatment.
“Cooperberg says local therapy for men with high-risk prostate cancer was normally radiotherapy, with surgery not being nearly as common. He adds that a growing body of evidence dictates that surgery in prostate cancer may be a more effective local therapy than radiation alone. According to the body of evidence, cancer-related survival and overall survival were normally boosted when surgery was involved for these patients.”
University of Colorado Cancer Center | Dec 3, 2015
“In 1048 prostate cancer patients previously treated with docetaxel and 996 metastatic, castration-resistant patients, treatment with the androgen-lowering drug abiraterone acetate (Zytiga) led to longer overall disease control, even when a very high Gleason score indicated especially aggressive cancer.Results recently published in the Annals of Oncology show that for patients with Gleason score greater than 8, post-docetaxel treatment with abiraterone extended progression-free survival from 5.5 months to 6.4 months, and pre-chemotherapy abiraterone treatment extended progression-free survival from 8.2 months to 16.5 months.”
“After decades of overtreatment for low-risk prostate cancer and inadequate management of its more aggressive forms, patients are now more likely to receive medical care matched to level of risk, according to a study by researchers at UC San Francisco.
“In the first study to document updated treatment trends, researchers found that from 2010 to 2013, 40 percent of men with low-risk prostate cancer opted for active surveillance, in which the disease is monitored closely with blood tests, imaging studies and biopsies. Treatment is deferred unless these tests show evidence of progression.
“In contrast, less than 10 percent overall of low-risk prostate cancer patients pursued active surveillance in the years from 1990 through 2009. Rates for radiation therapy for this low-risk group have also slipped since 1995, the authors noted in the study published in JAMA earlier this month.”
“African American men are more likely to develop prostate cancer than European American men, and are also more than twice as likely to die from it. Although there are many reasons that contribute to this health disparity, new research shows that African American men may have a distinctly different type of prostate cancer than European American men, according to new genomic fingerprinting results.
“ ‘This study, this line of research, is about finding better and more appropriate therapies for African American men,’ says corresponding author of the study, Kosj Yamoah, M.D., Ph.D., Chief Resident in the Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University. ‘The first step is to figure out how prostate cancer is different and more aggressive at the genomic level.’ In research published in the Journal of Clinical Oncology on July 20th, Dr. Yamoah and colleagues identify a subset of genes known as biomarkers that define a genomic subtype of prostate cancer that is more common in African American men, and which signals a more aggressive disease.”
“Cleveland Clinic researchers have discovered for the first time that a metabolite of an FDA-approved drug for metastatic prostate cancer, abiraterone (Abi), has more anti-cancer properties than its precursor. The research will be published online June 1st in Nature.
“Cleveland Clinic researcher Nima Sharifi, M.D., found that abiraterone, a steroid inhibitor, is converted into the more physiologically active D4A (Δ4-abiraterone) in both patients and animal models with prostate cancer who take the drug. Furthermore, they found that D4A is more effective than abiraterone at killing aggressive prostate cancer cells, suggesting that some patients may benefit from direct treatment with D4A.
“Prostate cancer cells are fueled by androgens (male hormones). When prostate cancer spreads, androgen deprivation therapy (‘medical castration’) is used to cut off the tumor’s energy supply. However, aggressive, metastatic tumors can become resistant to this type of therapy. In a landmark 2013 publication in Cell, Dr. Sharifi described a genetic mutation that enables prostate cancer cells to produce their own hormones for fuel, making them resistant to traditional hormone deprivation therapies.”
“Biopsy guided by a fusion of magnetic resonance imaging (MRI) and ultrasound (US) improves detection of aggressive prostate cancer compared with mapping or targeting alone and systematic 12-core biopsy.
“Among the first 1,000 men to undergo MRI-fusion biopsy of the prostate at the University of California Los Angeles (UCLA), the presence of a grade 5 region of interest on fusion biopsy was the strongest predictor of high-grade prostate cancer. ‘Patients who had a grade 5 lesion compared to those who had no suspicious lesions had 23 times the odds of having Gleason ≥7 cancer,’ said Christopher Filson, MD, at UCLA.
“In a separate series of men presenting for prostate biopsy at New York University (NYU), MRI-targeted biopsy increased the detection of Gleason ≥7 prostate cancer by 23% compared with systematic biopsy while decreasing the detection of Gleason 6 disease by 26%.