Super Patient: John Wagontall Gets a Third Opinion and Survives Prostate Cancer

Update:  We are deeply saddened to report that John passed away on December 18, 2016. It is a privilege to continue to share his story and keep his memory alive.

In the summer of 2004, John Wagontall looked like the picture of health. The 46-year-old Canadian had been a firefighter for 20 years, was an avid cyclist, and also worked out alongside his wife as she trained for a bodybuilding competition. The only sign that something was wrong was a bit of blood in his urine.

His doctor told John he had a bladder infection, prescribed antibiotics, and sent him home. And all appeared to be well until a few months later, when his urine was bloody again. This time, his doctor sent him to a urologist to learn the underlying cause of his recurring bladder infection. Continue reading…

Statins at Start of Androgen Deprivation Therapy Increase Treatment Efficacy

“Statin use has been associated with improved outcome in prostate cancer. In a study reported in JAMA Oncology, Harshman et al found that statin use at the time of initiation of androgen-deprivation therapy was associated with prolonged time to progression during androgen-deprivation therapy in men with hormone-sensitive prostate cancer. The potential mechanism of this effect may be statin competitive inhibition of dehydroepiandrosterone sulfate (DHEAS) uptake.

“Androgen-deprivation therapy for biochemical or metastatic recurrence or new metastatic disease between January 1996 and November 2013 showed that 283 men (31%) were taking statins at the start of androgen-deprivation therapy. After a median follow-up of 5.8 years, 644 patients (70%) had disease progression while receiving androgen-deprivation therapy, with a median time to progression during androgen-deprivation therapy of 20.3 months. Median time to progression was 27.5 months (95% confidence interval [CI] = 21.1–37.7 months) in statin users vs 17.4 months (95% CI = 14.9–21.1 months) in nonusers (P < .001).”

ASCO 2015: Notable Reports on Prostate Cancer Treatment

This year’s American Society of Clinical Oncology (ASCO) annual meeting was short on any truly exciting developments in prostate cancer treatment. In stark contrast to other cancers, such as lung, breast, kidney, and melanoma, there were no reports of note on targeted and immunotherapies in prostate cancer. The two presentations summarized here offered new strategies in chemotherapy. Continue reading…

Addition of Chemotherapy Drugs to Androgen Suppression Improves Relapse-Free Survival in High-Risk Localized Prostate Cancer

“In a French phase III trial (GETUG 12) reported in The Lancet Oncology, Fizazi et al found that the addition of docetaxel and estramustine (Emcyt) to androgen-deprivation therapy (ADT) improved relapse-free survival among patients with high-risk localized prostate cancer…

“In the open-label trial, 413 patients with treatment-naive disease and at least one risk factor (stage T3-T4, Gleason score ≥ 8, prostate-specific antigen [PSA] concentration > 20 ng/mL, or pathologic node-positive disease) underwent staging pelvic lymph node dissection and were randomized to ADT (goserelin 10.8 mg every 3 months for 3 years) plus four cycles of docetaxel 70 mg/m2 on day 2 and estramustine 10 mg/kg/d on days 1 to 5 every 3 weeks (n = 207) or ADT alone (n = 206). Local treatment was administered at 3 months. The primary endpoint was relapse-free survival in the intention-to-treat population. Follow-up for other endpoints is ongoing.

“The chemotherapy and ADT alone groups were balanced for age (median 62 and 62 years), Gleason score (42% and 43% ≥ 8), pathologic node-positive status (29% in both), and serum PSA level (> 20 ng/mL in 59% in both).”

Adding ADT to RT Improved PFS After Radical Prostatectomy

“Assigning men in biological relapse after radical prostatectomy to combined salvage treatment with hormone therapy and radiation therapy significantly delayed disease progression compared with radiation therapy alone, according to the results of the GETUG-AFU 16 phase III trial (abstract 5006).

“ ‘Salvage radiotherapy combined with limited androgen deprivation therapy improves the 5-year progression-free survival rate compared to radiotherapy alone,’ said study presenter Christian Carrie, MD, of the department of radiation oncology at the University of Lyon-Centre Leon Berard. ‘There is no significant difference in overall survival, but the follow-up is still too short.’

“Between October 2006 and March 2010, 743 patients were enrolled in GETUG-AFU 16 and randomly assigned to radiation therapy alone (n = 374) or radiation plus hormone therapy with goserelin 10.8 mg for 6 months (n = 369). The primary endpoint of the trial was progression-free survival.”

Metabolic Syndrome up with ADT in Prostate Cancer

“For patients with prostate cancer treated with androgen deprivation therapy there are increases in components of metabolic syndrome and in the prevalence of full metabolic syndrome, according to a study published in the June issue of The Journal of Urology.

“Juan Morote, M.D., from Hospital Vall d’Hebron and Universitat Autónoma de Barcelona in Spain, and colleagues conducted an observational prospective study involving 539 prostate cancer patients scheduled to receive three-month depot luteinizing hormone-releasing hormone analogs for longer than 12 months. The authors examined the prevalence of full metabolic syndrome, assessed according to different definitions, and its components…

” ‘Counseling patients on the prevention, early detection, and treatment of specific metabolic alterations is recommended,’ the authors write.”

ASCO: Chemo-ADT Combo Still Winning in Prostate Cancer

“Men with advanced prostate cancer lived significantly longer if they received upfront chemotherapy in addition to androgen deprivation, results of a randomized trial showed.

“As compared with men who received only androgen deprivation therapy (ADT), those who also got docetaxel had a 10-month improvement in median overall survival (OS). The difference translated into a 24% reduction in the mortality hazard. Subgroup analysis showed that patients with metastatic disease at the start of treatment derived even greater benefit from docetaxel, a 22-month improvement in median overall survival.

“The study is at least the third reported within the past year showing a significant survival benefit with upfront docetaxel, making a strong case for standard of care, as reported during a press briefing prior to the American Society of Clinical Oncology meeting, which begins here May 29.

” ‘Our headline conclusion would be that docetaxel would be considered routine therapy for men with newly diagnosed metastatic disease,’ said Nicholas James, MD, of the University of Warwick and Queen Elizabeth Hospital in Birmingham, England.”

Men Receiving Androgen Deprivation Therapy may Experience Cognitive Impairment

“Cognitive impairment can occur in cancer patients who are treated with a variety of therapies, including radiation therapy, hormone therapy, and chemotherapy. After chemotherapy treatment it is commonly called ‘chemo brain.’ Signs of cognitive impairment include forgetfulness, inability to concentrate, problems recalling information, trouble multi-tasking and becoming slower at processing information. The number of people who experience cognitive problems following cancer therapy is broad, with an estimate range of 15 to 70 percent.

“There have been several studies analyzing this side effect in breast cancer patients, but few have investigated cognitive impairment following androgen deprivation therapy (ADT) for men being treated prostate cancer. A new Moffitt Cancer Center study indicated that men who are on androgen deprivation therapy have greater odds of experiencing impaired cognitive function.

“Androgen deprivation therapy is commonly used to treat prostate cancer, often on an open-ended basis for therapy of advanced prostate cancer. It is estimated that 44 percent of men with prostate cancer undergo ADT at some point. The goal of this type of therapy is to block the male hormones, including testosterone, from stimulating the growth of the prostate cancer cells. However, the side effect of ADT on cognitive function in men with prostate cancer has not been measured as much.”

Statin Drugs Can Delay Prostate Cancer Progression in Patients Receiving Androgen Deprivation Therapy, Study Shows

“Men who went on cholesterol-lowering statin drugs when they began androgen deprivation therapy for prostate cancer had a longer time in which their disease was under control than did men who didn’t take statins, a clinical trial led by Dana-Farber Cancer Institute investigators shows.

“In a study published online today by JAMA Oncology, the researchers report that men who had been taking statins since the start of androgen deprivation therapy (ADT) went a median of 27.5 months before their disease began to worsen, compared to 17.4 months for men who didn’t take statins. The trial involved 926 patients, 70 percent of whom had their disease progress during a six-year period.

“ ‘This median 10-month benefit in delaying disease progression suggests that statins could be a valuable addition to our current therapies for prostate cancer,’ says the study’s first author, Lauren Harshman, MD, medical oncologist at the Lank Center for Genitourinary Oncology at Dana-Farber. ‘These results are supported by multiple prior epidemiologic studies demonstrating that statin use may be associated with improved outcomes in prostate cancer, but require validation.’ “