Markers for Prostate Cancer Death Can Identify Men in Need of More Aggressive Treatment

Excerpt:

“Prostate cancer (PC) is the second leading cause of male cancer death in the United States with an estimated 26,000 deaths in 2016. Two-thirds of all PC deaths observed in the US are men with localized disease who developed metastasis. Several markers for dying from prostate cancer exist, but whether these are markers for telling who is likely to die early from any cause, and how their performance compares, is unknown. Identifying such a marker is important because we can then identify which men may benefit from new, more aggressive treatments for prostate cancer.”

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Removal of Ovaries Decreases Death from Breast Cancer Associated with BRCA1 Mutation

“Removal of the ovaries, a procedure known as an oophorectomy, was associated with a 62 percent reduction in breast cancer death in women diagnosed with breast cancer and carrying a BRCA1 gene mutation, according to an article published online by JAMA Oncology.

“Women who carry a germline mutation in either the BRCA1 or BRCA2 gene face a lifetime risk of breast cancer of up to 70 percent. Once they are diagnosed with breast cancer, they face high risks of both second primary breast and ovarian cancers. Other studies of BRCA gene mutation carriers have reported reduced mortality associated with oophorectomy for women with a history of breast cancer, according to the study background.

“Steven A. Narod, M.D., and Kelly Metcalfe, Ph.D., of the Women’s College Research Institute, Toronto, Canada, and coauthors sought to confirm these earlier observations in a group of women with BRCA1 and BRCA2 gene mutations and early-stage breast cancer. Their study included 676 women, of whom 345 underwent oophorectomy after being diagnosed with breast cancer, while 331 women retained both ovaries.”


Socioeconomic Factors Affect Odds of Death After a Lung Cancer Operation

“People with limited education and low income have higher odds of death within 30 days after undergoing an operation for lung cancer than those who are more educated and financially better off, according to new research published as an article in press on the website of the Journal of the American College of Surgeons in advance of print publication later this year.

” ‘In order to get uniform superior outcomes for our patients, we need to identify the patients who are at risk for worse outcomes,’ said study co-author Felix G. Fernandez, MD, FACS, a lung surgeon and an assistant professor of surgery at Emory University School of Medicine. Atlanta. ‘This is the first step in describing where those disparities exist.’ ”

“For the study, Dr. Fernandez and his colleagues sought to determine the specific clinical and socioeconomic factors that lead to disparities in 30-day survival for patients undergoing operations for lung cancer.

“They analyzed data from over 215,000 lung cancer operation admissions entered into the National Cancer Data Base (NCDB) between 2003 and 2011. This cancer registry is a joint program of the America College of Surgeons and American Cancer Society and is the largest cancer database in the U.S., providing patient demographic data, insurance status, diagnosis, treatment and how long patients live after treatment. NCDB captures an estimated 70 percent of newly diagnosed cancer cases in the United States from approximately 1,500 cancer programs accredited by the Commission on Cancer of the American College of Surgeons.”


Aspirin Does Not Help to Stave off Death from Prostate Cancer

“Aspirin use does not appear to reduce the risk of mortality associated with prostate cancer, according to research published in the April issue of The Journal of Urology.

“Jonathan Assayag, M.D., of the Jewish General Hospital in Montreal, and colleagues followed a cohort of 11,779 men, diagnosed with nonmetastatic prostate cancer between 1998 and 2009, until 2012. The associations of aspirin use with prostate cancer mortality and all-cause mortality were assessed.

“The researchers found that, at a mean follow-up of 5.4 years, post-diagnostic use of aspirin was associated with increased risks of prostate cancer mortality (hazard ratio [HR], 1.46; 95 percent confidence interval [CI], 1.29 to 1.65) and all-cause mortality (HR, 1.37; 95 percent CI, 1.26 to 1.50). Further analysis showed that the risk of prostate cancer mortality was increased in patients initiating aspirin use after the diagnosis of prostate cancer (HR, 1.84; 95 percent CI, 1.59 to 2.12), but not in those who already were using aspirin before the diagnosis (HR, 0.97; 95 percent CI, 0.81 to 1.16). A similar pattern was observed for increased risk of all-cause mortality associated with post-diagnostic aspirin use (HR, 1.70; 95 percent CI, 1.53 to 1.88), but not pre-diagnostic aspirin use (HR, 0.98; 95 percent CI, 0.87 to 1.18).”


Inflammatory Marker Linked With Poor Prognosis in Melanoma

“A new study indicated that the measurement of levels of C-reactive protein (CRP) in the blood has been found to be an independent prognostic marker for survival in patients with melanoma. Patients with the most markedly increased levels of CRP were found to be at high risk for melanoma recurrence and death.

“ ‘We believe it is reasonable to include measurement of CRP in prospective investigations of outcomes of patients with melanoma, including in trials of systemic therapy,’ wrote Shenying Fang, MD, PhD, of the University of Texas MD Anderson Cancer Center, and colleagues in the Journal of Clinical Oncology. ‘Furthermore, although these data cannot determine whether interventions to reduce inflammation and/or CRP could benefit selected patients with melanoma, they do suggest that preclinical investigation of such interventions is justified.’

“This study is not the first to show a link between levels of CRP and cancer. Prior research has shown an association between CRP and lung and colorectal cancer, and a small study indicated that the marker may be prognostic in patients with early-stage melanoma.”


Study Suggests Exercise Benefit for Localised Prostate Cancer

“Moderate physical activity appears to reduce death rates among men diagnosed with prostate cancer that hasn’t spread, according to a 15-year study by Swedish researchers.

“The results, published in Cancer Epidemiology, Biomarkers Prevention, are encouraging say experts, but need confirming in larger trials.

“The study looked at 4,623 men in Sweden, who were diagnosed with localised prostate cancer between 1997 and 2002, and followed them until 2012.

“They completed questionnaires about their levels of exercise. 561 of the men died during the study, 194 of them from prostate cancer.

“Analysis showed that men who did the equivalent to walking or cycling for 20 or more minutes a day were 30 per cent less likely to have died from any cause, and 39 per cent less likely to have died of prostate cancer.”


Postdiagnosis Aspirin Use Associated With Reduced Disease-Specific Mortality Only in High-Risk Subgroup of Men With Nonmetastatic Prostate Cancer

The gist: A new study says that men with high-risk nonmetastatic prostate cancer might lower their risk of death by prostate cancer if they take aspirin after being diagnosed. A high dose of aspirin appears to be no better than a low dose.

“A recent analysis of a large clinical database indicated that postdiagnosis aspirin use was associated with a 57% reduction in prostate cancer–specific mortality among men with nonmetastatic prostate cancer. In a study in a prospective cohort reported in the Journal of Clinical Oncology, Jacobs et al found that postdiagnosis aspirin use was associated with reduced disease-specific mortality only among men with high-risk cancers, with no obvious difference in outcome according to aspirin dose being detected in this subgroup…

“The study included men diagnosed with nonmetastatic prostate cancer in the Cancer Prevention Study-II Nutrition Cohort between enrollment in 1992 or 1993 and June 2009. Aspirin use was recorded at enrollment, in 1997, and every 2 years thereafter. Through 2010, there were 441 prostate cancer deaths among 8,427 prostate cancer cases with information on prediagnosis aspirin use and 301 deaths among 7,118 cases with information on postdiagnosis aspirin use.

“Multivariate analyses of prostate cancer-specific mortality included adjustment for age at diagnosis, race, year of diagnosis, tumor extent (T1–T2 or T3–T4), nodal involvement, Gleason  score (2–6, 7, ≥8, unknown), initial treatment type, use of cholesterol-lowering drugs, cardiovascular disease, and prediagnosis prostate-specific antigen testing not leading to a prostate cancer diagnosis.”


Aspirin May Cut Mortality in Nonmetastatic Prostate Cancer

“Daily aspirin use, even at low doses, may reduce mortality among men with high-risk nonmetastatic prostate cancer, according to research published online Oct. 20 in the Journal of Clinical Oncology.

“Eric J. Jacobs, Ph.D., of the American Cancer Society in Atlanta, and colleagues analyzed data for men diagnosed with nonmetastatic prostate cancer to assess the association between daily aspirin use and prostate cancer-specific mortality (PCSM). The men were enrolled in the Cancer Prevention Study-II Nutrition Cohort between 1992 or 1993 and June 2009, and followed up through 2010.

“The researchers found that, after multivariable adjustment, neither prediagnosis (hazard ratio [HR], 0.92; 95 percent confidence interval [CI], 0.72 to 1.17) nor postdiagnosis (HR, 0.98; 95 percent CI, 0.74 to 1.29) daily use of aspirin showed a statistically significant association with PCSM compared with no aspirin use. Among men diagnosed with high-risk cancers (≥T3 and/or Gleason score ≥8), postdiagnosis daily aspirin use was associated with lower PCSM (HR, 0.60; 95 percent CI, 0.37 to 0.97). In this subgroup, no difference in mortality risk was observed according to aspirin dose, such as the typical low dose of 81 mg per day (HR, 0.50; 95 percent CI, 0.27 to 0.92) or higher doses (HR, 0.73; 95 percent CI, 0.40 to 1.34).

” ‘A randomized trial of aspirin among men diagnosed with nonmetastatic prostate cancer was recently funded,” the authors write. “Our results suggest any additional randomized trials addressing this question should prioritize enrolling men with high-risk cancers and need not use high doses.’ “


Screening Trial Confirms Benefit of 'Bowel Scope' Test

Editor’s note: This story is about the results of a clinical trial—a research study done with volunteer patients. The study measured the benefit of a colorectal cancer screening tool known as the Bowel Scope. The Norwegian researchers found that the number of deaths from colorectal cancer “could be reduced by as much as 27 per cent if everyone over the age of 50 had Bowel Scope testing.”

“A new trial of bowel cancer screening using flexible sigmoidoscopy – also known as Bowel Scope – has confirmed the benefits of adding the technique to existing screening programmes.

“The study, run by researchers from Norway, showed that the number of bowel cancer deaths could be reduced by as much as 27 per cent if everyone over the age of 50 had Bowel Scope testing.

“At the moment, NHS uses a screening test called the fecal occult blood test – which looks for telltale signs of bowel cancer in people’s stools.

“It is piloting the Bowel Scope test around England, with the aim of adding it to the bowel screening programme.”