“A molecular test can pinpoint which patients will have a very low risk of death from breast cancer even 20 years after diagnosis and tumor removal, according to a new clinical study led by UC San Francisco in collaboration with colleagues in Sweden. As a result, ‘ultralow’ risk patients could be treated less aggressively and overtreatment avoided, leading to fewer toxic effects.
” ‘This is an important step forward for personalizing care for women with breast cancer,’ said lead author Laura J. Esserman, MD, MBA, a breast cancer specialist and surgeon with UC Health. ‘We can now test small node-negative breast cancers, and if they are in the ultralow risk category, we can tell women that they are highly unlikely to die of their cancers and do not need aggressive treatment, including radiation after lumpectomy.’ ”
“A team of researchers from Cleveland Clinic, Louis Stokes Cleveland VA Medical Center, Kaiser Permanente Northwest, and other clinical sites have demonstrated that a new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease.
“By identifying molecular changes in the prostate specific antigen (PSA) protein, the findings, published online last month by European Urology, suggest that once validated, use of IsoPSA may substantially reduce the need for biopsy, and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.”
“They look like glowing jade necklaces of such unearthly brilliance they could be a Ming emperor’s. But if Dr. Gerardo Fernandez is right, the green fluorescent images of prostate cells could be even more valuable, at least to the thousands of men every year who unnecessarily undergo aggressive treatment for prostate cancer.
“That’s because the glimmering images promise to show which prostate cancers are destined to remain harmless for the rest of a man’s life, and thus might spare many patients treatment that can cause impotence and incontinence.”
“Younger age was associated with lower risks for disease progression and biopsy-based Gleason score upgrades during active surveillance of low- or intermediate-risk prostate cancer, according to a study published in Journal of Clinical Oncology.
” ‘The results of this study indicate that younger patients with low-risk prostate cancer experienced favorable outcomes when managed with active surveillance at nearly 5-year median follow-up,’ Michael Leapman, MD, assistant professor in the department of urology at Yale University School of Medicine, told HemOnc Today. ‘Younger patients have conventionally been counseled to receive definitive treatment, even in the setting of low-risk disease. This study is impactful as it may expand the use of surveillance, potentially limiting the harms of overtreatment for patients with screening-detected low-grade tumors.’ ”
“Recent studies have reopened discussion of a seemingly closed case against earlier use of chemotherapy in prostate cancer.
“Chemotherapy has an established role in the management of metastatic castration-resistant prostate cancer, but its use in earlier-stage disease has remained controversial. Given the heterogeneous nature of the disease, prolonged clinical course associated with indolent disease, and concern about overdiagnosis and overtreatment, clinicians have reached no consensus about potential patient subgroups that might benefit from earlier use of chemotherapy. Differences of opinion played out again in pro/con articles published online in JAMA Oncology.”
“A new analysis indicates that many men with prostate cancer obtain second opinions from urologists before starting treatment, but surprisingly, second opinions are not associated with changes in treatment choice or improvements in perceived quality of prostate cancer care. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings also explore motivations for seeking second opinions, and suggest that second opinions may not reduce overtreatment in prostate cancer.”
“Urologists at University of California, San Diego School of Medicine and Genesis Healthcare Partners have tested a new model of care for patients with low-risk prostate cancer. The evidence-based approach uses best practices to appropriately select and follow patients to avoid disease overtreatment. Results of the three-year study are now published online in the journal of Urology.
” ‘Active surveillance is a strategy that is recommended by physician and quality organizations to avoid the overtreatment of slow-growing prostate cancer,’ said Christopher Kane, MD, senior author and chair of the Department of Urology at UC San Diego Health. ‘Acceptance of this strategy by patients and urologists, however, has lagged for a number of reasons. What we have developed is a safe method to enhance acceptance and use of this disease management approach.’ ”
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“Almost half of patients with advanced lung cancer receive more than the recommended number of radiation treatments to reduce their pain, according to a new study published in the Journal of the National Cancer Institute.
“Radiation therapy that is palliative, or not intended to cure, can reduce the pain from lung tumors and improve quality of life. But unnecessary treatments add to costs and require needless trips to the hospital—and can lead to radiation toxicity and difficulty in swallowing.
“Guidelines developed from clinical trials recommend no more than 15 radiation treatments be given for pain in stage 4 lung cancer. The guidelines recommend that patients not receive chemotherapy at the same time, to reduce the risk of toxicity.”
“A paper published in the Journal of Clinical Oncology, authored by Tosoian et al, reports on the long-term outcomes of prospective active surveillance (AS) of patients with favorable-risk prostate cancer.
“The authors point out that the common widespread practice of screening for prostate cancer in the United States, using prostate-specific antigen (PSA), may have led to overdiagnosis and overtreatment of the disease.
“The US Preventive Services Task Force has issued a grade D recommendation to reduce the use of PSA screening, and the National Institutes of Health has made a study of the outcomes of AS a research priority as well.”