“Men with localized prostate cancer face good odds: Their relative five-year survival rate is nearly 100 percent. However, men with metastatic disease — prostate cancer that has spread to another organ like the lungs — have a relative five-year survival rate of only 29 percent.
“Currently, the mainstay treatment for metastatic prostate cancer is hormone therapy, which uses drugs to lower the levels of male sex hormones like testosterone in the body to slow the growth of prostate cancer. Two of the latest hormonal agents, abiraterone acetate and enzalutamide, have shown some improvements in overall survival. Unfortunately, hormone therapy isn’t a cure and most patients become resistant to the drugs.”
“The anxiety many men experience after being diagnosed with prostate cancer may lead them to choose potentially unnecessary treatment options, researchers from the University at Buffalo and Roswell Park Cancer Institute report in a new study.
” ‘Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment, such as choosing surgery over active surveillance,’ said UB’s Heather Orom, the lead author on the study, published in the February issue of the Journal of Urology.”
“Vascular-targeted photodynamic therapy with padeliporfin was significantly better than active surveillance over a 2-year period in men with low-risk localized prostate cancer, according to a new study. The treatment could allow men to avoid more radical therapy.
” ‘Focal therapy and active surveillance are both tissue-preserving strategies,’ wrote study authors led by Mark Emberton, MD, of University College London in the United Kingdom. ‘However, focal therapy differs from active surveillance in that it treats disease—by the process of selective tissue ablation—above a certain risk threshold and monitors disease below that threshold, because the latter is deemed to be clinically significant.’ ”
“Experts have again come out in favor of the ‘less-is-more’ approach to breast cancer surgery and have endorsed previous recommendations not to automatically harvest all lymph nodes if cancer is found in a sentinel node, new guidelines from the American Society of Clinical Oncology (ASCO) indicate.
” ‘The standard of care used to be to take all lymph nodes, but the data have been quite compelling over the last few years, and now, it’s generally accepted that a complete lymph node dissection isn’t necessary for all patients,’ lead author Gary Lyman, MD, MPH, Fred Hutchinson Cancer Research Center, Seattle, Washington, said in a statement.
” ‘So if a woman has only one or two sentinel lymph nodes that are cancerous, and if the tumor is not too big and not too aggressive, there’s no value in doing a complete lymph node dissection,’ he added.”
“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.”
“A new report on Swedish men with non-aggressive prostate cancer suggests that a lot more American men could safely choose to monitor their disease instead of seeking immediate radiation treatment or surgery.
“Published online October 20 in the Journal of the American Medical Association (JAMA) Oncology, the report shows that well over half of 32,518 men in Sweden diagnosed with prostate cancers least likely to spread chose monitoring during a recent, five-year period over immediate treatment.”
“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.”
“This was a randomized phase III trial including 6693 women with early-stage breast cancer designed to assess whether patients at high clinical risk (via Adjuvant! Online) and low genomic risk (via MammaPrint) would have similar metastasis-free survival if treated without chemotherapy. A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. No significant difference in the 5-year metastasis-free survival rate was noted in women who received chemotherapy compared with those who did not (95.9% vs 94.7%).
“These findings suggest that nearly half of women at high clinical risk may not need chemotherapy for breast cancer.”