New Study Finds That Lymph Node Removal Isn’t Necessary for All Melanoma Patients

Excerpt:

“Many patients with melanoma need a sentinel-lymph-node biopsy to determine if cancer cells have spread there, but a positive finding doesn’t mean all the lymph nodes in the area must be removed, according to new international study.

“Many  with melanoma need a  biopsy to determine if cancer cells have spread there, but a positive finding doesn’t mean all the lymph nodes in the area must be removed, according to a new international study conducted in part by researchers in Utah that may change standard treatment for melanoma patients whose cancer has spread.”

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Thousands of Men with Prostate Cancer Get Risky Treatment They Don’t Need. New Approaches Could Curb That

Excerpt:

“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.”

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Metastatic Prostate Cancer Cases Surge, Adding to Screening Controversy

Excerpt:

“A new study documents a decade-long increase in the number of men who have incurable prostate cancer at their initial diagnosis, an ominous finding that prostate cancer-screening proponents have been predicting.

“Both screening and diagnosis of early-stage prostate cancer have declined, coinciding with recommendations from an influential government advisory panel. In 2008, the U.S. Preventive Services Task Force said not to do routine PSA blood testing of men over age 74. And in 2012, it said to not screen any men – not even those at high risk – because the harms of unnecessary treatment outweigh the benefits of catching cancer early.”

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Tattoos Mistaken as Cancer Metastases, Surgery Performed

“Physicians should be aware that tattoo ink can look like the spread of cancer to the lymph nodes on diagnostic imaging — and unnecessary treatment can result.

“That is the take-home message from a case report of a 32-year-old woman with locally advanced cervical cancer.

“The 14 tattoos that extensively covered the legs of the mother of four had been applied over an 11-year period. Images included a black panther, the phrase ‘I’ve got baggage’ (with the image of a suitcase), and the title of a children’s show, Yo Gabba Gabba. The most recent tattoo had been applied 2 years before her presentation.

“As in many cases of locally advanced cervical cancer, imaging was performed before surgery to look for metastatic disease, according to Narine Grove, MD, and colleagues from the University of California, Irvine.”


Melanoma Treatment May Not Always Require Extensive Lymph Node Removal

“Not all melanoma patients may need surgery to remove lymph nodes surrounding their tumor, a new clinical trial has found.

“Cancer doctors usually remove all lymph nodes located near a melanoma tumor — the deadliest type of skin cancer — if they find that the cancer has spread to at least one lymph node.

“But such surgery did not improve survival in a group of nearly 500 patients with very small tumors, according to findings scheduled for presentation Saturday at the annual meeting of the American Society of Clinical Oncology (ASCO), in Chicago.

” ‘I think that our study is the beginning of the end of a general recommendation of complete lymph node dissection for patients with positive sentinel nodes,’ senior study author Dr. Claus Garbe, a professor of dermatology at the University of Tubingen in Germany, said in an ASCO news release.”


One in Five Women with Breast Cancer Don't Know About Test Results That Might Help Them Avoid Chemo

“Although 90 percent of women with early-stage breast cancer said they were aware they took a genomic test that identified their level of risk for a recurrence of the disease, one in five didn’t know the results of that analysis, according to a new fact sheet by the UCLA Center for Health Policy Research.

“The test, called gene expression profiling, or GEP, is used by physicians to help guide treatment decisions and can potentially help people avoid unnecessary chemotherapy. One of a number of emerging ‘precision medicine’ genomic technologies, the GEP estimates the activity of specific genes in breast cancer cells, which can help predict whether there is a greater chance for breast cancer to return. Those with a high risk for cancer growth benefit by having chemotherapy as part of their treatment, the authors write, but chemo has no added value for those with a low risk.”


Prostate Screening: Combining MRI with Conventional Prostate Surveillance Effective, Study Suggests

“Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.

“Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.

“The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident.”


Study: Oncotype DX Test Is Useful to Predict Risk of Cancer Return in Patients with DCIS

The gist: A new study has confirmed that a test called Oncotype DX is a reliable way to predict how likely it is that a woman’s cancer will come back (recur) after she undergoes surgery for ductal carcinoma in situ (DCIS). If a patient’s cancer is more likely to recur, she may decide on additional aggressive treatment to prevent it. Patients with DCIS that is unlikely to return after surgery may choose to forgo unnecessary treatments.

“Ductal carcinoma in situ (DCIS), which accounts for 30% of all newly diagnosed breast cancer, is actually a precancerous lesion. A proportion of patients will have progression to invasive breast cancer, but up until recently, it has not been possible to identify which patients require further treatment to prevent recurrence.

“Oncotype DX DCIS is a 12-panel gene test with a scoring system that categorizes cancers as low, intermediate, or high risk for local recurrence over 10 years following treatment with breast-conserving surgery alone. A large population-based study presented at the 2014 San Antonio Breast Cancer Symposium validated Oncotype DX DCIS in a diverse population of women with DCIS (Abstract S5-04)…

“The current study is important because the ECOG E5914 study that showed Oncotype DX DCIS was predictive of local recurrence was based on only a select population of women. ‘Our results confirm the ECOG E5914 results in a more diverse population,’ explained lead author Eileen Rakovitch, MD,Sunnybrook Health Sciences Centre, University of Toronto, Canada.”


Study Finds Over-Treatment for Prostate Cancer Patients with Life Expectancies of Fewer than 10 Years

“National guidelines recommend that men with low- and intermediate-risk prostate cancer who have life expectancies of fewer than 10 years should not be treated with radiation or surgery, since they are unlikely to live long enough to benefit from treatment. Yet a new study by UCLA researchers found that more than half of such men are receiving these aggressive treatments putting them at risk for potentially debilitating side effects.

“In the first study to rigorously address prostate cancer treatment trends by life expectancy in a large, nationally representative sample, UCLA researchers found that more than half of prostate cancer patients 66 years and older have life expectancies of fewer than10 years, but half of those still were over-treated for their prostate cancer with surgery, radiation or brachytherapy—the implantation of radioactive seeds in the prostate.

“Randomized controlled studies have suggested that significant differences in survival between watchful waiting—monitoring the cancer closely but not treating it—and aggressive therapies don’t develop until 10 years after treatment. Thus it makes sense not to treat men expected to die of something else within 10 years. But the UCLA researchers found that men were being treated aggressively anyway, with little regard for their quality of life, said study first author Dr. Timothy Daskivich, a UCLA Robert Wood Johnson fellow.

” ‘Life expectancy is poorly integrated into treatment decision-making for prostate cancer, yet it is one of the primary determinants of whether a patient will benefit from treatment with surgery or radiation,’ Daskivich said. ‘Because these treatments have side effects such as erectile dysfunction, urinary incontinence and bowel problems, it’s critical for men with limited life expectancies to avoid unnecessary treatment for low- and intermediate-risk prostate cancer.’ “