The methods used to anesthetize prostate cancer patients and control pain when their prostate glands are surgically removed for adenocarcinoma may affect their long-term cancer outcomes, a study led by Mayo Clinic has found. Opioids, painkillers commonly given during and after surgery, may suppress the immune system’s ability to fight cancer cells. The research suggests that supplementing general anesthesia with a spinal or epidural painkiller before a radical prostatectomy reduces a patient’s need for opioids after surgery, and this finding was associated with a lower risk of cancer recurrence. The findings are published online in the British Journal of Anaesthesia.
MULTIMEDIA ALERT: Video of Dr. Sprung is available for download from the Mayo Clinic News Network.
The immune system’s strength is especially important in cancer surgery because surgical manipulation of a tumor may spread cancer cells. The immune system can be impaired by general anesthesia, the overall stress surgery places on the body and by post-surgical systemic opioid use. The study found better outcomes in radical prostatectomy patients who had general anesthesia supplemented with spinal or epidural delivery of a long-acting opioid such as morphine, than in those who received general anesthesia only.
“We found a significant association between this opioid-sparing technique, reduced progression of the prostate tumor and overall mortality,” says senior author Juraj Sprung, M.D., Ph.D., a Mayo Clinic anesthesiologist.
Despite the dramatic results of the Prostate Cancer Prevention Trial (PCPT), which showed a significant reduction in prostate cancer among those taking finasteride, physicians have not increased its use, according to a study published in the September issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
The first results of the PCPT were published in 2003 in The New England Journal of Medicine and were widely reported. The randomized controlled trial consisted of 18,000 men and showed a 25 percent reduced risk of prostate cancer.
Unfortunately, it also showed a 27 percent increased risk in high-grade tumors, which was noted in an accompanying editorial. Ian Thompson, M.D., chairman of the department of urology at the University of Texas Health Science Center, who led the study, said the editorial may have colored the perception of finasteride.
There’s more than one way to kill a cancer cell.
Cliff Berkman is working on a better way—one that specifically targets prostate cancer cells and causes a type of natural death that spares surrounding tissues from damage. In a recent paper in the journal “Cancer Letters,” he describes a method that delivers to the cells a chemical that, when exposed to a certain type of light, prompts the cells to die and disappear with minimal side effects.
“Ultimately, what we’re trying to do is cure cancer with light,” said Berkman, a Washington State University chemistry professor.
Men living in deprived areas are far less likely to be treated with the most common types of radical treatment for prostate cancer than those in more affluent places, says a study published on bmj.com today.
A large scale study carried out by researchers from Cambridge found that patients from the most deprived areas are 26% less likely to have radiotherapy than men from the most affluent areas and 52% less likely to have radical surgery.
Prostate cancer is the most common malignancy in men and its incidence has been increasing, particularly since the late 1980s and early 1990s.
Johns Hopkins epidemiologists say that prostate cancer patients who gain five or more pounds near the time of their prostate surgery are twice as likely to have a recurrence of their cancer compared with patients whose weight is stable.
“We surveyed men whose cancer was confined to the prostate, and surgery should have cured most of them, yet some cancers recurred. Obesity and weight gain may be factors that tip the scale to recurrence,” says Corinne Joshu, Ph.D., M.P.H., postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health.
Joshu and her colleagues sent questionnaires to 1,337 men with prostate cancer who had undergone surgery to remove their prostate at the Johns Hopkins Hospital. The researchers asked each participant to recall their dietary, lifestyle and medical factors from five years before their surgery through one year after.
At a time of growing debate over prostate cancer treatments, U.S. Medicare officials will take a closer look at radiation therapy and its ability to reduce deaths and side effects in men.
The Center for Medicare and Medicaid Services (CMS) has asked a panel of outside experts meeting on Wednesday to say how confident they are that various types of radiation treatment can improve patient outcomes.
Researchers have found that many prostate cancers are so slow-growing that most men will die from other causes, sparking debate over whether diagnosis is too frequent and whether treatments, which also include surgery, are excessive.
Shahriar Koochekpour, MD, PhD, Assistant Professor of Microbiology and Immunology, Biochemistry and Molecular Biology, and Genetics at LSU Health Sciences Center New Orleans, led research that has discovered, for the first time, a genetic mutation in African-American men with a family history of prostate cancer who are at increased risk for the disease. Dr. Koochekpour, who is also a member of the LSUHSC Stanley S. Scott Cancer Center, identified an inheritable genetic defect in the receptor for the male hormone, androgen (testosterone), that may contribute to the development of prostate cancer and its progression. Scientific reports linking inheritable androgen receptor mutations to prostate cancer in Caucasians are rare, and this is the first one that focuses on the African-American population. The study is available in the advance online publication of the Nature Publishing Group’s Asian Journal of Andrology.
Dr. Koochekpour and his laboratory discovered this genetic change by testing DNA extracted from white blood cells of African-American and Caucasian men from Louisiana who had a proven medical history of prostate cancer in their families.
“We detected this mutation only in African-American men with prostate cancer,” notes Dr. Koochekpour.
Given the bind that many prominent American men have thrust themselves into — think Tiger Woods, Mark Sanford, Eliot Spitzer, et al. — it seems it really is possible to have too much of a good thing. And your prostate gland appears to agree.
According to a new research out of the UK, men who have frequent sex in their twenties and thirties were at a greater risk of developing prostate cancer later in life. What’s even more unusual is that researchers showed that young men who masturbated frequently, as opposed to those who have sex frequently with a partner, were at an even greater risk of developing prostate cancer.
New Mayo Clinic research studied the association between prostate-specific antigen (PSA) levels and prostate size and found that routine annual evaluation of prostate growth is not necessarily a predictor for the development of prostate cancer. However the study suggests that if a man’s PSA level is rising quickly, a prostate biopsy is reasonable to determine if he has prostate cancer. These findings are being presented this week at the North Central Section of the American Urological Association (http://www.ncsaua.org/) in Scottsdale, Ariz.
VIDEO ALERT: Additional audio and video resources are available on the Mayo Clinic News Blog (http://newsblog.mayoclinic.org/2009/11/09/routine-prostate-size-evaluation-not-as-effective-in-cancer-screening/).
These Mayo Clinic study findings were based on data in the Olmsted County Study of Urinary Health Status among Men, a large cohort study of men living in Olmsted County, Minn. Researchers randomly selected 616 men between the ages of 40 and 79 who did not have prostate disease. Patients participated in examinations every two years for 17 years, which included PSA and prostate volume measurements using ultrasound, to determine changes in prostate disease.
Men with lower cholesterol are less likely than those with higher levels to develop high-grade prostate cancer - an aggressive form of the disease with a poorer prognosis, according to results of a Johns Hopkins collaborative study.
In a prospective study of more than 5,000 U.S. men, epidemiologists say they now have evidence that having lower levels of heart-clogging fat may cut a man’s risk of this form of cancer by nearly 60 percent.
“For many reasons, we know that it’s good to have a cholesterol level within the normal range,” says Elizabeth Platz, Sc.D., M.P.H., associate professor at the Johns Hopkins Bloomberg School of Public Health and co-director of the cancer prevention and control program at the Johns Hopkins Kimmel Cancer Center. “Now, we have more evidence that among the benefits of low cholesterol may be a lower risk for potentially deadly prostate cancers.”
Clinical researchers at Princess Margaret Hospital (PMH) can now answer the question that baffles many clinicians – why do some men with elevated prostate specific antigen (PSA) levels who are carefully monitored and undergo repeated negative biopsies still develop aggressive prostate cancer?
The answer is hidden tumours located on the top of the prostate that evade traditional diagnostic procedures, including ultrasound-guided needle biopsy. The PMH research, published online today in the British Journal of Urology International (BJU 8938), demonstrates that magnetic resonance imaging (MRI) is the best tool to reveal such tumours.
“Our findings identify a specific high-risk group whose tumours are difficult to diagnose because of location. These men benefit from MRI, which guides the biopsy procedure with a high degree of accuracy,” says author Dr. Nathan Lawrentschuk, Urologic Oncology Fellow, PMH Cancer Program, University Health Network. “The research team calls the clinical presentation of elevated PSA and repeated negative biopsy results in ‘prostate evasive anterior tumour syndrome’ (PEATS).”
New research indicates that over half of men who choose “watchful waiting” as the initial strategy for prostate cancer need no treatment over the long haul.
With “watchful waiting,” patients with early prostate tumors are monitored regularly and only treated if their cancer progresses.
“Patients and doctors should not assume that any/all cancer must be immediately treated,” lead researcher Dr. Martin G. Sanda, from Beth Israel Deaconess Medical Center, Boston, told Reuters Health.
NewYork-Presbyterian Hospital/Weill Cornell Medical Center has established a new Prostate Cancer Institute, dedicated to pursuing aggressive and innovative prostate cancer treatments while providing patient care in a comfortable and compassionate setting. Dr. Ashutosh Tewari, a leading robotic urologic surgeon, has been appointed as its director.
Dr. Tewari is an internationally acclaimed expert on robotic prostatectomy and other minimally invasive robotic surgeries, of which he has performed more than 2,000 in New York. A prolific researcher, he has also written upwards of 200 scientific articles. His clinical interests involve urologic oncology with special emphasis on the care of patients with prostate, bladder and other urological cancers.
“I am proud to have Dr. Tewari lead the Prostate Cancer Institute,” says Dr. Peter Schlegel, professor and chairman of urology at Weill Cornell Medical College, and urologist-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Berlin, Germany: New research has found that hormone therapy used to treat men with advanced prostate cancer is associated with an increased chance of developing various heart problems. Some choices of therapy appear, however, to be less risky than others.
Researchers told Europe’s biggest cancer congress, ECCO 15 – ESMO 34 , in Berlin today (Tuesday 22 September) that the findings of their study, the largest and most comprehensive to date on the issue, indicate that doctors need to start considering heart-related side effects when they prescribe endocrine therapy for prostate cancer and might want to refer patients to a cardiologist before starting treatment.
A few smaller studies have indicated that some types of hormone therapy increase the risk of coronary heart disease and heart attacks in prostate cancer patients, but others have found no increased risk. This is the first large study to investigate how the broader range of hormone therapies affect a wider range of heart problems and provides for the first time a detailed picture of the impact of each sort of hormone therapy on individual types of heart trouble.
A third of the previously identified single-nucleotide polymorphisms, or SNPs, associated with prostate cancer in men of European or African ancestry were also associated with prostate cancer in a Japanese population, according to a new study published online September 2 in the Journal of the National Cancer Institute.
Genome-wide association studies have primarily been performed in populations of European ancestry, but little is known if the associations discovered in one population are relevant for other populations.
In this study, Matthew L. Freedman, M.D., of the Department of Medical Oncology at the Dana-Farber Cancer Institute in Boston, and colleagues evaluated 23 SNPs previously reported to be associated with prostate cancer risk and clinical covariates (tumor aggressiveness and age at diagnosis, for example) in almost 1350 Japanese men (311 case subjects and 1035 control subjects).