June, 2013

Observation Is Safe, Cost-Saving in Low-Risk Prostate Cancer, Study Suggests

June 17, 2013 — Many men with low-risk, localized prostate cancers can safely choose active surveillance or “watchful waiting” instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at Dana-Farber Cancer Institute and Massachusetts General Hospital. Writing in the June 18 issue of the Annals of Internal Medicine, the authors said their statistical models showed that “observation is a reasonable and, in some situations, cost-saving alternative to initial treatment” for the estimated 70 percent of men whose cancer is classified as low-risk at diagnosis. The researchers, led by Julia Hayes, MD, a medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber, said their findings support observation — active surveillance and watchful waiting — as a reasonable and underused option for men with low-risk disease. “About 70 percent of men in this country have low-risk prostate cancer, and it’s estimated that 60 percent of them are treated unnecessarily” with various forms of radiation or having the disease removed with radical prostatectomy surgery, said Hayes, who is also a senior scientist at MGH’s Institute for Technology Assessment. A clinical trial called PIVOT reported that such men had about the same small risk of death over a 12-year period whether they underwent radical prostatectomy or simply observation. Hayes and her co-authors created mathematical models to construct a variety of scenarios, focusing on men ages 65 or 75 at diagnosis, and including estimated costs associated with treatment and different forms of observation. In active surveillance (AS), patient undergo blood tests for prostate specific antigen (PSA) every three months, rectal examinations every six months, and a prostate gland biopsy at one year and then every three years. If the tests find the cancer is more aggressive than originally thought, the patients begin treatment aimed at curing the disease. “This approach could also be described as deferred treatment,” said Hayes. A patient who chooses watchful waiting (WW) is observed without intensive monitoring and is given palliative treatment when the cancer becomes symptomatic. Treatments for low-risk prostate cancer include radical prostatectomy, intensity-modulated radiation therapy (IMRT) or brachytherapy (radioactive seed implants.) The investigators calculated the quality-adjusted life expectancy, or QALE, for the different strategies. (QALE takes into account both the years of life gained and factors that reduce quality of life, such as undergoing invasive tests, the impact of treatment and complications, and disease...

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Men With Prostate Cancer Should Eat Healthy Vegetable Fats, Study Suggests

Men with prostate cancer may significantly improve their survival chances with a simple change in their diet, a new study led by UC San Francisco has found. By substituting healthy vegetable fats — such as olive and canola oils, nuts, seeds and avocados — for animal fats and carbohydrates, men with the disease had a markedly lower risk of developing lethal prostate cancer and dying from other causes, according to the study. The research, involving nearly 4,600 men with non-metastatic prostate cancer, could help with the development of dietary guidelines for men with the disease. While prostate cancer affects millions of men around the world, little is known about the relationship between patients’ diets following their diagnosis and progression of the disease. The study was published online on June 10 in JAMA Internal Medicine. “Consumption of healthy oils and nuts increases plasma antioxidants and reduces insulin and inflammation, which may deter prostate cancer progression,” said lead author Erin L. Richman, ScD, a post-doctoral scholar in the UCSF Department of Epidemiology and Biostatistics. “The beneficial effects of unsaturated fats and harmful effects of saturated and trans fats on cardiovascular health are well known,” Richman said. “Now our research has shown additional potential benefits of consuming unsaturated fats among men with prostate cancer.” Analyzing Intake of Fats from Various Sources Nearly 2.5 million men in the United States currently live with prostate cancer and another quarter-million men are expected to be diagnosed this year. One in six men in the U.S. will be diagnosed with the disease during their lifetime. In recent years, evidence has indicated that diet might be an important way for men with prostate cancer to take an active role in determining their disease outcome and overall health. Research on advanced prostate cancer has suggested that fat intake may be relevant to disease progression, but this is the first study to examine fat consumption post-diagnosis in relation to risk of lethal prostate cancer and overall survival. The new paper analyzed intake of saturated, monounsaturated, polyunsaturated and trans fats as well as fats from animal and vegetable sources. The data were derived from the Health Professionals Follow-up Study, which began in 1986 and is sponsored by the Harvard School of Public Health and is funded by the National Cancer Institute. The fat intake study involved 4,577 men who had been diagnosed with non-metastatic prostate cancer between 1986 and 2010. During...

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Early diagnosis of prostate cancer is stopping spread of disease

Monash University research reveals that in the past two decades more men are being diagnosed early and, as a result, more are getting treatment. When 1993’s data is compared with that of 2008-11, it also shows a “dramatic surge” in those diagnosed before the cancer spreads. And a new study of 2000 men shows that many with low-risk cancer are being spared radical treatment, as doctors opt for a more conservative approach to managing the disease. Dr Sue Evans, of the university’s Department of Epidemiology and Preventive Medicine, said almost three-quarters of men received curative treatments, such as surgery and radiotherapy from 2008-11. This compared with just a quarter of men who had treatment intended to cure the cancer in 1993. Dr Sue Evans, of the university’s Department of Epidemiology and Preventive Medicine, said almost three-quarters of men received curative treatments, such as surgery and radiotherapy from 2008-11. This compared with just a quarter of men who had treatment intended to cure the cancer in 1993. Dr Evans said another sign doctors were detecting prostate cancer earlier was that the level of PSA (prostate-specific antigen) in the blood was now lower when men were diagnosed. The level of PSA has dropped to 6.8ng/ml, compared with 20.1ng/ml in 1993. Victorian Prostate Cancer Registry data also showed that only 3 per cent of men were diagnosed with the disease after it had spread. There has also been a sixfold drop in the number of men requiring more radical hormonal therapy. The number of men who were not receiving active treatment for their prostate cancer also declined from 36 per cent in 1993 to 23 per cent from 2008-11. “There have been fears overseas that men are being overtreated, but it appears in Victoria that the approach is more conservative,” Dr Evans said. The research, published in the Medical Journal of Australia, found Victorian men with a low-risk prostate cancer were four times less likely than US men to get treatment in the first 12 months of their disease. Men over 75 were more than 10 times as likely not to receive active treatment as those under 55 years. “These men are often not treated because they are not going to die from prostate cancer and it saves them the side-effects of treatment such as impotence and incontinence,” Dr Evans said. The research also found that a year after diagnosis, 41 per...

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