Archive | June, 2011

Investigational Drug Cabozantinib Active Against Advanced Prostate Cancer

When prostate cancer stops responding to androgen deprivation therapy (ADT), it is referred to as hormone-refractory prostate cancer.  Although advances have been made in the treatment of hormone-refractory prostate cancer, challenges remain and new drugs continue to be developed.

An investigational drug called Cabozantinib is showing promise in the treatment of hormone-refractory prostate cancer particularly among patients with bone metastases.

Researchers conducted a Phase II clinical trial among 171 patients with progressive cancer in which more than three-quarters of the men had bone metastases. All patients were initially treated with 12 weeks of Cabozantinib. On bone scan, 76% of the patients with bone metastases had partial or complete disappearance of the bone metastases. For patients taking narcotics for bone pain, 67% had a reduction in pain and 56% decreased or stopped their narcotic use.  More than two thirds of patients had some reduction in metastases outside of the bone.

Side effects include fatigue, gastrointestinal symptoms and high blood pressure.

These results were presented at the 2011 annual meeting of the American Society of Clinical Oncology.

Additional studies are underway.

Cabozantinib has not yet been approved by the U.S. Food and Drug Administration.

Posted in Prostate Treatment0 Comments

Infections Secondary to Transrectal Prostate Needle Biopsy

If prostate cancer is suspected, a prostate needle biopsy is recommended.  This surgical procedure takes about 15 minutes and is usually performed in the urologist’s office.

Post biopsy infections are very rare, occurring in less than 1% of patients however research reports suggest that the rate of infectious complications, including sepsis may be increasing. Recently published news articles highlighted these findings, and it is important for urologists to be aware of this issue.

According to the AUA Best Practice Statement on Urologic Surgery Antimicrobial Prophylaxis, the antimicrobial of choice prior to prostate needle biopsy is a fluoroquinolone or a second- or third-generation cephalosporin. Alternative agents include an aminoglycoside plus metronidazole or clindamycin.  Oral fluoroquinolones are the most commonly used agents in clinical practice.

The primary reason for post-biopsy infections appears to be the presence of fluoroquinolone-resistant organisms in the fecal flora. Risk factors which predict the presence of resistant bacteria are not well defined, but may include previous fluoroquinolone administration, and patient occupation as a healthcare worker. Prior to performing a transrectal prostate biopsy, urologists should consider broadening the antimicrobial coverage in patients with these risk factors. Furthermore, in men with signs of an infection after prostate needle biopsy, the presence of resistant bacteria is likely and broad-spectrum treatment should be initiated.

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FDA Calls for Warning Labels on Drugs for Enlarged Prostate

The U.S. Food and Drug Administration is calling for new warning labels on part of a class of medications used to primarily treat enlarged prostate called 5-alpha reductase inhibitors (5-ARI).  This new warning is based on the results of two large prostate cancer trials where it shows that the medications may raise the risk of developing an aggressive form of prostate cancer. The drugs involved include popular medications sold under brand names Proscar and Propecia (sold by Merck & Co.) and Avodart and Jalyn (sold by GlaxoSmithKline).

Propecia, a lower dose version of Proscar and is prescribed to treat hair loss in men is updating its label even though it was not included in the trials. FDA said “the applicability of the Avodart and Proscar studies to Propecia is currently unknown.”

FDA is advising doctors not to start patients on these drugs until prostate cancer and other urological conditions have been ruled out.  Prostate cancer can mimic the symptoms of an enlarged prostate.

Recent research has also shown that Proscar, Propecia and Avodart are all associated with increased risk of erectile dysfunction in men who take the medications.

According to FDA, between 2002 and 2009 almost 5 million men were prescribed one of these medications and of these nearly 3 million men were between the ages of 50 and 79.

“What both studies show conclusively is there is about 1% increase in being diagnosed with high-grade prostate cancer if you got these drugs even though you are less likely to get a low-grade cancer.  You have to weigh the 24% reduction against the 1% increased incidence of high-grade disease.” says Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital in Boston.  He added, “These drugs should only be used in men who have an additional indication to take them beyond prostate cancer prevention.”

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Six Cups or More of Coffee May Lower Men’s Risk for Prostate Cancer

New research suggests that men who drink six or more cups of coffee a day may be lowering their risk for advanced prostate cancer by 60 percent.

Kathryn Wilson, a research fellow in epidemiology at Harvard School of Public Health in Boston and lead researcher for this study said “There are a lot of compounds in coffee that have various biological effects.  It’s a major source of antioxidants and that might have anti-cancer effects.  Coffee also seems to have effects on insulin which has been associated with a lower risk of type 2 diabetes and insulin is thought to play a role in many cancers, including prostate cancer. Compounds in coffee also have an impact on sex hormone levels.”

For the study, the researchers collected data on almost 48,000 men who took part in the Health Professionals Follow-Up Study in 1986 and followed them until 2008. Every four years these men reported on how much coffee they drank.

The researchers then calculated the risk for prostate cancer tied to the amount of coffee consumed. During the period of the study, they identified 5,035 cases of prostate cancer, of which 642 were fatal cases in which the cancer was metastatic, meaning that it had spread beyond the original site.

The Harvard team found that drinking six or more cups of coffee each day was associated with an almost 20 percent lower risk of developing prostate cancer, compared to those who did not drink coffee.

In addition, the odds of developing a more lethal or advanced prostate cancer dropped by 60 percent, compared to men who abstained from coffee – a statistically significant and “substantially lower” relative risk, according to the researchers.

Even men who drank less coffee — one to three cups a day — had a 30 percent lower risk of developing lethal prostate cancer, and reductions in risk were observed whether the men drank caffeinated or decaffeinated coffee.

After taking into account other lifestyle factors, such as age, smoking, obesity and exercise, the decline in the odds for prostate cancer remained.

The study was limited by self reported data and the lack of data on coffee intake from earlier periods of the men’s lives, the researchers noted.

Right now the study findings point only to an association between coffee and a healthier prostate. More study will be needed to confirm the findings and to see if a biological explanation for the phenomenon exists.

The finding comes on the heels of a published Swedish study that found that women who drank five or more cups of coffee per day saw a significant drop in their risk for a particularly aggressive form of breast tumor.

Posted in Feature, Prostate Health0 Comments


June 2011
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