Archive | Prostate Health

No Relationship Between Small Prostate Size and High Grade Cancer

Previously, radical prostatectomy series have shown an inverse relationship between prostate size and high grade cancer.  It was suggested that smaller sized prostates arise in a low androgen environment, which enables development of more aggressive cancer.  A recent study by a team of authors from Stanford University School of Medicine in the Journal of Urology, however, shows that small prostate size is not associated with high grade cancer.  The authors argue that previous observations are the result of ascertainment bias driven by prostate specific antigen performance.

The study’s authors analyzed 1,404 patients from the Stanford Radical Prostatectomy Database with clinical stage T1c (723) and T2 (681) disease who had surgery between 1988 and 2002 and underwent detailed morphommetric mapping by a single pathologist.  They used multivariate linear regression to analyze the effects of age, prostate weight and prostate specific antigen on total and high grade cancer volume and percentage of high grade disease.

Patients who underwent biopsy due to abnormal prostate specific antigen (stage T1c had a prostate weight that was negatively associated with total cancer volume, which is the volume of high grade disease and percentage of high grade disease.  For patients who underwent biopsy based on abnormal rectal examination (stage T2), these relationships were not present.

The authors conclude that improved prostate specific antigen performance for high grade disease results in ascertainment bias in patients with T1c disease.  For this reason, the relationship between prostate size and high grade disease may be a result of grade dependent performance of prostate specific antigen rather than true tumor biology.

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Brisk Walking Slows Down Prostate Cancer Progression

A recent study at the University of California, San Francisco (UCSF) and the Harvard School of Public Health found that an association between brisk walking and lowered risk of prostate cancer progression in a study of 1,455 men in the U.S. diagnosed with early-stage prostate cancer.

The research team found that men who walked briskly at least at three miles per hour for at least three hours each week after diagnosis were about sixty percent less likely to develop biochemical markers of cancer recurrence or less likely to need a second round of prostate cancer treatment.  The study was published in the journal Cancer Research.

This new finding complements an earlier study published by UCSF’s June Chan, ScD, and collaborators at the Harvard School of Public Health showing that physical activity after diagnosis could reduce disease-related mortality in a distinct population of men with prostate cancer.  The recent study by Erin Richman, ScD, a postdoctoral fellow at UCSF is the first to focus on the effect of physical activity after diagnosis on early indications of disease progression, such as rise in prostate-specific antigen (PSA) blood levels.

An advantage of this study is the focus on early recurrence of prostate cancer, which occurs before men may experience painful symptoms of prostate cancer metastases, a frequent cause for men to decrease their usual physical activity. Additionally, the researchers reported that the benefit of physical activity was independent of the participants’ age at diagnosis, type of treatment and clinical features.  This work was funded by the Department of Defense, the Prostate Cancer Foundation, Abbott Labs, and through a National Institutes of Health training grant.

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Diabetes Mellitus is Associated With Increased Prostate Tumor Risk

Even though previous studies have suggested that men with diabetes mellitus (DM) have a lower risk of prostate cancer, Duke University researchers now report that their findings suggest that there is a relationship between DM and increased risk of aggressive prostate tumors.

Leah Gerber, MSc, and colleagues at the Duke University Prostate Center retrospectively analyzed statistical data from 1,848 men from the center’s database who underwent radical prostatectomy for prostate cancer at Duke University Medical Center between 1999 and 2009 and who had complete clinical information.  The number of patients with DM at time of surgery was 197 or 10.7% of men in the study.

After the researchers adjusted for demographic and clinical covariates, they found that men with preexisting DM had almost 50% increased risk of aggressive prostate cancer compared to men without DM.  Race and obesity did not appear to have an effect on this association.  These findings could partly explain why meta-analyses show that pre-existing DM is a significant risk factor for prostate cancer and overall mortality.  Gerber reports that if the findings hold in other populations, then the finding can be used to stratify patients by risk and identify therapeutic agents acting within the molecular pathways by both disease processes.  Additionally, the team reported that investigating pharmacological agents used to treat DM should continue to determine a potential benefit against prostate cancer.

The study data was presented at the 2011 annual meeting of the American Urological Association and funded by the Duke Division of Urologic Surgery.

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Long Term Acetaminophen Use Associated with Lower Prostate Cancer Risk

A new study from American Cancer Society shows that acetaminophen use of 30 tablets a month or more for five or more years was associated with an estimated 38% lower risk for prostate cancer.  This study is one of the two studies of prostate cancer to date that have examined the association with acetaminophen use that was both long-term and regular.

Researchers of this study examined the association between acetaminophen use and prostate cancer incidence by obtaining information completed by 78,485 men from the Cancer Prevention Study II Nutrition Cohort in 1992 study enrollment questionnaires. It was updated using follow up questionnaires in 1997 and every two years thereafter. From 1992 to 2007, 8,092 prostate cancer cases were identified. Current regular use of acetaminophen, more than 30 pills a month for 5 years or more was associated with lower risk of overall prostate cancer.  Current regular use of less than 5 years duration was not associated with prostate cancer risk.

Led researcher Eric Jacobs, Ph.D., an epidemiologist from American Cancer Society said “Our findings do not justify use of acetaminophen to prevent prostate cancer still the results of this study could lead to further research on acetaminophen that might provide biological insights about the process of prostate cancer development and how this process could be slowed.

Acetaminophen, commonly used as pain-reliever is relatively safe when used at recommended doses but can cause acute liver failure in an overdose.

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Pomegranate Extract Slows Down Prostate Cancer Progresssion

In a phase 2 double-blind study led by Michael A. Carducci, MD, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, researchers found that treatment with the pomegranate extract (POMx) was associated with a greater than six-month median increase in PSA doubling time (PSADT).  Previous research had shown that pomegranate extract, which is rich in antioxidants and vitamin C, has antitumor effects.

This study had an enrollment of 92 men who were randomized to receive a low or high dose of POMx.  None of the mens’ cancer had spread beyond the prostate at the beginning of this study.  The low-dose group took one POMx capsule (1 gram of extract) plus two placebo capsules), and the high-dose group took three POMx capsules (3 grams of extract).  Men were treated until they had disease progression or for 18 months.  PSA levels were measured every three months.

Carducci reported that the median PSADT increased from 11.9 months prior to treatment to 18.5 months after treatment at the Genitourinary Cancers Symposium.  PSADT did not differ significantly between the treatment arms.  In the low-dose arm, it increased from 11.9 to 18.8 months.  In the high-dose arm, it increased from 12.2 to 17.5 months.  Dr. Carducci’s group observed PSA declines in 13 patients during the study.  There were no significant changes in testosterone observed in either group.  There were no clinically significant toxicities, but eight patients experienced mild to moderate diarrhea.  He noted that one of the limitations of this study is the lack of a control arm with patients only taking a placebo.  Additional research is necessary because it remains unclear whether reducing the doubling time of the PSA levels in fact improved the prognosis of the patient.

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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.

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Progress in Prostate Cancer Detection with New Pro-PSA Test

For prostate cancer, the only current commercially available screening tests approved by FDA results in a high number of false positive results which leads to unnecessary biopsies, over detection and over treatment of indolent cancer. This is particularly true on the aggressive form of the cancer.

There is a new test that was recently approved for commercial use in Europe.  It is called Pro-PSA.  It measures a more specific PSA subform called -2 Pro-PSA.  It is even more accurate when the results are analyzed using a mathematical formula that provides an overall Prostate Health Index.  The formula divides the Pro-PSA number by the free-PSA. Then the quotient of the two is multiplied by the square root of the total PSA.

“The logic behind the formula is that the higher the Pro-PSA and total PSA and the lower the free-PSA, the more likely the patient has aggressive prostate cancer,” said lead investigator William Catalona, MD, Director of the Clinical Prostate Cancer program at Northwestern University in Chicago.

Dr. Catalona was the first to show, in 1991, that a simple blood test measuring PSA levels could be used to detect PCa.  In this current study, he and his colleagues followed 892 patients from 10 sites. The results, which was scheduled to be published in the May issue of the Journal of Urology, showed the new screening test was particularly useful for patients with a normal prostate exam whose PSA was in the 2-10 ng/mL range.

In their study, the researchers found that an increasing Prostate Health Index was associated with a 4.7-fold increased risk of prostate cancer and a 1.16-fold increased risk of Gleason 7 or greater disease on biopsy. Index results were not associated with age and prostate volume, Dr. Catalona said.

The FDA is currently reviewing the data from this current study.

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Delaying Prostate Cancer the Right Way

For the first time ever, researchers are conducting a study that focuses on changing a man’s entire lifestyle in order to delay the progression of prostate cancer.

The study uses dietary changes, exercise, and telephone counseling in order to stop or delay the progression of prostate cancer, announced UC San Diego Moores Cancer Center.

Male participants in the Men’s Eating and Living Study will eat at least seven servings of vegetables like kale and broccoli per day, along with tomato products, whole grains, beans, and fruit.

Scientists have known that a healthy diet rich in vegetables and low in meat and fat is associated with a reduced risk in prostate cancer.  Dr. J. Kellogg Parsons, a urologic oncologist at the Moores Cancer Center, said previous studies already have shown that such a diet may prevent the progression of prostate cancer, or even the development in the first place.

But, he says, “Ours is the first study to focus on changing the entire lifestyle rather than just giving the participants a supplement pill.”

“We focus on more vegetables, less meat, and comprehensive counseling which encourages a more active lifestyle.”

The study’s goals couldn’t come at a better time.  Nearly 100,000 American men are diagnosed annually with early-stage, low-risk prostate cancer.  And Dr. Kellogg believes too many of these men have overly aggressive treatment that reduces their quality of life.

Participants who qualify for the study are males up to 80 years old who have been diagnosed with non-aggressive prostate cancer within the last two years, are in the early stages, and have not yet received treatment of any kind.

The study’s researchers hope to show whether or not cancer can be controlled in its early stages without surgery or radiation.

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A Review on Diet and Prostate Cancer

After lung cancer, prostate cancer is the second leading cause of cancer deaths in men.  The older the men get, the higher the occurrence of the disease.

If you have prostate cancer or want to prevent prostate cancer there are numerous information that has looked at diet and prostate cancer.  Although some data are compelling, there is still so much to learn about diet and prostate cancer.

You might have already come across the tips below; it might not most likely reduce your risk to the disease but it should improve your health in general.

1. Maintain a diet rich in vegetables, fruits and whole grain.

Cruciferous vegetables such as broccoli, cabbage and cauliflower reduced the risk of prostate cancer by 41% according to a new study from the Fred Hutchinson Cancer Research Center in Seattle. These vegetables boast two phytochemicals which are thought to help deactivate cancer-causing substances. Lycopene present in tomatoes and other red fruits have been linked to lower risk of prostate cancer. A tablespoon of ground flaxseed a day contributes to 3 grams of fiber along with healthy omega-3 fatty acids, phytoestrogens and phytochemicals.

2. Stay away from red meat and refined/processed carbohydrates.

Eat fish a couple of times a week instead.  Fish have the so called long chain omega-3 which helps stop the development of cancer.  Saturated fats in animal meats and dairy products and processed foods that use hydrogenated fats/oils may help promote prostate cancer.

3. Engage in moderate intensity physically active at least 30 minutes a day.

You can also engage in vigorous-intensity physical activity at least 20 minutes on three or more days of the week. One recent study suggested that regular vigorous activity could slow the progression of prostate cancer in men age 65 or older

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Debunked Prostate Cancer Myths

“As prostate cancer is a major health issue, and not all prostate cancers are the same,” states Dr. Vorstman in his recent article dedicated to correcting patient misunderstandings about prostate cancer and treatment options, “it is vitally important that men and their spouses deal with factual information only.”  Dr. Vorstman is concerned about the emerging prostate cancer myths and is working to inform the public in hopes to shed light on the reality of the disorder.  He explains over 20 myths and the facts about the topics in his recently published article.

One myth has deterred men from seeking medical expertise in regards to their prostates:  If no urinary symptoms are present, then you do not have cancer.  Dr. Vorstman states that most men who are diagnosed with prostate cancer when it is early enough to be treatable actually have no urinary symptoms at all, nor do they  have problems that show up on their examination, but rather are diagnosed entirely through PSA abnormalities.

“This is one of the most damaging myths,” warns the doctor, “as it causes some men to skip the PSA test, and therefore fail to discover their cancer before it is too late for effective treatment.”

While this myth leads to inactivity, other myths over-emphasize PSA numbers.  The PSA test is simply an indication that prostate cancer may be present, but elevated PSA numbers combined with the percent of free PSA can point to the need for a prostate biopsy.  The biopsy is what determines whether or not the prostate contains cancer.  The PSA test itself is simply the first step in the diagnostic process.  This means that men with low PSA numbers can still have prostate cancer.  In fact, because of this, Dr. Vorstman recommends checking the percent free PSA and doing a digital rectal exam for all patients, regardless of their PSA number.

Yet another common myth comes with strong advertising.  This myth suggests that certain supplements will prevent prostate cancer.  Although no danger exists for taking vitamins and such supplements may promote overall health, science has not yet proved that supplements or other dietary changes actually lower a man’s risk for cancer.

Finally, Dr. Vorstman warns against myths surrounding prostate cancer treatment.  In the past, prostate cancer was often universally treated with surgery.  Many believe this is still the case today; however, according to Dr. Vorstman, “This is no longer true with the wide range of minimally invasive prostate cancer treatments on the market.  Today’s patient can protect his quality of life while successfully treating prostate cancer without surgery, so it is vital that he and his spouse look at all of the options.”

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