Dutasteride (Avodart according to GalxoSmithKline) is used to treat an enlarged prostate. It works by blocking the production of a natural substance that enlarges the prostate. This shrinks the prostate, relieves symptoms of BPH (benign prostatic hypertrophy), such as frequent and difficult urination, and decreases [...]]]> Source: New England Journal of Medicine; BBC Health

Dutasteride (Avodart according to GalxoSmithKline) is used to treat an enlarged prostate. It works by blocking the production of a natural substance that enlarges the prostate. This shrinks the prostate, relieves symptoms of BPH (benign prostatic hypertrophy), such as frequent and difficult urination, and decreases the chance that surgery will be needed to treat this condition.

Why am I telling you this? Have I suddenly started working for GlaxoSmithKline and wish to pitch their on-patent medications to stave off the competition from the generics?  No.  Not at all.  I’m telling you because the results of a 4 year study of some 6,500 men taking dutasteride showed a 23% lower risk of prostate cancer compared with those taking a placebo (a fake pill, typically made of sugar).

This isn’t the first study to initially show promise. In 2003, a study of men taking finasteride, a BPH drug now marketed as Propecia by Merk.  (Yes for hair loss), was said to also lower the risk of prostate cancer.  However, there were issues with the aggressive nature of the tumors found in that group.  Oh and both medications can cause sexual dysfunction and frequent and painful urination.

The Glaxo funded study (you had to know that) looked at men aged 50 to 75 years in the “high risk” for prostate cancer category given elevated PSA scores but without demonstrable cancer.  Among those with a family history of prostate cancer, those also taking dutasteride are reported to have cur their risk of developing cancer by 31.4%.  Why the disparate numbers?  It’s not clear.  And what about the tumors that did develop?  The researchers felt that those found during the trial were likely present to begin with but too small to be detectable.  According to them, this suggest that the drug shrinks early prostate tumours or keeps their growth at sub-detectable levels.  (The later of which doesn’t appear to be all that helpful).

The proponents of the study believe that the drug might offer thousands of men a simple way to reduce their risk of disease.  This would mean that more men with a high PSA could potentially avoid unnecessary or more involved treatment including surgery on the prostate, chemotherapy and radiation and all of the attendant side effects and symptoms which follow.

Others, like Dr. Helen Rippon of the Prostate Cancer Charity, aren’t so charitable.  (See what I did there?)  According to Dr. Rippon, “[W]e don’t yet know what will happen to these men in the coming years and whether they will still go on to develop the disease [Prostate Cancer] and it will be many years before we know if the drug [dutasteride] can provide any long-term benefit to men.”

~Posted by D.M. Schwadron, Esquire

192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  [...]]]> Source:  Annual Genitourinary Cancers Symposium; Medline

192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  To you or I 15.1 months to live vs. 12.7 may not seem like a lot but if you were dying and those were your options, wouldn’t you want more time?  It is thought that giving the combination of drugs early in the diagnostic stage might translate to even greater survival times.

To that end researchers are developing better diagnostic tools for Prostate Cancer.  Showing promise is the PCA3 urine test.  Apparently overly expressed in men with prostate cancer, gene 3 is a fair predictor for advanced prostate disease.   The current complaints against the standard PSA testing is the high rate of false positives resulting in biposy.

Finally, the tried and true cystoscopy procedure (Yes, the one where they insert a catheter with a small camera into the bladder. Over the river and through the woods…Well not quite.  Cystoscopy has been found to be remarkable cost-effective.  Accordingly, look for it to be featured more in insurance schemes and offered more by urologists.  Cynical? Perhaps.  But you’ll see.

~Posted by D.M. Schwadron, Esquire

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer [...]]]> Source: American Cancer Society

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.

There it is. No specific PSA recommendations, or even whether PSA testing should be considered mandatory.  So start “talking to your doctor” about screening.  Does this sound an awful lot like the burden of screening for Prostate Cancer is being placed back upon the patient? Yeah. It sounds that way to me too.

~Posted by D.M. Schwadron, Esquire

What do these three things have in common?  Well, men who are non-smokers and who eat more soy MAY have a lower risk of getting lung cancer than other men.  Okay, the non-smoking part may be an obvious one, but the soy?

Soybeans contain natural compounds called isoflavanones.  Isoflavanones mimic estrogen, [...]]]> Source: American Journal of Clinical Nutrition

What do these three things have in common?  Well, men who are non-smokers and who eat more soy MAY have a lower risk of getting lung cancer than other men.  Okay, the non-smoking part may be an obvious one, but the soy?

Soybeans contain natural compounds called isoflavanones.  Isoflavanones mimic estrogen, a hormone which women have in spades.  In contrast, men have high levels of testosterone.  Estrogen is associated with lower levels of breast cancer and prostate cancer, which makes intuitive sense. (Yes, men do get breast cancer. Women, however, do NOT get prostate cancer).

Enter researchers in Japan at the National Cancer Center in Tokyo who studied over 36,000 Japanese men between 45 to 75 years of age who were cancer free at the outset.  The group was compared with some 40,000 Japanese women.  Over the course of 11 years.

The results? 1 in 75 men (and 1 in 225 women) were diagnosed with lung cancer within 11 years.  (Men tend to get lung cancer at higher rates than women).  Of 13,000 men who never smoked, only 22 of them who ate very little soy were diagnosed with lung cancer.  Only 13 of them who ate a lot of soy (up to 162 grams per day) contracted lung cancer.

I was sold up until this point too, however, the authors of the study were very equivocal as to whether the intake of soy itself was the cause of the lower risk or whether non-smoking males adopted other healthier behaviors, such as exercise, which could explain the lower risk.

So what should one take away from such a study?  Well, there is a suggestion that eating more isoflavanones may be good for men.  In fact increased soy intake has already been demonstrated to lower risk of prostate cancer.  It follows that increased soy intake may also be beneficial for non-smoking males who wish to avoid lung cancer as well.  Again, just a suggestion.

~Posted by D.M. Schwadron, Esquire

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States.

The drops are driven largely by declines in rates of new cases and [...]]]> Source: U.S. Centers for Disease Control & Prevention

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States.

The drops are driven largely by declines in rates of new cases and rates of death for the three most common cancers in men (lung, prostate, and colorectal cancers) and for two of the three leading cancers in women (breast and colorectal cancer). New diagnoses for all types of cancer combined in the United States decreased, on average, almost 1 percent per year from 1999 to 2006. Cancer deaths decreased 1.6 percent per year from 2001 to 2006.

These findings are from a report authored by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). The report was published early online Dec. 7, 2009, in the journal Cancer.

Overall cancer rates continue to be higher for men than for women, but men experienced the greatest declines in incidence (new cases) and mortality (death) rates. For colorectal cancer, the third most frequently diagnosed cancer in both men and women, and the second leading cause of cancer deaths in the United States, overall rates are declining, but increasing incidence in men and women under 50 years of age is of concern.

With accelerated cancer control efforts to get more Americans to adopt more favorable health behaviors (such as quitting smoking) and higher use of screening (colonoscopy), as well as optimal treatment outcomes for colorectal cancer (read more effective chemotherapy), there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” said NCI Director John E. Niederhuber, M.D. “Yet we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

“The continued decline in incidence and death rates for all cancers combined is extremely encouraging, but progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of esophagus, liver and pancreas,” said Betsy Kohler, executive director of NAACCR.

Long-term incidence trends for colorectal cancer have been fairly consistent for men and women, with major declines from 1985 to1995, minor increases from 1995 to1998, and significant declines from 1998 to 2006.

“This report shows that we have begun to make progress reducing colorectal cancer. Yet, colorectal cancer still kills more people than any other cancer except lung cancer,” said CDC Director Thomas Frieden, M.D.

Let’s hope this trend continues downward on incidence and upward on survival.

~Posted by D.M. Schwadron, Esquire

A brief preface:  testing of drugs to see if they are effective in treating cancers is first done by researchers in laboratories on “cell-lines” grown in the laboratory.  However while scientists can duplicate cells they still need original cells from human patients to start with.

Following a review [...]]]> Sources:  Journal of the National Cancer Institute; BBC Health

A brief preface:  testing of drugs to see if they are effective in treating cancers is first done by researchers in laboratories on “cell-lines” grown in the laboratory.  However while scientists can duplicate cells they still need original cells from human patients to start with.

Following a review of such cell lines it was determined that cells thought to be representative for esophageal adenocarcinoma (a cancer of the esophagus) also contained tumor cells from the lung, bowel and stomach.  Cancer cells in different parts of the body act differently and also respond to drugs and treatment differently.

If enough of these cell lines are contaminated it could mean that the data from a number of studies upon potential new cancer drugs could be invalidated. How widespread is this problem?  more than 100 scientific publications, at least 3 U.S. research grants and 11 U.S. patents along with numerous clinical trials upon patients.

The result? More time to develop new (and needed) cancer drugs that may have shown promise in the laboratory.

~Posted by D.M. Schwadron, Esquire

After years of being viewed as a potential health problem, coffee is fighting back and this time it’s kicking your prostate in the…well…

So this must be why my urologist asked me how much coffee I drink this morning. (Yes I saw a urologist, more on that in [...]]]> Source: Wall Street Journal; National Institutes of Health (NIH)

After years of being viewed as a potential health problem, coffee is fighting back and this time it’s kicking your prostate in the…well…

So this must be why my urologist asked me how much coffee I drink this morning. (Yes I saw a urologist, more on that in the future).  There is new research funded by the NIH which suggests that men who drink 6 or more cups of coffee per day had a 60% lower chance of developing aggressive prostate cancer then their tea drinking girly counterparts. (Okay, I added that last bit).  Those drinking 4-5 cups of coffee per day had a 25% lower risk and those (Like me) with the 3 cup daily max had a 20% lower risk of developing aggressive prostate cancer.

Like the whole wine and cholesterol deal, expect the usual backlash and qualifiers but, if true then this might finally be the justification we all needed for those $3.00 Sbucks forays. You all know what I’m talking about.

~Posted by David Marc Schwadron, Esquire

The UK (that’s the United Kingdom or Great Britain for the slower ones) where, largely due to prior colonial influence, one can still get a really good curry take out has some interesting news.

An extract of tumeric (the yellow spice in curry) called curcumin has shown promise in killing of cancer cells. [...]]]> Source:  Cancer Research UK

The UK (that’s the United Kingdom or Great Britain for the slower ones) where, largely due to prior colonial influence, one can still get a really good curry take out has some interesting news.

An extract of tumeric (the yellow spice in curry) called curcumin has shown promise in killing of cancer cells. A research team from Cork (Google it) has found that within 24 hours curcumin began killing cells containing cancer.

This follows an earlier study (2006) by University of Arizona researchers which found that curcumin had an anti-inflammatory effect on osteoarthritis sufferers. Those researchers posited that tumeric compounds may have application to other inflammatory disorders including asthma, Multiple Sclerosis and in a moment of pure irony -IBS (Irritable Bowel Syndrome).

So can you get the same effect from your local curry house? Probably not at this point, but interesting stuff, notwithstanding, no?

~Posted by David Marc Schwadron, Esquire

A Newcastle Research Team (The University, not the beer) is testing the use of a common chemotheraphy drug TSA (Trichostatin A) to halt labor contractions. Sounds like a bad idea, I know, but keep an open mind.

One of the effects of TSA, besides killing cancer cells, is that it increases the levels of [...]]]> Source: BBC Health

A Newcastle Research Team (The University, not the beer) is testing the use of a common chemotheraphy drug TSA (Trichostatin A) to halt labor contractions. Sounds like a bad idea, I know, but keep an open mind.

One of the effects of TSA, besides killing cancer cells, is that it increases the levels of a protein PKA (Protein Kinase A) which is responsible for muscle relaxation.  Increased muscle relaxation…decreased contractions…right?  By how much though?  Researchers measured a 46% reduction in spontaneous contractions and a 54% reduction in contractions induced by oxytocin (a drug used to stimulate contractions).

Great, right? Well, not exactly.  According to one of the lead researchers, TSA can also kill up to 10% of the genes in a cell.  If you need to ask why that’s  a problem you probably should be reading an easier blog. Given the dangers to infants and mothers associated with premature labor, this is a start in the right direction and a trend to watch.

Posted by David Marc Schwadron, Esquire

A recent Swedish study (Yes, where the candy fish come from) comparing PSA (Prostate Specific Antigent) Test results of 540 men before they were eventually diagnosed with prostate cancer and 1,000 healthy men failed to determine the point where a PSA Test was a diagnostic predictor of prostate cancer.

What [...]]]> Source: BBC Health; British Medical Journal

A recent Swedish study (Yes, where the candy fish come from) comparing PSA (Prostate Specific Antigent) Test results of 540 men before they were eventually diagnosed with prostate cancer and 1,000 healthy men failed to determine the point where a PSA Test was a diagnostic predictor of prostate cancer.

What does that mean?  Okay.  Very low concentrations of PSA (less than 1 ng.ml) basically ruled out a future diagnosis of prostate cancer.  The problem lies in setting the upper ranges. Currently those men with a PSA of 3 ng/ml who are aged 50-59 are candidates for urological follow up.  Men 60 and over with a PSA of 5 ng/ml are also.  But beyond that there is still not enough information.  A viable concern is that over-diagnosis might lead to over-treatment with the attendant side effects of impotence and incontinence.  (Aren’t you glad you don’t have a prostate ladies?)

Prostate cancer has risen to the 2nd most common cause of cancer related deaths in the UK. Rates are somewhat lower in the US with an average mortality age of 80.  Prostate cancer is typically “survivable” if diagnosed and treated early.  Oddly the UK approach of less PSA Testing seems to be the opposite of that in the States.  Time will truly tell on this one.

Posted by David Marc Schwadron, Esquire