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Senior Citizen Health & Medicine
Prostate Cancer Studies Find Benefit to Radiation,
No Harm in Testosterone Replacement in Older Men
November 14, 2006 With 230,000 men, primarily
senior citizens, diagnosed with prostate cancer every year, it is not
surprising that in the current issue of the Journal of the American
Medical Association focusing on men's health, there are two articles on
treatment of this cancer. One reports on a study finding radiation
therapy after surgery reduces the risk of recurrence, but does not
lengthen survival. The other finds testosterone replacement therapy,
used frequently in senior citizens, appears to have little effect on the
prostate gland, contrary to reports that it may be harmful.
Reviews of both studies are below.
Adding Radiation Therapy for Treatment of
Advanced Prostate Cancer May Offer Benefit
Treating advanced prostate cancer with radiation
therapy after removal of the prostate gland reduces the risk of disease
recurrence, but does not appear to significantly improve the length of
survival, according to this study in the November 15 issue of JAMA.
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Related Stories |
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Prostate Cancer Cells Killed by Protein Made by the
Cancer
Senior citizens with cancer or enlarged prostate
may be helped by discovery
November 10, 2006 Prostate cancer is high on the
radar for most older men, since it strikes about 680,000 in the world
every year and more than 220,000 die. Encouraging news, however, was
reported today that scientists have found a way of using a protein made
by prostate cancer to target and kill the cancer cells themselves.
Read more...
Researchers Urge New Approach to Prostate Cancer
Screening with Early PSA Base
Even a slight change
in PSA may indicate a potential for cancer
November 1, 2006 Even a slight change in PSA
(prostate-specific antigen) may indicate a potential for cancer, say
researchers, who recommend that men as young as 40 establish a baseline
PSA. The researchers at the Johns Hopkins University School of Medicine
say that how fast the amount of PSA in a mans blood increases, or PSA
velocity (PSAV), is an accurate gauge of tumor aggression and danger,
even when PSA levels are so low as to not warrant a biopsy.
Read more...
Prostate Cancer Appears Cured in 89 Percent of Men
Treated with IMRT
After eight years
they are alive and show no signs of cancer
September 27, 2006 - The vast majority of prostate
cancer victims 89 percent - treated with high-dose, intensity
modulated radiation therapy (IMRT) are alive and show no evidence of the
cancer eight years after the treatment. This is the encouraging report
on the largest study ever of men with prostate cancer treated by IMRT.
The 561 patients, primarily senior citizens with an average age of 68,
were treated at Memorial Sloan-Kettering Cancer Center.
Read
more...
PSA of Prostate Cancer Victims Can Predict How Long
They Will Survive
Patients with lower PSA levels 7 months after
therapy lived longer
By Nicole Fawcett, University of Michigan Health System
August 25, 2006 - A test used to detect prostate
cancer can also help doctors know when treatment is working. A mans
prostate specific antigen, or PSA, level after seven months of hormone
therapy for advanced prostate cancer predicted how long he would
survive, according to a new multicenter study conducted by the Southwest
Oncology Group and led by researchers at the University of Michigan
Comprehensive Cancer Center.
Read more...
Large Study Finds Some Prostate Cancer Patients
Possibly Overtreated
Risks and benefits of immediate treatment not
always well-defined for less aggressive cancers
By Nicole Fawcett
University of Michigan Health System
August 15, 2006 - More than half of men with
lower-risk prostate cancer received surgery or radiation treatment when
a wait-and-see approach of no therapy and active surveillance would have
been a reasonable option, according to a new study from the University
of Michigan Comprehensive Cancer Center.
Read more...
Prostate Cancer Cells Killed by RNA-Based Drug
Duke University files for patent on experimental technology
August 10, 2006 - Acting as a genetic Trojan horse,
an experimental RNA-based drug -- the first of its kind -- tricks its
way into prostate cancer cells and then springs into action to destroy
them, while leaving normal cells unharmed. Prostate cancer is most
common in older men, with 70 being the average age of diagnosis.
Read more...
Read more
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Health & Medicine |
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Gregory Swanson, M.D., of the University of Texas
Health Science Center, San Antonio, presented the findings of the study
today at a JAMA media briefing on mens health in New York.
Radical prostatectomy (removal of the prostate
gland) is selected for treatment of localized prostate cancer by
approximately one-third of the 230,000 patients newly diagnosed each
year in the United States.
It is commonly accepted that this treatment has
optimal results in patients with cancer confined to the prostate. But
cancer outside of the prostate is detected at radical prostatectomy in
38 percent to 52 percent of patients, and this is associated with a risk
of disease recurrence, progression, and death, according to background
information in the article.
Adding (adjuvant) radiation therapy to treatment
has been used for more than 4 decades to reduce the risk of disease
recurrence, but it is unknown if this reduces the risk of the cancer
spreading or improves survival.
Dr. Swanson and colleagues conducted a study
comparing usual care with adjuvant radiation therapy for 425 men with
cancer outside of the prostate after radical prostatectomy to determine
the effect on metastasis-free survival and overall survival.
The patients were enrolled between August 1988 and
January 1997, with median (midpoint) follow-up of 10.6 years. Men were
randomly assigned to receive external beam radiotherapy (214) or usual
care plus observation (211).
A total of 43.1 percent of the patients in the
observation group were diagnosed with metastatic disease or died (median
metastasis-free estimate, 13.2 years) vs. 35.5 percent of the patients
in the adjuvant radiotherapy group (median metastasis-free estimate,
14.7 years), a difference that was not statistically significant.
There were no significant between-group differences
for overall survival (71 deaths in the radiotherapy group vs. 83 deaths
in the observation group).
The researchers did find that patients in the
adjuvant radiotherapy group had a 57 percent lower risk of PSA relapse,
and a 38 percent reduced risk of disease recurrence, compared to
patients in the observation group.
Adverse effects were more common with radiotherapy
vs. observation (23.8 percent vs. 11.9 percent), including rectal
complications and urinary incontinence.
The results of this study provide guidance for
clinicians and patients in weighing options for adjuvant radiotherapy
for pathologically advanced disease. Arguments in favor of radiation
include the approximately 50 percent reduction in risk of PSA relapse or
disease recurrence, and perhaps the nonsignificant reduction in risk of
metastasis-free survival, the primary study end point, the authors
write.
Arguments against adjuvant radiotherapy must
include that the study had negative findings, ie., a significant
reduction in metastatic disease was not demonstrated. Despite prolonged
follow-up of these patients, the rate of metastatic disease was
significantly less than anticipated.
Editor's Note: This study was supported in part by
Public Health Service Cooperative Agreement grants awarded by the
National Cancer Institute, Department of Health and Human Services, and
by a National Cancer Institute of Canada grant.
Testosterone Replacement Therapy Appears Safe for
Prostate
Preliminary research suggests that testosterone
replacement therapy for men with low testosterone levels appears to have
little effect on the prostate gland, contrary to some reports that this
therapy may be harmful, according to this study in the November 15 issue
of JAMA.
Leonard S. Marks, M.D., of the Urological Sciences
Research Foundation and University of California, Los Angeles, presented
the findings of the study today at a JAMA media briefing on mens health
in New York.
Testosterone replacement therapy (TRT) in aging men
is a widespread, growing practice.
According to pharmaceutical industry estimates,
more than 1.8 million prescriptions for testosterone products were
written in the United States in 2002, a 30 percent increase over the
previous year and a 170 percent increase over the previous 5 years.
In 2005, a total of 2.3 million prescriptions were
written for these products. Serum levels of testosterone decline with
age, and many aging men with low levels of the hormone may experience
depression, sexual dysfunction, diminished lean body mass, muscle volume
and strength, and reduced bone mineral density, according to background
information in the article.
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Low Testosterone after Age 40 Increases Death Risk
for Men by 88 Percent
Testosterone level declines
with age - about 1.5% yearly after 30
August 14, 2006 - Men who have a low testosterone
level after age 40 may have a higher risk of death over a four-year
period than those with normal levels of the hormone, according to a
report in the August 14/28 issue of the Archives of Internal Medicine,
one of the JAMA/Archives journals.
Read more...
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Such changes, in association with low testosterone
levels, have been called male menopause.
Aspects of the syndrome may be improved with TRT,
and most testosterone prescriptions are currently written for men older
than 45 years, a demographic in which prostate disease is most common.
Between 2 and 4 million men, nearly all in this prostatic age group,
may be candidates for treatment, the authors write. In men with advanced
prostate cancer, testosterone administration often worsens the disease.
Thus, when aging men receive supplemental
testosterone, a primary concern is prostate safety. Even in men with no
sign of prostate cancer, the possibility of stimulating growth in
subclinical disease exists. Instances of prostate cancer in men
receiving testosterone supplementation have been reported.
When TRT is prescribed, careful monitoring for
prostate disease is considered mandatory. But there is little
information regarding the effects of TRT on prostate tissue in men.
Dr. Marks and colleagues conducted a randomized
controlled trial to assess the effects of TRT on prostate tissue of 44
men, age 44 to 78 years, with low serum testosterone levels. The study
was conducted between February 2003 and November 2004. Participants were
randomly assigned to receive by injection 150 mg of replacement
testosterone or matching placebo every 2 weeks for 6 months. Of the 44
men randomized, 40 had prostate biopsies performed both at baseline and
at the end of the study and were included in the final analysis (TRT, n
= 21; placebo, n = 19).
Testosterone replacement therapy increased serum
testosterone levels to the mid-normal range with no significant change
in serum testosterone levels in matched, placebo-treated men. In
prostate tissue, TRT increased median (midpoint) androgen (male sex
hormone) concentrations only slightly compared with baseline levels or
between the 2 groups.
No treatment-related change was observed in
prostate histology, tissue biomarkers, gene expression, or cancer
incidence or severity. Treatment-related changes in prostate volume,
serum prostate-specific antigen, voiding symptoms, and urinary flow were
slight.
under the conditions herein, including the
biopsy to detect cancer performed pretreatment, a degree of prostate
safety is defined for men undergoing TRT, the authors write. The
prostate risks to men undergoing TRT may not be as great as once
believed, especially if the results of the pretreatment biopsy are
negative. However, establishment of prostate safety for large
populations of older men undergoing longer duration of TRT requires
further study, the researchers conclude.
Editor's Note: This study was supported by
unrestricted educational grants from Watson Laboratories (Salt Lake
City) and Solvay Pharmaceuticals (Marietta, Ga.); a National Institutes
of Health/National Cancer Institute Spore grant (Drs. Epstein, Veltri,
Makarov, and Partin); a National Institutes of Health grant (Dr. Hess);
the Prostate Cancer Foundation (Dr. Nelson); a National Institutes of
Health/National Cancer Institute Spore grant; and a National Institutes
of Health grant (Drs. Mostaghel and Nelson).
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