Observation Is Safe, Cost-Saving In Low-Risk Prostate Cancer

Study suggests low-risk patients can forego immediate treatment

EMBARGOED FOR RELEASE: Monday, June 17, 2013, 5 p.m. ET
Contacts: Teresa Herbert or Richard Saltus, 617-632-4090 or teresa_herbert@dfci.harvard.edu

BOSTON – 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 recurrence.) The researchers also estimated the lifetime costs of each strategy, which ranged from $18,302 for watchful waiting for men aged 75 to $48,699 for a 65-year-old patient treated with IMRT therapy.

The bottom line result was that observation was more effective and, in some cases, less costly than initial treatment for low-risk prostate cancers. Watchful waiting yielded two additional months of QALE (9.02 vs. 8.85 years) over active surveillance and saved an average of $15,374 for men aged 65 and saved $11,746 in men aged 75 years.

Hayes acknowledged that the study made assumptions based on limited research data on these issues. Nevertheless, “it appears that active surveillance and watchful waiting are safe alternatives to initial treatment for prostate cancer based on these assumptions. But it’s important to emphasize that these decisions are very much a matter of individual choice.”

Study co-author Philip Kantoff, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber and a professor of medicine at Harvard Medical School, commented: “This study delineates the cost benefit of active surveillance as well as watchful waiting – the less aggressive assessment strategy.

“A previous study by Dr. Hayes and colleagues demonstrated that active surveillance is a reasonable option for men with low-risk disease and associated with a better quality of life,” Kantoff added. “As non-treatment becomes a more accepted option for these patients, selecting those who require less aggressive assessment including biopsy will become important.”

The study’s senior author is Pamela McMahon, PhD, at MGH’s Institute for Technology Assessment. Others include Daniel Ollendorf, MPH, and Steven Pearson, MD, MSc, of the Institute for Clinical and Economic Review; Michael Barry, MD, of MGH; and Pablo Lee, BS, of MGH’s Institute for Technology Assessment.

The research was supported by National Cancer Institute grant CA92203-08, Department of Defense grant W81XWH-09-0512, and a grant from the Prostate Cancer Foundation.

–Written by Richard Saltus, Dana-Farber Cancer Institute

About Dana-Farber Cancer Institute

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center, designated a comprehensive cancer center by the National Cancer Institute. It provides adult cancer care with Brigham and Women’s Hospital as Dana-Farber/Brigham and Women’s Cancer Center and it provides pediatric care with Boston Children’s Hospital as Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Dana-Farber is the top ranked cancer center in New England, according to U.S. News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding. Follow Dana-Farber on Facebook: www.facebook.com/danafarbercancerinstitute and on Twitter: @danafarber.

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NASHVILLE, TN USA (Press Release) – January 30, 2012 – The size of a man’s prostate gland may help predict the severity of cancer, with a smaller prostate being more likely to harbor serious disease.
This finding by a group of Vanderbilt-Ingram Cancer Center researchers was published in the December issue of the Journal of Urology. Fourth-year medical resident Judson Davies, M.D., was first author on the paper.

The VICC cancer investigators reviewed 1,251 cases of prostate cancer among men who had their prostates surgically removed between January 2000 and June 2008. The patients were considered to have low-risk disease because their prostates were producing low levels of prostate specific antigen (PSA) and they had a Gleason score of six or less. The Gleason score is a measure of the grade or severity of cancer found during initial biopsies.

The researchers looked at cases of only low-risk patients who might be candidates for less aggressive treatment, including observation – sometimes called “active surveillance.” These options are considered safe for some patients because prostate cancer often grows so slowly that it may never pose a threat to the patient’s life.

The VICC investigators found that in 31 percent of the cases, when pathologists examined tissue removed after surgery, the severity of the cancer was upgraded from the pre-surgery analysis and men with smaller prostates were more likely to have their cancer upgraded after surgery.

“Our field suffers from this great confusion because in half of men you can find prostate cancer in microscopic amounts that may not be clinically significant and yet it’s the second leading cause of cancer death among men,” explained Daniel Barocas, M.D., MPH, assistant professor of Urologic Surgery and senior author on the study. “The more you look for it, the more you find it but that doesn’t help us figure out who needs treatment and who doesn’t.”

Cancer investigators are trying to ascertain additional clues that will help physicians counsel patients about whether it is safe to choose less aggressive treatment instead of removing the prostate gland or treating it with radiation. In earlier research, Barocas and his colleagues found hints that prostate size might provide additional prognostic information.

“There’s nothing about size that would necessarily predict a bad outcome. What it’s really about is the ratio of PSA to size, or PSA density, meaning that a small prostate that is making a lot of PSA is likely to be due to a bad tumor, whereas a large prostate making a lot of PSA is likely to be due to benign enlargement of the prostate (BPH),” said Barocas.

Barocas said the new findings provide one more piece of evidence for physicians to consider when talking with their patients. Based on these new findings, in a low-risk patient he would be more likely to recommend aggressive treatment if the prostate is very small because there may be a greater chance of high-grade disease.

But prostate size still isn’t a definitive clue and more precise tests are needed.

“The imaging for prostate cancer is relatively weak because the disease tends to be diffuse, rather than growing in what we think of as a tumor – a spherical nodule. Prostate cancer tends to grow along the glands in a sort of flat pattern, so it’s a little harder to detect. A better test, which we don’t yet have, would reliably image or identify where in the prostate the tumor lies,” said Barocas.

What will be necessary is larger scale investment in prospective research to identify better biomarkers and imaging techniques to determine which cancers are truly threatening to patients.

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BIDMC study identifies key risk factors for prostate patients who need treatment

By Michael Lasalandra, Beth Israel Deaconess Medical Center Correspondent

More and more, men diagnosed with low grade prostate cancer are choosing to defer treatment, preferring to monitor the status of their cancer by having regular blood tests and tissue biopsies that are designed to let them know if they need to be treated or if they can continue to hold off.

The practice is called “active surveillance.” The problem is that the tests are not definitive. Sometimes, a cancer can be growing or turning more aggressive but the testing may not show it.

Now, a study done by doctors at Beth Israel Deaconess Medical Center has shed more light on which of these cancers are more likely to progress. The findings could help men in making the decision to watch and wait or go ahead with surgery or radiation treatment.

“This is going to be very helpful for patients in choosing active surveillance,” said Dr. William C. DeWolf, senior author and Chief of the Division of Urological Surgery at BIDMC.

“Active surveillance is the most up and coming strategy available to patients who are realizing they can have prostate cancer and not necessarily have it treated if their tumor is low grade,” he added. “We’re trying to save quality of life. But in order to do that, we have to know how to predict if you are a good candidate or not. When you have cancer you want to know your odds. Does it have to be treated or can it be left alone?”

In the study of 135 men who were followed for as long as ten years, tests showed the cancer was progressing in just 30 percent. The other 70 percent of subjects showed no progression and were allowed to continue in the study.

Risk factors for those who saw their cancer progress were those with a family history with prostate cancer or those with a PSA density of greater than .08 ng/ml/cc of blood.

The PSA test is a blood test that measure levels of a protein linked to prostate cancer. A high PSA level is usually the first indication that there may be a problem.

PSA density measures the level of the protein in relation to the size of the prostate itself. It is derived by dividing the PSA number by the gland volume in cubic centimeters (ccs).

DeWolf said those with a family history and a PSA density greater than .08 have a 50 percent chance of seeing their cancer progress within two years. Those with no family history and a PSA density of less than .08 have a 30 percent chance of progressing within eight years, he said.

In addition, another factor that plays a role in the predictive process is PSA velocity, or how fast PSA levels increase. If a man’s PSA score doesn’t increase between trhe first and second biopsies more than .1 – for example from 6 to 6.1 ng/mL of blood – and this factor is added to that of family history and PSA density, the odds of his cancer progressing are about 15 percent over eight years, DeWolf said.

“We are using this information to personalize therapeutic decisions as best we can,” said Dr. Glenn Bubley, director of Genitourinary Oncology at BIDMC and a co-author of the study that appeared in the Journal of Urology this past February. “We can give the patient some sense of what his risk of progression might be.”

Many men with prostate cancer don’t want to be treated if they don’t have to because the treatments carry a high risk of impotence or incontinence.

The men who were enrolled in the study were all considered to have low-grade cancer — based on their initial biopsy results. They had to have cancer in fewer than three of the tissue cores taken, no more than 50 percent cancer involvement of each of the positive cores and the grade of the cancer had to be less than 6 on what is known as the Gleason scale, which measures aggressiveness.

All patients were monitored with 20-core biopsies every 12 to 18 months. A total of 21 patients — 17 percent of those who progressed during the study — had shown cancer progression at the time of their first re-biopsy, according to Dr. DeWolf.

“The purpose of this paper was to devise a statistical system so we could tell people what the odds are that they will progress,” Dr. DeWolf said. “We found as they entered the study if they did not have a family history and had a PSA density of less than .08, the odds of progressing would be around 30 percent. This helps people understand whether it is worthwhile to not get treated and just go on active surveillance verses getting treated.”

Co-author Dr. Marc Garnick, an oncologist specializing in prostate cancer at BIDMC and editor of the Harvard Medical School Annual Report of Prostate Diseases, said most men can go a long time without treatment.

“The bottom line is that two-thirds of men who have prostate cancer with certain characteristics can go long periods without being treated or they may never need to be treated,” Dr. Garnick said. “I’ve had a patient on active surveillance for 16 years.”

Besides this study, which is continuing, BIDMC is participating in a national trial of active surveillance known as the Prostate Cancer Active Surveillance Study (PASS). Dr. Martin Sanda of BIDMC is enrolling patients in this study, which is designed to identify and validate biomarkers — proteins, DNA, RNA, hormones — that predict aggressive prostate cancer.

BIDMC already has the largest single instuitition active surveillance study cohort in New England with 150 patients currently enrolled.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

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Study Supports ‘Active Surveillance’ for Low-Risk Prostate Cancer

BOSTON—Retirement-age men with slow-growing prostate cancer may wish to consider monitoring their disease rather than being treated immediately, according to a new study led by investigators at Dana-Farber Cancer Institute and Massachusetts General Hospital (MGH).

The study results, to be published in the Dec. 1 issue of the Journal of the American Medical Association, provide information to the thousands of American men in the 65-year-old age range who each year face the decision of how to deal with newly diagnosed prostate cancer when the cancer has characteristics that suggest a very low risk of spreading beyond the prostate. Because there is limited information comparing outcomes of treatment options for low risk disease, investigators developed a computer model simulating hypothetical patients whose quality of life and response to treatment were based on reports in medical literature.

“The analysis demonstrates that for this group of prostate cancer patients, a course of ‘active surveillance’ in which patients receive a blood test (PSA) every three to six months, a physical exam every six months, and periodic re-biopsies of their tumor tissue is a reasonable alternative to immediate treatment in terms of quality of life,” says study lead author Julia Hayes, MD, of
Dana-Farber and the MGH Institute for Technology Assessment. If surveillance reveals that the cancer has become more of a threat, it can then be treated.

Every year, about 200,000 men are diagnosed with prostate cancer in the United States, 90 percent of whom receive immediate treatment, which can include surgery, hormonal treatment, or radiation therapy. However, in more than 70 percent of men with prostate cancer, the disease is low-risk, meaning it is unlikely to become life-threatening, and may not require immediate treatment.

“In recent years, active surveillance has emerged as an alternative to initial treatment for men with this type of prostate cancer,” Hayes says. “But, while clinical studies are under way comparing active surveillance to front-line treatment, it will be years before they yield definitive results. The computer model we created allows us to anticipate those studies’ findings, and provides information to help men and their physicians negotiate this difficult decision.”

“Our analysis showed that 65-year-old men with low-risk, localized prostate cancer who chose active surveillance had a higher quality of life than those who received surgery or radiation right away, in part because they were able to avoid or delay adverse effects of treatment” she states.

Patients approach the decision with different sets of preferences: some may be anxious about leaving the disease untreated; others may be more concerned about the potential side effects of treatment, which can include urinary incontinence, erectile dysfunction, and bowel disturbances. When these patient preferences were changed in the model, the results of the model changed, in some cases favoring initial treatment. Therefore, the authors urge patients to discuss these issues with their families and doctors in order to choose the approach that best reflects their own preferences and values.

In the study, researchers used a measure called Quality-Adjusted Life Expectancy (QALE) to compare active surveillance to initial treatment. “QALE takes into account both the quality and length of each patient’s life,” explains the study’s senior author, Pamela McMahon, PhD, of the Institute for Technology Assessment at MGH. “It weighs the benefits and side effects of treatment, as well as how men feel about being treated or not being treated. It’s an attempt to capture the physical and psychological aspects of disease and its treatment as thoroughly as possible.”

One of the main surprises of the study was that active surveillance held its edge over immediate treatment from a quality-of-life standpoint even when researchers entered data into their computer model that exaggerated any negative health effects of active surveillance, Hayes says.

“Thousands of men each year face the decision of whether to be treated immediately for low-risk prostate cancer or use active surveillance,” McMahon says. “Our study offers them evidence that can be a useful starting point for discussions with their families and doctors.”

The study was conducted as part of a series of comprehensive analyses of the comparative effectiveness of active surveillance versus treatment for men with low-risk prostate cancer conducted by the Institute for Clinical and Economic Review (ICER), based at MGH’s Institute for Technology Assessment. ICER has also produced a website for low-risk prostate cancer patients based on these analyses to aid patients in their decision-making.

The study was funded in part by grants from the National Cancer Institute, the U.S. Department of Defense, and the Prostate Cancer Foundation, and by funding from the Blue Shield of California Foundation.

Co-authors of the study are: Philip Kantoff, MD, and Christopher Sweeney, Dana-Farber; Daniel Ollendorf, MPH and Steven Pearson, MD, of ICER; Michael Barry, MD, and James Stahl, MD, of MGH; Susan Stewart, PhD, Harvard University Interfaculty Program for Health Systems Improvement and the National Bureau of Economic Research; and Vibha Bhatnager, MD, University of California San Diego.

Dana-Farber Cancer Institute (www.dana-farber.org)is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute. It provides adult cancer care with Brigham and Women’s Hospital as Dana-Farber/Brigham and Women’s Cancer Center and it provides pediatric care with Children’s Hospital Boston as Dana-Farber/Children’s Hospital Cancer Center. Dana-Farber is the top ranked cancer center in New England, according to U.S. News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding.

About the MGH Institute for Technology Assessment

The mission of the Institute for Technology Assessment (ITA) is to conduct health outcomes research to guide the development, evaluation and utilization of medical technologies that improve the quality and cost-effectiveness of medical care. Institute faculty have training and expertise in biostatistics, epidemiology, economics, decision science, outcomes analysis, health care policy and regulatory law. Research activities emphasize the evaluation of non-drug technologies, including devices, diagnostics, and procedures. A unique focus is on the evaluation of technologies during the early stages of development, from discovery to preliminary clinical testing, when extensive data regarding clinical effectiveness may not yet be available. In these instances, computer models are utilized in order to simulate expected outcomes (using the methods of decision analysis), and thereby predict costs, effectiveness, and overall impact on the healthcare system. For more information, please visit www.mgh-ita.org.

About the Institute for Clinical and Economic Review

The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all. For more information, please visit www.icer-review.org.

Active Surveillance for Prostate Cancer: Patient Selection and Management

“Screening for prostate cancer using prostate-specific antigen (psa) has been appealing. However, the significant associated decline in prostate cancer mortality comes at the cost of a very high rate of diagnosis, and many patients with indolent, non-life-threatening cancer are exposed to the risk of significant side effects from radical treatment.” Read More

Another Study Validates Watchful Waiting

Many of the arguments against Active Surveillance (watchful waiting) seem to be based on the fear of losing a window of effective treatment– to the effect that there simply is too much risk of developing aggressive and lethal cancer if one does not get treated soon after diagnosis. Hopefully those offering anecdotes of cases where prostate cancer quickly turned lethal realize that none of these where the diagnosis was not low risk cancer–Gleason sum greater than 7, PSA greater than 10, more than 50% of cores positive, PSA density greater than 0.15– were ever candidates for AS in the first place. Hopefully discussions of the pros and cons of AS start with acknowledgement that the classic D’Amico risk classifications- Low, Intermediate, and High Risk- are accepted by virtually all prostate cancer doctors, irrespective of treatment biases, as staging tools for selecting treatment options. Not perfect, but as yet none of our prostate cancer tools, including all treatment options, are ‘perfect.

The number of studies continue to increase showing that, FOR APPROPRIATELY SELECTED LOW-RISK CANCERS, deferring treatment until the monitoring shows treatment is appropriate does not increase the risk of aggressive cancer, nor of increased risk of mortality from prostate cancer. And, the increasing number of well-monitored Active Surveillance programs HAVE developed criteria to assess when it is time to get treated.

The abstract below on the experiences at UCSF show similar outcomes to AS programs at Sunnybrook (Toronto), Johns Hopkins, and Royal Marsden (London), among others.

—————————————–

Surgical management after active surveillance for low-risk prostate cancer: Pathological outcomes compared with men undergoing immediate treatment – Abstract
BJU Int. 2010 Aug 26. [Epub ahead of print]
Dall’era MA, Cowan JE, Simko J, Shinohara K, Davies B, Konety BR, Meng MV, Perez N, Greene K, Carroll PR
Department of Urology, University of California, Davis, CA, USA.

To compare the pathological outcomes of men undergoing radical prostatectomy (RP) after a period of active surveillance (AS) with those of a similar risk group undergoing immediate surgery.

We identified men through our institutional database who underwent RP within 6 months of diagnosis or after a period of AS. The primary outcome of the present study was Gleason upgrade to >/=7 after prostatectomy. Pathological stage and positive surgical margin rate were assessed as secondary outcomes. Binomial logistic regression models were used to determine associations of treatment subgroups with pathological upgrade, upstage and positive margins.

Thirty-three men with initially low-risk cancer features underwent RP after a median (range) of 18 (7-76) months of AS. A total of 278 men with low-risk disease features underwent immediate RP within 6 months of diagnosis. Rates of Gleason upgrading to >/=7, pathological category pT3 and positive surgical margins did not differ significantly from the immediate RP group. On multivariate analysis of low-risk patients, adjusting for baseline pathological features, treatment group (AS followed by prostatectomy vs immediate prostatectomy) was not associated with Gleason upgrading (odds ratio, OR, 0.35; 95% CI, 0.12-1.04), non-organ-confined disease (OR, 1.67; 95% CI, 0.32-8.65) or positive surgical margins at prostatectomy (OR, 0.95; 95% CI, 0.16-5.76).

The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.

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Eggs, Poultry With Skin Raise Risk of Prostate Cancer Progression

An interesting study was published in March of this year that adds to our understanding of factors that affect prostate cancer recurrence and progression. Conducted by Erin Richman and colleagues at Harvard, it was published in the American Journal of Clinical Nutrition. These same Harvard researchers have given us other useful information in past years. This current paper by Richman was a prospective trial in which consumption of processed and unprocessed red meat, fish, poultry, and eggs was examined to see if eating any of these foods affected the risk of prostate cancer recurrence or progression.

Reference: Richman EL, Stampfer MJ, Paciorek A, Broering JM, Carroll PR, Chan JM. Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression. Am J Clin Nutr. 2010 Mar;91(3):712-21.

Data was collected from 1,294 men, already diagnosed with prostate cancer and participating in the Cancer of the Prostate Strategic Urologic Research Endeavor, who had not had recurrence or progression as of 2004-2005. These men were followed for an average of 2 years.

During the two years of the study, 127 events were observed. Events were defined as prostate cancer death, metastases, elevated prostate-specific antigen or secondary treatment.

The most important finding was that greater consumption of eggs or poultry with skin on it was associated with 2-fold increases in risk when a comparison was made between those who ate the most with the least of either eggs or chicken with skin. Men with higher prognostic risk at diagnosis, that is had a higher Gleason score, and a high poultry intake, had a 4-fold increased risk of recurrence or progression compared with men with low/intermediate prognostic risk and a low poultry intake (P for interaction = 0.003). This study did not find a connection between eating processed or unprocessed red meat, fish, or skinless poultry after prostate cancer diagnosis with prostate cancer recurrence or progression.

These data may, at least for the time being, change what we tell men with prostate cancer. I write, “for the time being” as these kinds of studies are famous for “changing their minds” as new data accumulate.

[My esteemed colleague, Steve Austin’s response after reading these findings was, “I’ve grown leery over the years in putting too much stock in observational reports. Often the findings fall apart when intervention trials are run.” Yet he wisely adds, “However, when it comes to stuff like this, a prospective observation is probably the best we’ll ever do.”

Of the approximately 192,280 cases of prostate cancer diagnosed in 2009, over 90%, are still in the localized or regional stages for which 5-year survival is almost 100%. In cases of distant metastases, 5-year survival drops to only 32%.

Identifying factors, which patients can change, that may affect progression of prostate cancer for the better is important. Certain foods are associated with increasing or decreasing risk of getting prostate cancer. Researchers in the past have suggested that a, “diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC”.

These studies generally assume that the same factors that increase the risk of getting prostate cancer in the first place, will affect existing cancer similarly. The truth is that we know a lot less about dietary factors that may affect recurrence and progression.

A 2006 study reported that eating a lot of fish or tomato sauce after diagnosis decreased the risks of recurrence and progression: “Men in the highest versus lowest quartile of post-diagnostic fish consumption had a multivariate hazard ratio (HR) of progression of 0.73 – the comparable HR for tomato sauce was 0.56”. In other words, the guys who ate the most fish had a 27% lower risk while those who ate the most tomato sauce had a 44% lower risk of recurrence or progression.

The Richman et al., the authors of the current study, had expected that eating processed meat or red meat, because of their high saturated fat content, would increase risk of progression. They also assumed that poultry and eggs, because they contained lower levels of saturated fat and because they contained more omega-3 fats, would lower risk. They were wrong on all counts.

They found, “no evidence of an association between processed red meat, unprocessed red meat, or fish with prostate cancer progression.” They did find “an increased risk of prostate cancer progression associated with higher poultry intake that was not statistically significant.” There was a, “significant 2-fold increased risk of prostate cancer progression among men in the highest quartile of egg intake compared with the lowest quartile.” Translated that means that those eating an average of five and a half eggs a week were twice as likely to have their cancer return or progress compared to the guys that ate less than a single egg in a two-week period.

It was when the poultry data was broken down to compare the data from men who ate their birds skinless with men who preferred their birds with skin attached, that striking results occurred. Eating skinless poultry did not increase risk of cancer recurrence or progression, but eating poultry with skin, more than doubled the risk.

How much of this should we believe? Admittedly this study wasn’t perfect; the short follow-up time produced a relatively small number of cases of recurrence or progression from which to analyze and compare data. Information on what the men ate before they got prostate cancer was not collected. Eating skinless poultry may have been a marker for those men attempting to make more aggressive dietary changes. Thus the skinless eaters may have made other changes in their life styles that could explain the effect.

A 2004 review found no association between eggs or poultry and the risk of initially getting prostate cancer. In 2007, researchers suggested that there could be different factors that promote prostate cancer after diagnosis than may have initially triggered the cancer. Still other factors may be responsible for determining how aggressive the cancer will be.

As a side note, this last study from 2007 reported that increased levels of alpha-linolenic acid in the diet were associated with higher risks of prostate cancer, a troubling piece of information. The prime source of this fatty acid is flax seed oil. Many men with prostate cancer, under the impression that flax oil fights prostate cancer, consume large quantities of flax oil. This study suggests they may be making matters worse.

This is not the first time poultry has been linked with prostate cancer. The American Institute of Cancer Research suggested a possible association between total poultry and prostate cancer in their 2007 report. A 2001 study reported an association between poultry skin and risk of metastatic prostate cancer.

The authors of this current study, Richman et al., had thought that levels of saturated fat in foods would be the main predictor of risk. Because their results do not support this idea, they have proposed an alternative explanation for their findings. Eating poultry skins may cause enough of an increase in heterocyclic amines as to change the risk of cancer recurrence.

This idea isn’t new. “Others [have] suggested [an] association with higher meat intake, possibly due to heterocyclic amines and polycyclic aromatic hydrocarbons, produced during grilling or frying” with prostate cancer.

Poultry contains more heterocyclic amines than any other type of meat. This has led to some interesting theories as heterocyclic amine, “intakes were estimated to be greatest for African American males, who were estimated to consume approximately 2- and approximately 3-fold more [heterocyclic amines] than white males”. This difference “may at least partly explain why prostate cancer (PC) kills approximately 2-fold more African American than white men”.

This current study adds to our knowledge of specific dietary advice we might give to men who have been diagnosed with prostate cancer.

It does something else though. It gives us a very different angle from which to approach this cancer. Rather than just focusing on treatments and supplements that kill cancer cells we can also seek ways to lower heterocyclic amines. Food can be prepared in different ways to lower production of these unwanted chemicals. Bowel flora can be changed to increase break down of these chemicals before they are absorbed. Even something as simple as eating yogurt or drinking beer with meals may help. The liver can be stimulated to speed their elimination. There’s more that we can do to control exposure and levels of heterocyclic amines than simply avoiding chicken skin.

Avodart May Lower Prostate Cancer Risk

“A widely prescribed drug used to shrink enlarged prostates appears to reduce the incidence of prostate cancer in men with an increased risk for the disease.” Read More

Less Advanced and Lethal Prostate Cancers in Coffee Drinkers

A recent Frontiers in Cancer Prevention Research Conference was the site of a presentation of the finding that men with a high intake of coffee have a lower risk of advanced and lethal prostate cancer.

Kathryn M. Wilson, PhD of Harvard School of Public Health and her colleagues evaluated data from nearly 50,000 participants in the Health Professionals’ Follow-Up Study. Coffee intake was assessed for 1986 and every four years thereafter until 2006.

While coffee drinking appeared to have a small protective effect on the overall risk of prostate cancer, when advanced and fatal cancers were analyzed, the risk of each was 59% lower in men who consumed the most coffee.

“Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be very exciting if this association is confirmed in other studies,” Dr. Wilson remarked.

Editor’s note: A reduction in the risk of prostate cancer has also been associated with other foods, such as tomato products containing lycopene, green tea, and especially cruciferous vegetables like broccoli and cauliflower.

Prostate Cancer and Pomegranate Juice

A study that began in 2003 is starting to yield important information when it comes to treating men who have undergone standard treatment for prostate cancer. The findings of the study were recently presented at the 104th Annual Scientific Meeting of the American Urological Association.1

The presentation described the trial that included 48 men 60+ years old who underwent radiation therapy or surgery to treat localized prostate cancer. After treatment, the men in the study all had escalating prostate-specific antigen (PSA) levels. Men who fail initial prostate cancer treatment show a progressive PSA elevation.

A six-year follow-up of the men who drank eight ounces of pomegranate juice a day revealed that those who continued drinking the juice had lower PSA levels than those who quit drinking the juice and were no longer in the trial.2

Jon Finkel

Higher Vitamin E Levels Predict Improved Prostate Cancer Survival

An article in Cancer Research reported improved prostate cancer survival among men with high vitamin E levels.*

Participants in the ATBC study whose vitamin E levels were among the top fifth of participants were found to have a 33% lower risk of dying of prostate cancer compared to those whose levels were in the lowest fifth. Men who received vitamin E supplements in the trial and whose levels of vitamin E were highest experienced the lowest risk of prostate cancer mortality, which was 49% less than that of subjects with the lowest vitamin E levels.

When all-cause mortality was analyzed among those with prostate cancer, participants in the top fifth of serum vitamin E levels were shown to have a 33% lower risk of death over the course of follow-up, suggesting “a possible effect for alpha-tocopherol on other causes of death in men with prostate cancer.”

Dayna Dye

For some prostate tumors, ‘watchful waiting’ seems safe

Men diagnosed with early, low-risk prostate cancer face a choice about treatment. Some tumors will not grow larger, but other tumors will progress, making them candidates for surgery, radiation, or chemotherapy. A new clinical trial shows that men with low-risk prostate cancer who decided to defer treatment for almost eight years did no worse than similar men who decided to have treatment sooner.

A team from Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and the University of California, San Francisco, analyzed medical records of more than 51,000 men enrolled in the Health Professionals Follow-up Study. Among the 3,331 men who were diagnosed with prostate cancer between 1986 and 2007, there were 342 men with low-risk tumors who chose not to have treatment in the first year. Half of those men still had not had treatment almost eight years after diagnosis.

There were few deaths from prostate cancer among the men who deferred treatment. Two percent of the men who deferred treatment died compared with 1 percent of the men with low-risk cancers who had treatment right away, a difference that was not statistically significant.

“I think it really brings some reassurance to the notion that it can be safe to defer treatment for the very low risk subset of prostate cancers,’’ said senior author Dr. Martin Sanda of Beth Israel Deaconess.

Active surveillance of patients based on prostate specific antigen screenings, repeated biopsies, and imaging tests can be used to track whether cancer is progressing, he said.

BOTTOM LINE: Men with low-risk prostate cancer who deferred treatment for a year or more fared no worse after eight years than men who chose early treatment.

CAUTIONS: The number of men who deferred treatment is small, so drawing conclusions about them should be done with caution. Patients were not randomly assigned to the waiting or immediate-treatment groups, so unknown differences among the men in the two groups might have biased the outcomes.

WHERE TO FIND IT: Journal of Clinical Oncology, Aug. 31

ELIZABETH COONEY

Selenium intake may worsen prostate cancer in some, study reports

BOSTON–Higher selenium levels in the blood may worsen prostate cancer in some men who already have the disease, according to a study by researchers at Dana-Farber Cancer Institute the University of California, San Francisco.

A higher risk of more-aggressive prostate cancer was seen in men with a certain genetic variant found in about 75 percent of the prostate cancer patients in the study. In those subjects, having a high level of selenium in the blood was associated with a two-fold greater risk of poorer outcomes than men with the lowest amounts of selenium. By contrast, the 25 percent of men with a different variant of the same gene and who had high selenium levels were at 40 percent lower risk of aggressive disease. The variants are slightly different forms of a gene that instructs cells to make manganese superoxide dismutase (SOD2), an enzyme that protects the body against harmful oxygen compounds.

The research findings suggest that “if you already have prostate cancer, it may be a bad thing to take selenium,” says Philip Kantoff, MD, director of Dana-Farber’s Lank Center for Genitourinary Oncology and senior author of the study that is published by the Journal of Clinical Oncology on its website now and later will be in a print journal. The lead author is June Chan, ScD, of the University of California, San Francisco.

The unexpected results are the first to raise concern about this potentially harmful consequence of taking supplemental selenium. Kantoff says, “These findings are interesting particularly in light of the recent negative results from the SELECT prevention study, which asked if selenium could protect against prostate cancer.”

The new study reveals the strong interaction between selenium and SOD2 to influence the biology of prostate cancer, a finding that these investigators had shown in a previous study. The authors say the current research demonstrated that variations in the make up of the SOD2 gene dramatically alter the effects of selenium on the risk of aggressive prostate cancer.

Selenium is a mineral found widely in rocks and dirt. Small amounts of selenium are essential for health: 40 to 70 micrograms is the recommended daily intake. In recent years, supplemental selenium has been sold and promoted as a means of preventing prostate cancer, largely based on observational studies that found higher risk of prostate cancer incidence and mortality in areas of the country that are naturally low in selenium.

However, research aimed at confirming the benefits of selenium supplementation have been mixed. Recently, the SELECT study, which involved 35,000 men, was halted early when, after more than five years, it showed that the supplements didnt affect the incidence of prostate cancer.

Previous studies had found that the risk of developing prostate cancer was modified by a strong interaction between SOD2 and selenium. The new research was designed to look at the effect of this interaction on men already diagnosed with prostate cancer.

Scientists examined banked blood samples, DNA, and medical records of 489 male Dana-Farber patients diagnosed between 1994 and 2001 with localized or locally advanced prostate cancer. Their mean age was 62, and their mean PSA (prostate-specific antigen) measurement was 6.0 ng/mL. About half the men were assessed as having a good disease risk, one-third had an intermediate risk, and the remaining one-sixth were at poor risk. The researchers measured the level of selenium in the blood and, using the stored DNA, they determined the SOD2 genotype — the specific form of the SOD2 gene carried by each patient.

Simply having a high level of selenium was associated with a slightly elevated risk of aggressive prostate cancer. But the risk was much more strongly affected by the interaction of selenium levels and whether the patient had a certain variant of the SOD2 gene. Men with the highest selenium levels and the “AA” form of the SOD2 gene were 40 percent less likely to have been diagnosed with aggressive prostate cancer than the men with same gene form but low levels of selenium.

But for men carrying the “V” form of the gene, selenium had the opposite effect. In these men, those with the highest levels of selenium in their blood were about twice as likely to have an aggressive type of prostate cancer as their counterparts with low selenium levels, says Kantoff, who is also a professor of medicine at Harvard Medical School.

The study couldnt determine whether any of the men had been taking selenium supplements or not. But the researchers noted that men in the large SELECT prevention trial had a much higher average selenium level than those in the current study. “Among the 25 percent of men with the AA genotype, having greater selenium levels may protect against aggressive disease,” the authors concluded. “However, for the 75 percent of men who carry a V allele, higher selenium levels might increase the likelihood of having worse characteristics.”

Therefore, they add, it is important to know which type of SOD2 gene a man has when considering the risks and potential benefits of taking selenium supplements. Additionally, the authors say the effects of the interaction between the SOD2 genotype and selenium may help explain apparently conflicting results of previous studies.

The results may seem counterintuitive to the public, who have been told for years that antioxidants can help people live longer, healthier lives with a lowered risk of cancer. However, Kantoff says, “There is some precedent to this research has suggested that antioxidants could be protective if you dont have cancer, but once you do, then antioxidants may be a bad thing.”

In addition to Kantoff and Chan, other authors of the paper include William Oh, MD, Wanling Xie, PhD, Meredith Regan, ScD, and Miyako Abe, PhD, of Dana-Farber; Meir J. Stampfer DrPH, MD, of Brigham and Women’s Hospital and the Harvard School of Public Health, and Irena King, PhD, of the Fred Hutchinson Cancer Research Center, Seattle.

The work was supported by grants from the National Cancer Institute and several foundations and charitable organizations.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

Green Tea Slows Prostate Cancer

Active compounds in green tea may slow the progression of prostate cancer, according to a new study published in Cancer Prevention Research.

The study, which was conducted at Louisiana State University, also showed that green tea might lower the incidence of prostate cancer in the first place.

The study is one of the few green tea trials that evaluated biomarkers in order to predict prostate cancer’s progression, said study leader James A. Cardelli, director of basic and translational research in the Feist-Weiller Cancer Center at LSU University Health Sciences Center-Shreveport.

The biomarkers tracked were PSA (prostate specific antigen), HGF (hepatocyte growth factor), and VEGF (vascular endothelial growth factor).

The study, which used compounds of green tea polyphenols in the form of Polyphon E provided by Polyphenon Pharma, involved 26 men ages 41 to 72 who were scheduled for radical prostactectomies. For an average of about 35 days up until the day before surgery, each man took four capsules of Polyphenon E, which was equal to drinking 12 cups of normally brewed green tea.

The researchers found that the green tea compounds significantly reduced serum levels of PSA, HGF, and VEGF, with reductions as great as 30 percent in some patients.

There were few side effects, and other biomarkers were “positively affected,” Cardelli said.

Referring to the LSU study and to a year-long clinical trial in Italy involving green tea polyphenols, Cardelli said, “These studies are just the beginning and a lot of work remains to be done. However, we think that the
use of tea polyphenols alone or in combination with other compounds currently used for cancer therapy should be explored as an approach to prevent cancer progression and recurrence.”

Selenium intake may worsen prostate cancer in some, study reports

BOSTON–Higher selenium levels in the blood may worsen prostate cancer in some men who already have the disease, according to a study by researchers at Dana-Farber Cancer Institute the University of California, San Francisco.

A higher risk of more-aggressive prostate cancer was seen in men with a certain genetic variant found in about 75 percent of the prostate cancer patients in the study. In those subjects, having a high level of selenium in the blood was associated with a two-fold greater risk of poorer outcomes than men with the lowest amounts of selenium. By contrast, the 25 percent of men with a different variant of the same gene and who had high selenium levels were at 40 percent lower risk of aggressive disease. The variants are slightly different forms of a gene that instructs cells to make manganese superoxide dismutase (SOD2), an enzyme that protects the body against harmful oxygen compounds.

The research findings suggest that “if you already have prostate cancer, it may be a bad thing to take selenium,” says Philip Kantoff, MD, director of Dana-Farber’s Lank Center for Genitourinary Oncology and senior author of the study that is published by the Journal of Clinical Oncology on its website now and later will be in a print journal. The lead author is June Chan, ScD, of the University of California, San Francisco.

The unexpected results are the first to raise concern about this potentially harmful consequence of taking supplemental selenium. Kantoff says, “These findings are interesting particularly in light of the recent negative results from the SELECT prevention study, which asked if selenium could protect against prostate cancer.”

The new study reveals the strong interaction between selenium and SOD2 to influence the biology of prostate cancer, a finding that these investigators had shown in a previous study. The authors say the current research demonstrated that variations in the make up of the SOD2 gene dramatically alter the effects of selenium on the risk of aggressive prostate cancer.

Selenium is a mineral found widely in rocks and dirt. Small amounts of selenium are essential for health: 40 to 70 micrograms is the recommended daily intake. In recent years, supplemental selenium has been sold and promoted as a means of preventing prostate cancer, largely based on observational studies that found higher risk of prostate cancer incidence and mortality in areas of the country that are naturally low in selenium.

However, research aimed at confirming the benefits of selenium supplementation have been mixed. Recently, the SELECT study, which involved 35,000 men, was halted early when, after more than five years, it showed that the supplements didn’t affect the incidence of prostate cancer.

Previous studies had found that the risk of developing prostate cancer was modified by a strong interaction between SOD2 and selenium. The new research was designed to look at the effect of this interaction on men already diagnosed with prostate cancer.

Scientists examined banked blood samples, DNA, and medical records of 489 male Dana-Farber patients diagnosed between 1994 and 2001 with localized or locally advanced prostate cancer. Their mean age was 62, and their mean PSA (prostate-specific antigen) measurement was 6.0 ng/mL. About half the men were assessed as having a good disease risk, one-third had an intermediate risk, and the remaining one-sixth were at poor risk. The researchers measured the level of selenium in the blood and, using the stored DNA, they determined the SOD2 genotype — the specific form of the SOD2 gene carried by each patient.

Simply having a high level of selenium was associated with a slightly elevated risk of aggressive prostate cancer. But the risk was much more strongly affected by the interaction of selenium levels and whether the patient had a certain variant of the SOD2 gene. Men with the highest selenium levels and the “AA” form of the SOD2 gene were 40 percent less likely to have been diagnosed with aggressive prostate cancer than the men with same gene form but low levels of selenium.

But for men carrying the “V” form of the gene, selenium had the opposite effect. In these men, those with the highest levels of selenium in their blood were about twice as likely to have an aggressive type of prostate cancer as their counterparts with low selenium levels, says Kantoff, who is also a professor of medicine at Harvard Medical School.

The study couldn’t determine whether any of the men had been taking selenium supplements or not. But the researchers noted that men in the large SELECT prevention trial had a much higher average selenium level than those in the current study.
“Among the 25 percent of men with the AA genotype, having greater selenium levels may protect against aggressive disease,” the authors concluded. “However, for the 75 percent of men who carry a V allele, higher selenium levels might increase the likelihood of having worse characteristics.”

Therefore, they add, it is important to know which type of SOD2 gene a man has when considering the risks and potential benefits of taking selenium supplements. Additionally, the authors say the effects of the interaction between the SOD2 genotype and selenium may help explain apparently conflicting results of previous studies.

The results may seem counterintuitive to the public, who have been told for years that antioxidants can help people live longer, healthier lives with a lowered risk of cancer. However, Kantoff says, “There is some precedent to this – research has suggested that antioxidants could be protective if you don’t have cancer, but once you do, then antioxidants may be a bad thing.”

In addition to Kantoff and Chan, other authors of the paper include William Oh, MD, Wanling Xie, PhD, Meredith Regan, ScD, and Miyako Abe, PhD, of Dana-Farber; Meir J. Stampfer DrPH, MD, of Brigham and Women’s Hospital and the Harvard School of Public Health, and Irena King, PhD, of the Fred Hutchinson Cancer Research Center, Seattle.

The work was supported by grants from the National Cancer Institute and several foundations and charitable organizations.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

Fish Consumption Improves Survival in Prostate Cancer

Men who consume large amounts of fish have better survival from prostate cancer, according to a long-term follow-up study.*

More than 20,000 men who participated in the Physician’s Health Study answered questionnaires at enrollment in 1983 about medical history, lifestyle characteristics, and food intake, and then reported all new illnesses each year thereafter. During follow-up of 19 years, 2,161 cases of prostate cancer occurred and 230 men died of the disease.

Total fish intake was not a significant predictor of developing prostate cancer. However, consumption of fish and of fish-derived omega-3 fatty acids increased the likelihood of surviving prostate cancer. Men who ate fish at least five times per week (versus less than once per week) had a 48% lower risk of death from prostate cancer, and men with the highest fatty acid intake had a 35% lower risk.

The results suggest that fish consumption delays prostate cancer progression.

—Laura J. Ninger, ELS

(From Life Extension, March 2009)

Studies fail to settle prostate testing debate

“Regular screening for prostate cancer may prevent the deaths of a small number of men but exposes many more to potentially needless treatments accompanied by serious complications, according to two landmark studies that fail to settle a long-running debate about the value of screening.” Read More

More Evidence Prostate Tests Overdiagnose Cancer

As many as two of every five men whose prostate cancer was caught through a PSA screening test have tumors too slow-growing to ever be a threat, says a new study that raises more questions about the controversial tests…… Read More

Pomegranate Juice Keeps Psa Levels Stable

Drinking an eight ounce glass of pomegranate juice daily increased by nearly four times the period during which PSA levels in men treated for prostate cancer remained stable, a three-year UCLA study has observed…… Read More

New Study: Testosterone Replacement Therapy and Prostate Cancer

For the past 65 years, it has been axiomatic that higher serum testosterone (T) levels cause increased prostate cancer (PCa) growth and that T supplementation carries the risk for converting occult PCa into a clinical PCa….. Read More

New Study: Two Years of Testosterone Therapy Associated with Decline in Prostate-Specific Antigen in a Man with Untreated
Prostate Cancer

Testosterone (T) therapy has long been considered contraindicated in men with prostate cancer (PCa).
However, the traditional view regarding the relationship of T to PCa has come under new scrutiny, with recent
reports suggesting that PCa growth may not be greatly affected by variations in serum T within the near-physiologic
range….. Read More

New study on side effects could help men choose a treatment

All prostate cancer treatments involve side effects but new American research may help men choose the best option.

In one of the first large studies to examine quality of life after therapy….
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Vitamin D doesn’t cut prostate cancer risk – Yahoo! News

Vitamin D — the so-called sunshine vitamin — does not appear to cut a man’s risk of getting prostate cancer, researchers said on Tuesday….
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Improving Diet, Lifestyle Slows Prostate Cancer

Intensive diet and lifestyle changes slow the progression of low-grade prostate cancer, this new research indicates that diet can influence the outcome of established prostate cancer…
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Study Details Effects of Prostate Cancer

One of the first large quality-of-life studies on today’s prostate cancer treatments suggests that for some men, it’s a matter of picking your poison and facing potential sexual, urinary or other problems…..
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High Lycopene Level Reduces Risk of Advanced Prostate Cancer

A newly published European study indicates taht men with the highest blood levels of lycopene are 60% less likely to develop advancedprostate cancer, compared….
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Resveratrol Suppresses Prostate Cancer Development

Researchers from the University of Alabama at Birmingham have shown that prostate cancer-prone mice fed resveratrol experience significant protection against development of the disease.1Found in red wine and some fruits and vegetables, resveratrol is a polyphenol antioxidant….
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Nonfat milk linked to prostate cancer

The amount of calcium and vitamin D in the diet appears to have little or no impact on the risk of prostate cancer, but the consumption of low-fat or nonfat milk may increase the risk of the malignancy, according to the results of two studies published in the American Journal of Epidemiology….
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Pectin lnduces Self-Destruction

Pectin lnduces Self-Destruction in Prostate Cancer Cells
Pectin, a plant—produced compound used in the preparation of homemade jellies, may
protect….
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Time Course and Predictors of Symptoms after Primary Prostate Cancer Therapy

Purpose: Understanding the distinctive patterns of treatment-related dysfunction after alternative initial treatments for early prostate cancer (PC) may improve patients’ choice of treatment and later help them adjust to its consequences….

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Green tea for a healthy prostate?

New research suggests that phytochemicals in green tea may help prevent the spread of prostate cancer. Since earlier research suggests….

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Many prostate cancer patients receive improper or ‘mismatched’ therapies

Prostate cancer patients often receive treatment that is contraindicated by pre-existing conditions, like urinary or bowel dysfunction, according to a new study. Dr. James Talcott of the Massachusetts General Hospital in Boston and co-investigators found that patients with certain pretreatment dysfunctions often receive contraindicated or “mismatched” therapies, which can lead to….

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Green Tea Shown To Prevent Prostate Cancer

“Numerous earlier studies, including ours, have demonstrated that green tea catechins, or pure EGCG (a major component of GTCs), inhibited cancer cell growth in laboratory models,” Bettuzzi explained. “We wanted to conduct a clinical trial to find out whether catechins could prevent cancer in men. The answer clearly is….

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