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New study may change how prostate cancer is treated

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A new study that used a one-two punch to treat prostate cancer has revealed significant promise; in fact, due to preliminary results, officials at the National Cancer Institute (NCI) decided to release them early on December 5 before a full analysis of the trial was completed. The NCI, a component of the National Institutes of Health, funded the study, which was conducted by a research team headed by Christopher Sweeney, MD, a medical oncologist at the Harvard-affiliated Dana-Farber Cancer Institute in Boston.

The study comprised 790 patients with advanced prostate cancer. Conventional treatment involves giving the patients hormonal therapy to suppress testosterone levels and then giving docetaxel chemotherapy if the cancer progressed. The study subjects were either given hormonal therapy alone or hormonal therapy plus the docetaxel. The researchers found that 69% of the men who were given the combination therapy were alive after three years, compared with 52.5% of the men who were started on hormone therapy alone. The preliminary results also revealed that men whose cancer had spread to at least four different locations in bone or had spread to a major organ such as the liver were the most likely to benefit from the combination treatment.

Dr. Sweeney noted that the evidence was strong enough to convince him to offer the combination therapy to all his patients who suffer from advanced prostate cancer. Docetaxel is marketed as Taxotere by Sanofi SA; a generic version is also available.

Prostate cancer is most successfully treated when found early. The American Cancer Society (ACS) reports the following statistics:

  • More than 90% of all prostate cancers are discovered while they are either localized (confined to the prostate) or regional (nearby). The five-year survival rate for men diagnosed with prostate tumors discovered at these stages is almost 100%.
  • In the past 25 years, the five-year survival rate for all stages combined has increased from 68% to almost 100%.
  • Prostate cancer is the most common cancer among men, excluding skin cancer.

At the early stage, there are usually no specific signs or symptoms of thee cancer. A prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) can provide the best chance of identifying prostate cancer in its earliest stages; however, these tests can have some limitations; thus, it is prudent for a man to discuss prostate screening with a physician.

The following are the most common symptoms of prostate cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • Weak or interrupted flow of urine
  • Urinating often (especially at night)
  • Difficulty urinating or holding back urine
  • Inability to urinate
  • Pain or burning when urinating
  • Blood in the urine or semen
  • Nagging pain in the back, hips, or pelvis if cancer has spread to the bones
  • Painful ejaculation

As a man ages, his prostate may enlarge and obstruct the flow of urine, or interfere with sexual function. An enlarged prostate gland, a condition called benign prostate hyperplasia, may require treatment with medicine or surgery to relieve symptoms. This common benign prostate condition, which is not cancer, can cause many of the same symptoms as prostate cancer.

In general, all men are at risk for prostate cancer. However, there are specific risk factors that increase the likelihood that certain men will develop the disease, including the following:

  • Age. Age is a risk factor for prostate cancer, especially for men 50 and older. Nearly two-thirds of all prostate cancers are diagnosed in men over the age of 65.
  • Race. Prostate cancer is more common among African-American men than it is among white American men. Japanese and Chinese men native to their country have the lowest rates of prostate cancer. However, when Chinese and Japanese men immigrate to the U.S., they have an increased risk of and mortality rate from prostate cancer when compared to their native populations. In Japan, the incidence of prostate cancer has increased as Western diets and lifestyles have been adopted.
  • Diet. Epidemiological data suggest that the diet consumed in Western industrialized nations may be a factor in developing prostate cancer. Consider the following information regarding diet and its effect on the risk for prostate cancer:
    • Fat. Some studies suggest that men who eat a high-fat diet, especially if it is high in red meat or high-fat dairy products, may have a greater chance of developing prostate cancer.
    • Fruits and vegetables. Diets high in fruits and vegetables may lower prostate cancer risk, although it is not clear which nutrient(s) may be responsible for this.
    • Vitamin E and selenium. The antioxidant Vitamin E, combined with selenium, has been shown to inhibit tumor growth in laboratory animals. But a large study found that supplements of these substances did not lower the risk of prostate cancer in men. In fact, the men taking vitamin E had a slightly higher risk of prostate cancer.
    • Carotenoids. Carotenoids, such as lycopenes, have been shown to inhibit the growth of human prostate cancer cells in tissue cultures (cells grown in the laboratory). The primary source of lycopenes is processed tomatoes. Again, however, it is not clear if lycopenes affect prostate cancer risk in men, as not all studies have found a benefit.
  • Obesity. Most studies have not found obesity to affect the risk of getting prostate cancer, but obese men may be more likely to develop more aggressive forms of prostate cancer.
  • Environmental exposures. Some studies show an increased risk of prostate cancer in men who are farmers, or those exposed to the metal cadmium while making batteries, welding, or electroplating. Additional research is needed in this area to confirm whether this is a true association.
  • Having a vasectomy, BPH (benign prostatic hyperplasia), or an STD (sexually transmitted disease). Researchers have looked at whether men who have had a vasectomy, BPH, or those who have been exposed to a sexually transmitted disease are at increased risk for prostate cancer. Some studies suggest a link, while others do not support these claims.
  • Family history of prostate cancer. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if the relatives were young at the time of diagnosis. Geneticists (doctors and scientists who study inheritance and the causes of genetic disease) divide families into three groups, depending on the number of men with prostate cancer and their ages of onset, including the following:
    • Sporadic. A family with prostate cancer present in one man, at a typical age of onset; sporadic means occurs by chance.
    • Familial. A family with prostate cancer present in more than one person, but with no definitive pattern of inheritance and usually an older age of onset.
    • Hereditary. A family with a cluster of three or more affected relatives within any nuclear family (parents and their children), a family with prostate cancer in each of three generations on either the mother or father's side, or a cluster of two relatives affected at a young age (55 or younger). Five to 10 percent of prostate cancer cases are considered hereditary.
  • Genetic factors. In the center of each cell of the human body, our genetic material—chromosomes—are found. Normally, cells contain 46 chromosomes, or 23 pairs, half of which are inherited from our mother, half from our father. The chromosomes contain genes—the body's blueprint. Genes code for traits, such as eye color and blood type, and also control important regulatory functions in the body such as the rate of cell growth. Some genes, when altered or mutated, give a higher risk for uncontrolled cell growth, which, in turn, can lead to tumor development. These genes have various names, but overall are referred to as cancer susceptibility genes. Approximately 5-10% of all prostate cancers are known to be attributed to an inherited DNA change.
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