Sunday, 15 October 2017

Food for thought on the PSA

This article gives food for thought on the PSA test, a test that had my doctor ignored the results of, I would now certainly have been dead. So for me, PSA remains king, but never forget this:
If your result is between 0 and 4 the medical profession say you are within limits, and thus safe. No, no, no, no and NO! All my tests were within this limit, but my doctor spotted that there had been a doubling in about 18 months, which is a warning sign that all is not well. It doesn't mean you have cancer, but it OFTEN does!
If you are a man over 50 and you do not know your actual PSA test number (not just..." the doctor said it was ok") and have not written it down so you can compare it to the previous year, then you are dicing with death!
Read on...
We are still waiting for a test that can—with complete accuracy—distinguish between men who have prostate cancer and those who are cancer-free. If prostate cancer is diagnosed, the test should also determine whether it’s an aggressive form that requires prompt treatment or a slow-growing tumor that may only need close monitoring.
A number of companies have introduced tests that could take us closer to that goal, but there’s still much to be learned about them and their proper role in the management of prostate cancer. Unfortunately, published studies are limited, and so far none of the tests has a long-term track record in the real world, where doctors screen, counsel, and treat patients.
Once a particular test has been approved by the Food and Drug Administration and is available, it can be marketed without proof of benefit. Furthermore, unsubstantiated claims abound for many tests. For now, all of these tests are intended to augment—not replace—a doctor’s clinical judgment along with the existing proven tests currently used to screen for and monitor prostate cancer.
Time will tell if any of these new tests add information that will significantly affect treatment decisions. Here’s an overview of the latest prostate cancer tests—and the questions we hope they can answer. All of the tests are available in the U.S. unless otherwise indicated.

Tests to indicate the need for a prostate biopsy

An elevated prostate-specific antigen (PSA) level can indicate that a man has prostate cancer; however, findings may also be elevated in men with less serious conditions, such as benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement (BPE). Yet most men with elevated PSA levels end up having an anxiety-provoking biopsy to rule out cancer. Two new tests show great promise in identifying appropriate biopsy candidates with greater accuracy:
• The Prostate Health Index. Commonly known as the phi test, measures blood levels of PSA, free PSA, and a precursor (or early form) of PSA, known as pro-PSA or p2PSA. Research suggests that pro-PSA levels are a better indicator of prostate cancer than total or free PSA levels and that men with elevated pro-PSA levels are at high risk for having an aggressive form of prostate cancer. Using a mathematical equation, the phi test combines all three variants to better determine whether prostate cancer is present.
The test is indicated for use in men age 50 and older whose digital rectal exam showed no signs of cancer and who have a total PSA value between 4 ng/mL and 10 ng/mL—a gray zone that could indicate prostate cancer or a less serious condition such as BPH. Like the other tests described herein, the phi test doesn’t deliver a definitive answer about what action to take—in this case, whether or not to have a biopsy.
Promo block
Instead, the phi test’s results, which are scored from 0 to 55 and above, reflect the probability that a biopsy will detect cancer. For example, a phi test score below 27 is associated with a 9.8 percent probability that prostate cancer is present, while a score of 55 or more suggests a likelihood of greater than 50 percent. As with all of the tests, phi test results must be considered in light of a man’s other risk factors.
• 4Kscore. This blood test (currently available in Europe and Mexico) measures levels of three PSA variants (total PSA, free PSA, and intact PSA), plus an enzyme called human kallikrein 2 (hK2), which is elevated in men with prostate cancer. Some scientists believe hK2 may promote the growth and spread of prostate cancer. The 4Kscore also uses a mathematical algorithm to calculate the risk of prostate cancer in a man with an elevated PSA level.

Tests to rule out a repeat biopsy

Some prostate biopsies produce inconclusive results. Others may be negative even in men with elevated PSA or other high-risk features. Typically, this means the procedure must be repeated even though only 10 to 36 percent of second biopsies detect cancer. The following tests can be used to help determine the need for a repeat biopsy.
• Progensa. This urine test detects the presence of a gene called prostate cancer antigen 3 (PCA3). This gene is overexpressed (or overactive) in 95 percent of men with prostate cancer, but not in men who have healthy prostates or BPH. Results are ranked from less than 5 to greater than 100, with a score of less than 25 indicating a decreased likelihood of a positive biopsy. Progensa is approved for use in men age 50 and older who have had one or more negative biopsies, but who a doctor nonetheless suspects may have prostate cancer.
• ConfirmMDx. Whether a particular gene is turned “off” or “on” can be determined by the presence or absence of specific chemical tags or methyl groups—methylation—of DNA, the building blocks of genes. When this process of DNA methylation turns off the activity of tumor suppressor genes, cancer may develop. Based on technology developed at Johns Hopkins and other institutions, ConfirmMDx analyzes the DNA methylation status of a man’s biopsied prostate tissue. Test results indicate that the biopsy specimen is positive or negative for methylation. A positive finding, which is mapped on a diagram of the prostate, suggests the need for a repeat biopsy.
• Prostate Core Mitomic Test. This test analyzes a man’s biopsied prostate tissue, looking for damage to mitochrondrial DNA (mtDNA) caused by cellular changes associated with prostate cancer development. A negative result suggests that the man is at low risk of undiagnosed prostate cancer and that a repeat biopsy can be deferred.
Promo block

Tests to determine the need for prostate cancer treatment

Many men with positive biopsies have low-risk tumors that won’t spread to other organs and become deadly. For some of these men, active surveillance may be a reasonable alternative to immediate treatment, but standard diagnostic tools are imperfect at distinguishing between indolent and aggressive tumors. Results from the following tests, when combined with a Gleason score and other clinical information, are intended to help provide reassurance about the decision to forgo or institute immediate treatment.
• Prolaris. This test uses a sample of tumor tissue removed during a biopsy and measures how rapidly cells are dividing as a way to gauge whether the tumor is more or less likely to be deadly. Prolaris scores range from -1.3 to +4.7 and are stratified by risk, with higher scores indicating a greater risk of dying from prostate cancer.
ProstaVysion. For this test, biopsied tissue is analyzed for the presence of two genetic biomarkers for prostate cancer. One biomarker, known as TMPRSS2:ERG, is a fusion of two genes and is associated with the presence of prostate cancer. The other biomarker, PTEN, is a “suppressor” gene that normally helps keep certain forms of cancer in check and is missing in 60 percent of men with metastatic prostate cancer. By examining those two markers, the test provides a molecular analysis of prostate cancer aggressiveness and the patient’s long-term prognosis.
• Oncotype DX. This test examines the interactions between 17 genes in a biopsy sample to predict whether a tumor is likely to be aggressive. The result, the Genomic Prostate Score, ranges from 0 to 100; a low score suggests that the tumor is less likely to grow and spread and aggressive treatment may not be necessary. Conversely, a higher score suggests a poorer prognosis and a greater need for immediate treatment.

Tests to determine the need for treatment after prostate surgery

Some men who have had a radical prostatectomy are at risk for recurrence and would benefit from additional therapies, such as radiation or hormone therapy, but identifying them is a challenge. At least one of the tests discussed above, Prolaris, as well as the tests below, may be able to help with that challenge.
Promo block
NADiA ProsVue. This blood test measures the rate of tiny changes in PSA levels over time, which can suggest that a man is at risk for recurrence. Patients are categorized as at reduced risk, which indicates that a man is at a lower risk for clinical (not biochemical) cancer recurrence for several years following his prostatectomy, or not at reduced risk.
Decipher. This test, which is not yet available in the U.S., analyzes tissue from the prostate tumor to look for 22 genes linked to prostate cancer metastasis. The results, which are presented as a percentage score, indicate whether a man is at high or low risk for metastases and, therefore, whether further treatment should be considered.

Monday, 2 October 2017

Interleukin-4 Stimulates the Spread and Growth of Prostate Cancer Cells, Researchers Find

A bone marrow protein that normally works to reduce inflammation after infection was found to also send signals to prostate cancer cells to promote their spread and growth outside of the prostate, a new study shows. The findings could provide the missing link as to why prostate cancer cells migrate to bones and may lead to new therapies that stop the process.
Inflammation is linked to poor prognosis in cancer. Cytokines, which are proteins secreted by cells as part of the normal immune response, are associated with the inflammatory process. For example, the pro-inflammatory cytokine interleukin-6 (IL-6) influences the growth and survival of prostate cancer cells.
Patients with progressive prostate cancer have elevated levels of the anti-inflammatory cytokine interleukin-4 (IL-4), and previous studies have shown that IL-4 can promote the growth and proliferation of certain cancer cells in vitro. This prompted the researchers to investigate the effect of IL-4 on prostate cancer cells isolated from patients.
After six days of growth in the presence of IL-4, the team found that the ability of malignant prostate cancer cells to form colonies, which is a measure of cell survival and proliferation, was enhanced in a concentration-dependent manner. But the cytokine did not influence the migration or invasive potential of prostate cancer cells.
The researchers then set out to identify the mechanism mediating IL-4’s effect on prostate cancer cells. They found that the signaling pathway is mediated by the STAT6 protein, which is known to be involved in metastasis.
The findings suggest that prostate cancer cells that have spread from the prostate into circulation, dock in the bones through the IL-4/STAT6 signaling and multiply to form a new tumor.
Norman Maitland, a professor at the University of York’s Department of Biology in the U.K., and one of the study’s authors, compares the process to that of a space rocket.
“We have always known that the two places where prostate cancer spreads are the bones and lymph nodes, but we have not fully understood why these two locations are preferred,” he explained in a press release. “If we imagine the prostate cancer cell as a floating ‘space rocket’ and the only way for it to perform its mission is to ‘dock’ with another ‘space vehicle’, we start to get a picture of what happens when a cancer cell moves around the body in search of a new home.
“Without this docking station, the ‘ship’, or cell, will just float around, not causing any further harm. The receptors on the ‘docking station’, or the protein in bone, act like a magnet for the receptors on the stem cells of the cancer and once it is ‘docked’, getting rid of the cancer becomes much harder,” he added.
The identification of this pathway offers a potential therapeutic opportunity by blocking STAT6 signaling. By using a STAT6 inhibitor that already has been tested in asthma, the team was able to disrupt the metastatic process.
“Clinical trials are some way off, but this is a positive and exciting step forward in tackling this disease and reducing the number of deaths,” Maitland said.

Thursday, 21 September 2017

Who are you?

I'm an ENFP - "The Campaigner"

What are you?

Go to this link, hit the 'take the test' button at the top right-hand corner. Until you know and understand who you are, it's hard to understand others...

So what about me....


It doesn’t interest me what you do for a living. I want to know what you ache for – and if you dare to dream of meeting your heart’s longing. It doesn’t interest me how old you are. I want to know if you will risk looking like a fool – for love – for your dreams – for the adventure of being alive.

Oriah Mountain Dreamer
The ENFP personality is a true free spirit. They are often the life of the party, but unlike Explorers, they are less interested in the sheer excitement and pleasure of the moment than they are in enjoying the social and emotional connections they make with others. Charming, independent, energetic and compassionate, the 7% of the population that they comprise can certainly be felt in any crowd

You Can Change the World With Just an Idea

More than just sociable people-pleasers though, ENFPs, like all their Diplomat cousins, are shaped by their Intuitive (N) quality, allowing them to read between the lines with curiosity and energy. They tend to see life as a big, complex puzzle where everything is connected – but unlike Analysts, who tend to see that puzzle as a series of systemic machinations, ENFPs see it through a prism of emotion, compassion and mysticism, and are always looking for a deeper meaning.
ENFPs are fiercely independent and much more than stability and security, they crave creativity and freedom.
Many other types are likely to find these qualities irresistible, and if they’ve found a cause that sparks their imagination, ENFPs will bring an energy that oftentimes thrusts them into the spotlight, held up by their peers as a leader and a guru – but this isn’t always where independence-loving ENFPs want to be. Worse still if they find themselves beset by the administrative tasks and routine maintenance that can accompany a leadership position. ENFPs’ self-esteem is dependent on their ability to come up with original solutions, and they need to know that they have the freedom to be innovative – they can quickly lose patience or become dejected if they get trapped in a boring role.

Don’t Lose That ’Little Spark of Madness’

Luckily, ENFPs know how to relax, and they are perfectly capable of switching from a passionate, driven idealist in the workplace to that imaginative and enthusiastic free spirit on the dance floor, often with a suddenness that can surprise even their closest friends. Being in the mix also gives them a chance to connect emotionally with others, giving them cherished insight into what motivates their friends and colleagues. They believe that everyone should take the time to recognize and express their feelings, and their empathy and sociability make that a natural conversation topic.
The ENFP personality type needs to be careful, however – if they rely too much on their intuition, assume or anticipate too much about a friend’s motivations, they can misread the signals and frustrate plans that a more straightforward approach would have made simple. This kind of social stress is the bugbear that keeps harmony-focused Diplomats awake at night. ENFPs are very emotional and sensitive, and when they step on someone’s toes, they both feel it.
ENFPs will spend a lot of time exploring social relationships, feelings and ideas before they find something that really rings true. But when they finally do find their place in the world, their imagination, empathy and courage are likely to produce incredible results.

Monday, 11 September 2017

PSA Screening Lowers Mortality, Analysis of Clinical Trials Concludes

Prostate cancer screening using prostate-specific antigen (PSA) does reduce mortality in prostate cancer, according to a review that used a new approach to analyze data from large clinical trials.
The findings suggest that current recommendations, which advise against PSA-based screening, might need to be revised, researchers write in their report, which was published in the journal Annals of Internal Medicine.
Interestingly, the study, “Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials,” used the same source data that the U.S. Preventive Services Task Force (USPSTF) had employed to issue recommendations against screening.
The studies were the European Randomized Study of Screening for Prostate Cancer (ERSPC; ISRCTN49127736) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO; NCT00002540).
The ERSPC reported a 21 percent drop in prostate cancer mortality with screening, while the PLCO found no difference.
But researchers from the Fred Hutchinson Cancer Research Center in Seattle and the University of Michigan, among many others, noted that the studies differed in key factors, including study design and adherence.
For instance, the PLCO screened annually, while the ERSPC screened participants every two to four years. The PLCO also had a higher PSA threshold for referring patients for a biopsy and stopped screening after six rounds, researchers said.
These and other factors made researchers conclude that the PLCO “compared the effects of an organized screening program versus opportunistic screening rather than screening versus no screening.”
To overcome these differences, the research team built a mathematical model that took these differences in “screening intensity” into account.
Using the analysis they discovered that the PLCO control group had been exposed to more intensive screening than controls used in the ERSPC study.
Their analysis further showed that when differences were taken into account there was no difference in the outcome of screening between the trials, which, in fact, showed that screening was beneficial.
Screening was linked to a 7 percent to 9 percent decrease in risk of prostate cancer death for each year of the standardized screening measure.
This translated into estimates ranging between a 25 percent and 31 percent lower risk of death in screened patients in the ERSPC study, and between 27 percent and 32 percent in the PLCO intervention group, when compared with no screening.
Researchers argued that their study overcame the limitations of traditional statistical analyses, and might act to complement study results from the trial when the benefits and harms of screening are considered.

Tuesday, 5 September 2017

Should you go for 'alternative' cures?

You can, of course, decide not to believe this article, but it's worth reading....

Link to home page of American Family Physician here....AFP 

People who choose alternative cures for common cancers are up to five times more likely to die compared to those opting for standard treatments, the lead scientist of a new study told AFP Friday.
The risk of death five years after diagnosis "was highest for breast and colon cancer," said lead author Skyler Johnson from the Yale School of Medicine in New Haven, Connecticut -- 5.6 and 4.6 times greater respectively.
Lung cancer patients who spurned surgery, radiation or chemotherapy in favour of herbs and vitamin, homeopathy, special diets or other unorthodox therapies were more than twice as likely to die over the same period, he reported last week in the Journal of the National Cancer Institute.
Five-year survival rates for prostate cancer remained high -- around 90 percent -- for both conventional and alternative treatments, but this was not necessarily evidence that the alternative therapies were as effective.
"Prostate cancer usually grows very slowly in the early stages so few people die," Johnson explained by email.
Faced with poor prognoses or painful courses of chemotherapy, which can cause severe nausea and weakness, many cancer patients place their faith in a wide range of treatments dismissed by most medical doctors as useless at best.
These include probiotics, vitamins and minerals; traditional Indian and Chinese methods such as Ayurvedic medicine and acupuncture; homeopathy and naturopathy; chiropractic or osteopathic manipulation; as well as yoga, Tai Qi and Qi Gong, all of which involve breath control.
Mind-over-matter approaches also include prayer, meditation, and guided imagery, in which one visualises one's cancer in order to overcome it.
Researchers led by Johnson identified 281 people in the United States with the four most common types of cancer -- breast, prostate, lung, and colon -- who turned towards one or more of these unproven treatments when diagnosed.
The team compared their health outcomes with those of 560 other cancer patients of comparable age, also taking into account race and different health factors.
On average, the first group was 2.5 times more likely to die within five years of diagnosis.
"For several reasons, I believe this may be an underestimate," Johnson told AFP.
To begin with, the data only covered only initial treatment, which means that some of the patients who first sought out alternative cures may have switched to standard treatments as their disease progressed, thus prolonging their lives.
It is also likely, he added, that the non-conventional medicine cohort was healthier, younger and had higher income and education -- attributes that translate into better survival rates.
"We don't know the exact number of people that make the decision to pursue alternative medicine instead of conventional cancer treatment," Johnson said.
Patients are reluctant to confide in doctors who are likely to frown upon their choices, he added.

But, he noted, all the miracle cancer cures on offer probably add up to a multi-billion dollar business.

Published Saturday, August 19, 2017.

Wednesday, 30 August 2017

New drug that enables your own cells to attack and kill cancer

This news today brings hope of a new way to fight all 
cancers. It's not a present wondercure, it could be 
years before it's been developed further and it 
becomes afordable to all, but it's a massive step in the 
right direction.
The new therapy turns a patient’s cells into a “living- 
drug,” and trains them to recognize and attack the 
disease. It is part of the rapidly growing field of immunotherapy that bolsters the immune system 
through drugs and other therapies and has, in some 
cases, led to long remissions and possibly even cures.
The Food and Drug Administration on Wednesday approved
the first-ever treatment that genetically alters a patient’s own
cells to fight cancer, a milestone that is expected to transform
treatment in the coming years.
The therapy, marketed as Kymriah and made by Novartis, was
approved for children and young adults for an aggressive type
of leukemia — B-cell acute lymphoblastic leukemia — that has
resisted standard treatment or relapsed. The F.D.A. called the
disease “devastating and deadly” and said the new treatment
fills an “unmet need.”
Novartis and other companies have been racing to develop
gene therapies for other types of cancers, and experts expect 
more approvals in the near future. Dr. Scott Gottlieb, the F.D.A. 
commissioner, said that more than 550 types of experimental
gene therapy were being studied.
There are drawbacks to the approach. Because Kymriah can
have life-threatening side effects, including dangerous drops
in blood pressure, the F.D.A. is requiring that hospitals and
doctors be specially trained and certified to administer it,
and that they stock a certain drug needed to quell severe
Continue reading the main story
 Kymriah, which will be given to patients just once and must be
 made individually for each, will cost $475,000. Novartis said
 that if a patient does not respond within the first month after
 treatment, there will be no charge. The company also said it
 would provide financial help to families who were uninsured
 or underinsured.

Emily Whitehead, shown here in May, was near death at age 6 from leukemia and became the first pediatric patient to receive the experimental gene therapy. She is now 12 and has been in remission for more than five years. CreditChildren’s Hospital of Philadelphia, via Associated Press 

Discussing the high price during a telephone news conference, a
Novartis official noted that bone-marrow transplants, which
can cure some cases of leukemia, cost even more, from
$540,000 to $800,000.
About 600 children and young adults a year in the United States
would be candidates for the new treatment.
The approval was based largely on a trial in 63 severely ill
children and young adults who had a remission rate of 83
percent within three months — a high rate, given that relapsed
or treatment-resistant disease is often quickly fatal.
The treatment was originally developed by researchers at the
University of Pennsylvania and licensed to Novartis. It was
identified in previous reports as CAR-T cell therapy, CTL019
or tisagenlecleucel.
The first child to receive the therapy was Emily Whitehead, who
was 6 and near death from leukemia in 2012 when she was
treated, at the Children’s Hospital of Philadelphia. Now 12,
she has been free of leukemia for more than five years.
To customize Kymriah for individual patients, white blood cells
called T cells will be removed from a patient’s bloodstream at
an approved medical center, frozen, shipped to Novartis in
Morris Plains, N.J., for genetic engineering and multiplying,
frozen again and shipped back to the medical center to be
dripped into the patient. That processing is expected to take
22 days.
Novartis said the treatment would be available at an initial
network of 20 approved medical centers to be certified within
a month, a number that would be expanded to 32 by the end of
the year. Five centers will be ready to start extracting T cells 
from patients within three to five days, the company said.

An intravenous bag of Kymriah, which must be customized for individual patients. It is expected to cost $475,000 and can have potentially fatal side effects. 


Certification is being required because the revved-up T cells can
touch off an intense reaction, sometimes called a cytokine
storm, that can cause high fever, low blood pressure,
lung congestion, neurological problems and other life-
threatening complications. Medical staff members need
training to manage these reactions, and hospitals are being
told that before giving Kymriah to patients, they must be sure
that they have the drug needed to treat the problems,
tocilizumab, also called Actemra.
Dr. Kevin J. Curran, a pediatric oncologist at Memorial Sloan
Kettering Cancer Center in Manhattan, said his hospital was
“99 percent” of the way through the certification process, and
would soon be offering Kymriah.
“This is a big paradigm shift, using this living drug,” Dr. Curran
said. “It will provide a lot of hope. This is the beginning.”
He said he expected that eventually this type of treatment
would work for other, more common types of cancer, not just for
The F.D.A.’s approval of Kymriah ushers in “a new approach to
the treatment of cancer and other serious and life-threatening
diseases,” the agency said in a statement, noting that the new
therapy is “the first gene therapy available in the United States.”
Dr. Carl June, a leader in developing the treatment at the
University of Pennsylvania, recalled that in 2010, when tests
showed that the first patient was leukemia-free a month after
being treated, he and his colleagues did not believe it. They
ordered another biopsy to be sure.
“Now, I have to keep pinching myself to see that this happened,”
Dr. June said, his voice breaking with emotion. “It was so
improbable that this would ever be a commercially approved
therapy, and now it’s the first gene therapy approved in the
United States. It’s so different from all the pharmaceutical
models. I think the cancer world is forever changed.”

Sunday, 27 August 2017

New technique for 3D visualization of prostate cancer tumors

Video: Targeted Prostate Biopsy Using MR-Ultrasound Fusion

 Webcast: Prostate Biopsy Using MR-Ultrasound Fusion

Suspicious areas seen on the MRI can be tracked and targeted during prostate biopsy

A new research study at UCLA aims to re-define prostate cancer significance through clinical validation of a tool which allows 3D visualization and tracking of the prostate. By fusing multi-parametric MRI (T2-weighted, diffusion-weighted imaging, dynamic contrast enhancement) with real-time ultrasound, suspicious areas seen on the MRI can be tracked and targeted during prostate biopsy. This research aims to improve currently available methods of cancer diagnosis.

Thursday, 24 August 2017

Prostate Cancer Runs in Families

                               Andre                  Me                      Paul 

Prostate cancer runs in families, and my family gives no better example. My Dad died of it over 20 years ago. Thankfully, that was the reason I had regular checks. It landed on me 7 years ago, and then my brother Paul 4 years ago. We are both still survivors after surgery, but my brother Andre can only wait; will it pass him by? My son Kyle is now within the age group 40+ when he should be having regular PSA checks, but will he? I was diagnosed with no symptoms, my PSA was even within limits! My cancer was about to break out it was so advanced. I was a ticking bomb. I was lucky!
Don't forget, it's not how large your PSA is that gives the clue that it could be prostate cancer, it's the increase in your PSA over time. My PSA was 3.8 before surgery, well within limits, but my doctor spotted that it had grown from 1.1 to 3.8 in just 2 years. Know your PSA. Know it every year and write it down. Know that at least you didn't welcome this cancer in through your front door.

Wednesday, 23 August 2017

Advance in Brachytherapy

A new brachytherapy isotope, Cesium-131, could be a game-changer, a study indicates. Brachytherapy involves placing radioactive implants, or seeds, directly onto tumors to destroy cancer cells while limiting damage to healthy tissue.

Cesium-131 Brachytherapy May Be Prostate Cancer Game-changer, Study Reports

IsoRay Medical markets the Cesium-131 brachytherapy that it developed as GammaTile. It is not only more cost-effective than other treatments, but also generates fewer side effects, researchers said.
Scientists have refined brachytherapy many times since its introduction in 1901. Some experts see Cesium-131 as an optimal version because it is both fast-acting and has a shorter delivery time than other brachytherapies — about 30 days.
A key advantage of Cesium-131 is shorter recuperation periods, meaning patients can recover their urinary, bowel, and sexual functions quicker than with other brachytherapy solutions.
Ninety-five percent of GammaTile’s radiation is confined to the tumors it treats, and the rate of radiation injury is very low, IsoRay said.
The findings suggest that Cesium-131 brachytherapy offers patients an ability to maintain the quality of life they had before treatment better than other options.
“For far too long, patients have been treated for prostate cancer based on a medical professional’s familiarity [with a therapy] or, in some cases, due to far greater financial benefits to the physician,” Brian Moran, medical director of the Chicago Prostate Cancer Center, said in a press release. “This study reinforces that a new, patient-friendly treatment exists. Brachytherapy with Cesium-131 leverages the isotope’s short half-life to significantly reduce the duration of long-term symptoms and side effects.”

Monday, 14 August 2017

Discovery of new prostate cancer biomarkers could improve precision therapy

Mayo Clinic researchers have identified a new cause of treatment resistance in prostate cancer. Their discovery also suggests ways to improve prostate cancer therapy. The findings appear in Nature Medicine.
In the publication, the authors explain the role of mutations in the SPOP gene on the development of resistance to one class of drugs. SPOP mutations are the most frequent genetic changes seen in primary prostate cancer. These mutations play a central role in the development of resistance to drugs called BET-inhibitors.
BET, bromodomain and extra-terminal domain, inhibitors are drugs that prevent the action of BET proteins. These proteins help guide the abnormal growth of cancer cells.
As a therapy, BET-inhibitors are promising, but drug resistance often develops, says Haojie Huang, Ph.D., senior author and a molecular biologist within Mayo Clinic's Center for Biomedical Discovery. Prostate cancer is among the most diagnosed malignancies in the United States. It is also the third leading cause of cancer death in American men, according to the American Cancer Society. Because of this, says Dr. Huang, improving treatments for prostate cancer is an important public health goal.
In the publication, the authors report SPOP mutations stabilize BET proteins against the action of BET-inhibitors. By this action, the mutations also promote cancer cell proliferation, invasion, and survival.
"These findings have important implications for prostate cancer treatment because SPOP mutation or elevated BET protein expression can now be used as biomarkers to improve the outcome of BET inhibitor-oriented therapy of prostate cancer with SPOP mutation or BET protein overexpression," says Dr. Huang. Mutations in the SPOP gene can then be used to guide administration of anticancer drugs in patients with prostate cancer: The Nature Medicine publication presents four major discoveries:
  • BET proteins (BRD2, BRD3, and BRD4) are true degradation substrates of SPOP.
  • SPOP mutations cause elevation of BET proteins in prostate cancer patient specimens.
  • Expression of SPOP mutants leads to BET-inhibitor resistance and activation the AKT-mTORC1 pathway that promotes cancer cell growth and survival.
  • Co-administration of AKT inhibitors overcomes BET inhibitor resistance in SPOP-mutated prostate cancer. Mayo Clinic Ventures, the technology commercialization arm of Mayo Clinic, has a patent application in place for this promising prostate cancer biomarker and therapeutic technology.

Story Source:
Materials provided by Mayo Clinic August 2017

Sunday, 6 August 2017

The robot that could cure your prostate cancer

A guide to the other advances helping win the war against this disease feared by men

     Thirty men a day in the UK die of prostate cancer. It is a gloomy statistic – yet talk to experts in the field and the mood is anything but pessimistic. In fact, there is a sense that science is on the verge of turning the disease from one to be feared to little more than a chronic illness controlled with drugs, like asthma or diabetes.

Survival rates are better than ever: the number of deaths keeps falling and ten years after diagnosis, 84 per cent of men are still alive.
From more accurate screening and less invasive diagnostic techniques to robotic surgery and targeted drugs, huge advances in treatments also mean men are more likely to be cured, and less likely to be left impotent or incontinent – the big worries for most.
Surgeon Christopher Ogden with the da Vinci Xi surgical robot that he uses to perform robotic prostatectomy at the Royal Marsden Hospital, London
Surgeon Christopher Ogden with the da Vinci Xi surgical robot that he uses to perform robotic prostatectomy at the Royal Marsden Hospital, London

‘Soon this could be a disease that men routinely survive, and has little impact on their daily life,’ says Dr Iain Frame, research director at the charity Prostate Cancer UK.
But with advances in therapies comes new information for every man with prostate cancer and his loved ones to absorb – much of it complex. We spoke to Britain’s foremost experts, who between them have treated tens of thousands of men, about the new developments every patient should be aware of and the treatments that really do make a difference…
Christopher Ogden is a surgeon at the Royal Marsden Hospital in London
Christopher Ogden is a surgeon at the Royal Marsden Hospital in London
Christopher Ogden, a surgeon at the Royal Marsden Hospital in London, pioneered the use of robotic surgery for prostate cancer – treating more than 2,500 men with a technique that revolutionised the treatment of the disease. 
He says: ‘Although surgery might not be the first thing we offer men with prostate cancer, many will at some point need to have the gland removed. The operation is called a radical prostatectomy and it offers a cure in 95 per cent of cases.
‘Decades ago, the only option was open surgery – with the prostate removed through a long incision below the navel. Then came keyhole surgery, where instruments and a camera were inserted though several tiny cuts in the abdomen.
‘About 13 years ago, I was the first British surgeon to use the Da Vinci robot, which is a high-tech version of keyhole surgery, where instruments are held by a machine with robotic arms.
‘Back then it was seen as a bit outlandish. Now it’s the gold standard in surgery, with nearly 100 robots in the country, and hundreds more surgeons trained to use them.
‘The arms are controlled by the surgeon from a console next to the operating table. The procedure eliminates the risk of surgical error through hand tremors or shakes. And the video display in the console is highly magnified, which means we are better at avoiding damage to nearby nerves.
‘This means the risk of the complication feared most by men, erectile dysfunction, may be reduced.
‘The robot performs at least twice as well as the best surgeon in getting all cancer out in one go – reducing the need for repeat surgery, and greater risk of erectile dysfunction and incontinence.’
Professor Roger Kirby is a consultant urologist and director of The Prostate Centre in London
Professor Roger Kirby is a consultant urologist and director of The Prostate Centre in London
Professor Roger Kirby, consultant urologist and director of The Prostate Centre in London, is a leading light in the field, having published more than 300 scientific papers on prostate tumours. He says:
‘Today, two-thirds of men with prostate cancer will never need to have surgery, and can instead undergo active surveillance – where regular checks are carried out to see if the tumour is progressing. If the cancer remains small and slow-growing, then there is no reason to operate.
‘Last year a study that tracked 1,600 men with prostate cancer for ten years found no difference in survival rates between men who had active surveillance, surgery or radiotherapy.
‘If they do need treatment, there are several options before surgery. Prostate tumours are very sensitive to testosterone, so we give men powerful hormone-blocking drugs which slow down cancer growth.
‘High-Intensity Focused Ultrasound [HIFU] – where a targeted blast of ultrasound is fired at the cancerous part of the prostate – destroys the tumour by heating it but leaves the rest of the prostate intact. But it's only offered on the NHS in clinical trials, and more research is needed before it can be more widely used.
‘Radiotherapy and chemotherapy also remain important treatment options – but robotic surgery may mean less so in the future.’
Nicholas James is Professor of Clinical Oncology at the Institute of Cancer and Genomic Sciences at the University of Birmingham
Nicholas James is Professor of Clinical Oncology at the Institute of Cancer and Genomic Sciences at the University of Birmingham
Nicholas James is Professor of Clinical Oncology at the Institute of Cancer and Genomic Sciences at the University of Birmingham, and chief investigator of the huge Cancer Research UK-funded STAMPEDE trial into treating aggressive prostate cancer. He says:
‘Prostate cancer is often in the news with stories of new drug developments, treatments, and tests. However, until a therapy is approved for use in the NHS, often the only way to access it is via a clinical trial.
‘I recommend men get themselves on to one if they can, and there are many being run by the NHS right now.
‘In a trial, all treatment must be done to impeccable standards to ensure the quality of the data.
‘This means that even patients who aren’t receiving the “new” drug or whatever is on trial still get a gold-standard level of quality when it comes to treatment.
‘If you are told there is a trial that isn’t suitable for you at the moment, then fine, but if your hospital simply doesn’t run trials, then I would try to look elsewhere for treatment. It is a badge of quality if a hospital is actively engaged in clinical trials.
‘One of the biggest recent treatment breakthroughs was discovered in the Cancer Research UK-funded STAMPEDE trial that I led.
‘There is also growing evidence from another British trial that doing an MRI of the prostate might spare some men the ordeal of a biopsy.
‘The scans also enable us to keep monitoring the patient more safely without them having to have a needle inserted into the prostate.
‘This means surveillance becomes safer, and more men will be able to avoid radiotherapy and surgery – in some cases totally, others for as long as possible.’
Dr Iain Frame is research director for the charity Prostate Cancer UK
Dr Iain Frame is research director for the charity Prostate Cancer UK
Dr Iain Frame, research director for the charity Prostate Cancer UK, describes it's ambitious’ ten-year plan to halve mortality and bolster survival through better diagnosis and new treatments. He says:
‘Our main goal is to improve diagnoses, which will cut death rates by picking up cancers at an earlier stage. At the moment we are not very good at differentiating very aggressive tumours from the slow-growing ones that may never cause a problem.
‘So we are funding research looking at ways to tell them apart – in cancer blood tests that have been dubbed liquid biopsies.
‘Most middle-aged men will be familiar with prostate specific antigen or PSA testing. The newer tests being researched look for genetic material and other compounds in the blood that are produced by tumours, and can tell us about the cancer without us actually having to take solid samples.
‘Last year, we drew up a ten-year plan which has a key objective of halving halve the number of deaths to about 7,000 a year by 2026, and better diagnosis will help make this a reality. We think it is ambitious but achievable.’
Rock drummer Kenney Jones has played in The Faces and The Who 
Rock drummer Kenney Jones has played in The Faces and The Who 
Rock drummer Kenney Jones, 68, of iconic bands The Faces and The Who, was diagnosed in 2013. The father- of six, who lives in Surrey with wife Jayne, 59, is now cancer-free. He says:
‘I am passionate about talking about prostate cancer because I want men to catch it early, giving them a better chance of survival.
‘I was incredibly lucky to have been caught at the “late” end of early. The disease was still contained inside the prostate.
‘But looking back, I’d had symptoms for years. I blamed getting up two or three times a night on having a few glasses of wine in the evening. I also ignored the fact that my urine flow had slowed down.
‘I was offered a PSA test, a blood test that can detect problems with the prostate, while at my GP surgery for something else. I’d never heard of this test, but it saved my life. Just over a week later I was diagnosed with prostate cancer and discussing treatment options.
‘My biggest worry was whether the cancer had spread. Thankfully, it hadn’t – and I was offered brachytherapy, a type of radiotherapy.
‘This involved having 80 tiny titanium pellets inserted into my prostate to kill the tumour. They blast away at it for a few months and once they’ve done their job, they become inert and remain inside.
‘There were side effects – the radioactivity causes the prostate, bladder and the whole area to become inflamed. I couldn’t pee. It all calmed down after a few months and it worked. I am cancer-free and everything down there works fine.
‘All men need to talk about prostate cancer. It’s a killer – I lost my friend Alvin Stardust to it because he was diagnosed so late.
‘I have also warned my four sons to be vigilant – there were many men younger than me in hospital when I was there. This disease doesn’t discriminate.’

Don't fear THAT won't hurt! 

By Dr Ellie Cannon  
Q) Does a test still involve THAT rather intimate examination?
A) A digital rectal examination is the normal way for a GP or specialist to examine a prostate. The gland is located in the pelvis, below the bladder, and can be examined by placing a finger into the rectum. It’s really not painful, and we do it all the time so you shouldn’t be embarrassed. The doctor can feel whether the prostate feels hard and irregular, which may be a sign of cancer. Urinary tract symptoms can also signal many far more common benign conditions, so an examination is an important way to distinguish between these.
Q) Is there anything I can do to reduce my risk?
A) Unlike other cancers, there are no ‘modifiable’ risk factors for prostate cancer – ones that you can improve yourself through lifestyle changes such as diet. It’s why screening tests and awareness is so important.
Q) If it’s not prostate cancer, what’s causing my symptoms?
A) You are far more likely to have a benign prostate condition than prostate cancer. Lower urinary tract symptoms such as waking at night to pass water, difficulties with flow and the increased need to go are common in men. These can be the signs of cancer but are also symptoms of benign prostate enlargement – a noncancerous condition treated with medication.
Q) Who needs to worry about prostate cancer?
A) A quarter of all new cancers in men are prostate, making it the most common male cancer – so really all men need to know about it. The average age of diagnosis is 72 and it is considered uncommon under the age of 50. Men from black Caribbean or African ancestry are at highest risk – and they are also more likely to have a more aggressive cancer. Your risk is increased by 2.5 times if your father had it.

Daily Mail publication August 2017