Posts tagged ‘prostate cancer’
Jonathan Yamzon, M.D., assistant clinical professor of surgery in the Division of Urology and Urologic Oncology, explains his approach to what’s known as “active surveillance” of men with prostate cancer. Patients need to be educated about their treatment options, he writes.
Active surveillance eligibility
Active surveillance is an option offered to patients with “low-risk” prostate cancer. It entails forgoing any immediate treatment, and instead monitoring a patient’s cancer to ensure it shows no signs of worsening. If there are any signs of disease progression, the option for curative treatment can still be offered. Active surveillance attempts to avoid unnecessary treatments for patients with prostate cancers that may not become clinically significant or impactful to a man’s life.
Such treatments have potential risks for side effects. Those considered low-risk have a prostate specific antigen (PSA) value of less than 10, a biopsy Gleason of six or less, and a rectal exam that reveals nothing beyond a small nodule confined to one side of the prostate. When one of my patients embarks on active surveillance, I repeat the PSA, rectal exam and biopsy to ensure that their tumor is in fact truly low-risk. The success of this strategy is predicated on recurring follow-ups and reassessment to detect worsening changes of the tumor grade, volume or stage. It is important to understand that if there are signs of cancer progression, we can still offer treatment with curative intent.
Currently, our ability to stratify who is low-risk is based on clinical parameters of the PSA, Gleason score and clinical stage, which is detected by a rectal exam. Newer biomarkers are being studied to improve risk stratification, including the use of novel markers in serum, urine, biopsy tissue and radiographic test like magnetic resonance imaging (MRI).
For most prostate cancer patients, surgery or radiation therapy is the initial and primary treatment against the disease. But some patients can benefit from chemotherapy and hormone therapy too, especially if there are signs of a relapse or if the cancer has spread beyond the prostate gland.
Here, Cy Stein, M.D., Ph.D., City of Hope’s Arthur & Rosalie Kaplan Chair in Medical Oncology, explains the role of drug therapy in treating prostate cancer, as well as recent and upcoming drug breakthroughs against the disease.
When is hormone therapy and/or chemotherapy an appropriate treatment for prostate cancer?
In many ways, when to start hormone and drug therapies for a prostate cancer patient is an art. That is because clinicians have to account for numerous factors, including the patient’s age and health, the cancer stage and biology and the disease response to other therapies. For example, hormone therapy may be considered if a patient relapses following surgery and radiation therapy. Meanwhile, chemotherapy may be prescribed for a cancer that has metastasized to other organs or one that does not respond to other treatments.
Additionally, hormone therapy and chemotherapy protocols for prostate cancer are constantly evolving with new research findings. For example, a recent major study showed that combining hormone therapy with chemotherapy early on is significantly more effective against prostate cancer than hormone therapy alone, thus changing clinical guidelines and standards of care.
In short, both hormone and drug therapies can become an integral part of prostate cancer treatment by preventing relapse, slowing its growth and even driving it back into remission. But these treatments also require meticulous planning by medical oncologists in collaboration with others in the patient’s care team and in alignment with the latest evidence.
What are some recent drug breakthroughs against prostate cancer? » Continue Reading
September is Prostate Cancer Awareness Month. Here, Bertram Yuh, M.D., assistant clinical professor in the Division of Urology and Urologic Oncology at City of Hope, explains the importance of understanding the risk factors for the disease and ways to reduce those risks, as well as overall prostate health.
“What are my prostate cancer risks?” That’s becoming a more common, and increasingly important, question.
A lot of men wonder what can be done to prevent or reduce their risk of prostate cancer. The good news is, there’s a lot of research being conducted in this area regarding risks and influencing factors.
We already know there are racial predilections, such as that African-American men are more likely to get prostate cancer and that, when they’re diagnosed, the cancer tends to be more aggressive. We also know that prostate cancer is less common in Asian-American and Hispanic men.
Further, while prostate cancer is certainly more common in older men, there is some recent clinical literature that states prostate cancer in younger men can be more aggressive. It is quite possible for a 47-year-old and a 77-year-old to have prostate cancers that behave differently.
I can’t treat every patient the same way just because their prostate-specific antigen (PSA) or Gleason grades look the same. In my role as a urology oncologist, I need to look at the whole patient.
Learn more about getting a second opinion at City of Hope by visiting us online or by calling 800-826-HOPE (4673). City of Hope staff will explain what’s required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.
Jennifer Linehan, M.D., an assistant clinical professor in City of Hope’s Division of Urology and Urologic Oncology in Antelope Valley, thought she knew all there was to know about treating prostate cancer. Then her father was diagnosed with the disease. This is her story.
My father is 69 years old, has no health problems, is very active and still works diligently every day, from 5 a.m. till the evening. He is always smiling, laughing and enjoying life no matter what comes his way. He is an inspiration to me.
About 12 months ago, I was waiting for him to send me his prostate specific antigen (PSA) results from his recent physical. I just wanted to take a look. He was busy at work and told me that his PSA number was fine. I asked my mom to email it to me anyway. His PSA score was 28. I was stunned. I re-read the number at least twice to make sure it didn’t read 2.8 instead of 28.
How could this be? I am a urologist. How did I miss this? My head spun as every worst-case scenario started to fill my mind. As I was trying to calm down, I realized he needed a prostate biopsy. I started to think about who would do his surgery. He needed to come to City of Hope. My thoughts were racing. I began to wonder how far the disease had spread.
Finally, I got the nerve to call my parents; they could hear that my voice was panicked. I was panicked. I knew the realities that came with a high PSA and being diagnosed with prostate cancer. I was trying to keep calm, but instead blurted out: “How did this happen? Hasn’t your primary care physician been checking?”
Apparently, my father had been given the option of having his PSA checked for the last five years, but he refused every time. He told me that it was easier not knowing and not getting checked, because he was feeling fine. I tried to explain to him that prostate cancer is a silent killer. Often, a man won’t have any symptoms until the disease has progressed into the spine. I took a deep breath, apologized for my overreaction, and walked my parents through the next steps.
I was supposed to be the calm one, in control, but it’s all so different when someone so close to you is diagnosed.
Counter-intuitive though it might seem, a prostate cancer diagnosis shouldn’t always lead to immediate prostate cancer treatment.
Although prostate cancer is the second-leading cancer killer of men, behind lung cancer, and causes more than 29,000 deaths in the U.S. each year, in many cases, the tumors are small, slow-growing and confined. That means that most prostate cancer tumors might not automatically warrant medical intervention.
“Active surveillance,” in which physicians closely monitor patients so they can identify early signs of disease progression, is emerging as the best course of action for many men with prostate cancer. The strategy enables doctors to treat cancer before it becomes a serious threat, while avoiding unnecessary risk by treating tumors unlikely to spread. » Continue Reading
More than 18,000 researchers, clinicians, advocates and other professionals will convene at the 105th American Association for Cancer Research (AACR) annual meeting taking place in San Diego from April 5 to 9. With more than 6,000 findings being presented over this five-day period, the amount of information can seem overwhelming.
But all those posters, presentations and seminars serve a purpose, which is best summed up by the theme of this year’s meeting: “Harnessing Breakthroughs –Targeting Cures.”
“We are in the generation of personalized, precision medicine where we can learn a great deal about cancers,” said Steven T. Rosen, M.D., City of Hope’s Irell & Manella Cancer Center Director’s Distinguished Chair. “Conferences such as AACR’s annual meeting lead to true dialogue, exchange of information and collaboration. This not only benefits the scientists’ own research projects, but also leads to meaningful advances for treating, detecting and preventing cancers.”
Added Rosen, who is also City of Hope’s provost and chief scientific officer: “City of Hope investigators are well-represented at this year’s annual meeting. They have made significant contributions to our understanding of cancers. This includes furthering our knowledge of individual cancers’ epidemiology and etiology, developing novel therapies and enhancing survivorship.”
The findings and knowledge that City of Hope researchers are sharing at this year’s conference include: » Continue Reading
Cancer of the prostate is the No. 2 cancer killer of men, behind lung cancer, accounting for more than 29,000 deaths annually in this country. But because prostate cancer advances slowly, good prostate health and early detection can make all the difference.
Many prostate cancer tumors don’t require immediate treatment because they’re small, confined and slow-growing. For patients with these type of tumors, so-called “watchful waiting,” increasingly known as “active surveillance” may be the best course of action. In “active surveillance,” physicians closely monitor patients so they can identify early signs of disease progression and treat the cancer before it spreads outside the prostate.
Here, Philip G. Pearson, M.D., and David W. Rhodes, M.D., of City of Hope | Pasadena, provide simple strategies that can help men better understand this important gland. They also explain why active surveillance is becoming a more common prostate cancer management option. » Continue Reading
Men with prostate cancer face tough choices: when, or even if, to treat their cancer; what procedure to use; and how to balance their chosen treatment with their quality of life. Now, a new multicenter clinical trial seeks to offer men another option – one that physicians hope will treat prostate cancers with fewer side effects.
As part of that trial, City of Hope has become the first center in the nation to perform a new procedure using a focused beam of ultrasound energy to “ablate” the prostate cancer. Traditional treatment approaches, such as surgery and radiation, are potentially very effective in treating prostate cancer – but some men are left facing incontinence or impotence. (Men with very slow-growing cancers may choose a “watch and wait” approach, monitoring the cancer and determining appropriate interventions if they become necessary.) » Continue Reading