Posts tagged ‘prostate cancer’
My colleagues in the clinic know I’ve got a soft spot. Last week, a patient of mine offered me a fantastic compliment. “You’re looking younger these days, Dr. Pal!” she said, offering me a big hug as she proceeded out of the clinic room.
Lovely, I thought. The early morning workouts are paying off.
She continued: “Now if you’d just consider using some Rogaine, I think you’d set the dial back about 10 years!”
Ouch. My nurse gave me a somber look, understanding the pain these words had inflicted. I wouldn’t consider myself to be vain by any means, but my hair loss has created increasing conflict between me and my bathroom mirror. With every passing morning, I notice a little less hair up front, and a bit less up top. This pattern, termed frontal and vertex balding respectively, plagues nearly half of American males, albeit to different degrees. Until recently, the major toll of this hair loss for me has been cosmetic, chipping away at my self-image as a youthful oncologist.
A recent study published in the Journal of Clinical Oncology, however, suggests a more significant price. The study authors, based at several U.S. institutions, utilized a database of over 39,000 male patients who were involved in a trial to assess cancer screening. These men were asked to recall their pattern of hair loss at the age of 45, characterizing the degree of frontal and vertex balding. » Continue Reading
Pick up any biotech industry report and you’re guaranteed to come across one term repeatedly – CAR-T therapy. A fierce competition is now underway to bring CAR-T treatments to market – several companies (Juno, Novartis, Kite and Cellectis, to name a few) have major stakes in the race. I’ve found the CAR-T buzz has also penetrated the clinic — not a day goes by that I don’t have a conversation with a patient regarding this emerging technology.
So what is CAR-T? Essentially, it’s an engineered immune cell (called a T cell) that has on its surface a highly specific protein called a chimeric antigen receptor (CAR). These “souped up” immune cells can mount a potent and highly specific attack against tumors.
Last year, a group of researchers from the University of Pennsylvania published results in the New England Journal of Medicine pertaining to 30 patients who had received CAR-T therapies. These patients were suffering from a relapse of acute lymphoblastic leukemia (ALL) and had failed standard treatments. The results were nothing short of remarkable – at six months following treatment, roughly two-thirds of patients remained free of disease.
These findings were a phenomenal leap forward for patients with this relatively rare disorder. A couple of roadblocks stand in the way of further development of CAR-T cells, however. » Continue Reading
The prostate cancer screening debate, at least as it relates to regular assessment of prostate specific antigen levels, is far from over.
The U.S. Preventive Services Task Force recommended against routine PSA screening for prostate cancer in 2012, maintaining that the routine use of the PSA blood test does more harm than good, threatening men’s quality of life. Many doctors and other medical professionals, however, never accepted this recommendation as prudent. They’ve continued to debate, or argue, the benefits and risks of regular prostate cancer screening.
A new study, led by Timothy E. Schultheiss, Ph.D, professor and chief of radiation physics at City of Hope, will add data fuel to the debate fire. In findings presented this week at the 2015 Genitourinary Cancers Symposium in Orlando, Florida, Schultheiss reports that the recommendations against PSA screening for prostate cancer may have led to an increase in higher-risk prostate cancer.
Schultheiss and his colleagues analyzed data on nearly 87,500 men treated for prostate cancer since 2005 and found a 6 percent increase in intermediate and higher-risk cases of the disease between 2011 and 2013. They estimated that the suggested trend could produce an additional 1,400 prostate cancer deaths annually.
For men walking out of the doctor’s office after a diagnosis of cancer, the reality can hit like a ton of bricks. The words echo: “Prostate cancer” … “Aggressive prostate cancer.” The initial feelings of grief, denial and anger are mixed with many thoughts: How much time do I have left? What else do I want to accomplish? What about my family, job and retirement plans?
Prostate cancer is the most common cancer in men – and the second-leading cause of cancer death – and a diagnosis of aggressive disease is often life-changing. As a urological oncology expert, I see men face the ups and downs of their diagnosis.
Although slow-growing cancers take decades to cause serious problems, fast-growing, or high-risk, cancer has the potential to quickly spread to other parts of the body. These tumors occur in up to 25 percent of men with prostate cancer, encompassing cancers of high Gleason grade, high levels of prostate specific antigen (PSA) or extremely abnormal prostates on physical exam.
Even if tests indicate that the cancer is only in the prostate, the prospect of cancer spreading or leading to death is anxiety-provoking and intimidating. Once men are able to reach the acceptance phase, the primary question becomes: What are my treatment options?
At City of Hope, our multidisciplinary team manages aggressive prostate cancer and the circumstances in which men need multiple forms of treatment. We not only have a proven track record in surgery for high-risk cancer, we also provide extended lymph node dissection, which offers extremely accurate assessment of the cancer’s spread. » Continue Reading
With this week’s World Cancer Day challenging us to think about cancer on a global scale, we should also keep in mind that daily choices affect cancer risk on an individual scale. Simply put, lifestyle changes and everyday actions can reduce your cancer risk and perhaps prevent some cancers.
According to the World Cancer Research Fund, about a third of the most common cancers could be prevented through reduced alcohol consumption, healthier diets and improved physical activity levels. If smoking were also eliminated, that number could jump to as many as half of all common cancers.
Here are a few suggestions. Truly, they’re not that difficult. Give them a try this week to mark World Cancer Day, Feb. 4, Try them the next week too. And the week after that …
In a word, exercise. Simple exercise benefits everyone, and even a little helps. Leslie Bernstein, Ph.D., professor and director of the Division of Cancer Etiology at City of Hope, recommends a 45-minute walk five days a week. While that is ideal, her research has found that, for some people, even 30 minutes per week can make a difference. The benefit of exercise applies for people of all weights and fitness levels.
The American Cancer Society recommends 150 minutes of moderate intensity or 75 minutes of high intensity exercise each week, preferably spread throughout the week. Don’t deny yourself the benefits just because you don’t have a large block of time or can’t get into the gym for a more formal workout. » Continue Reading
Explaining a prostate cancer diagnosis to a young child can be difficult — especially when the cancer is incurable. But conveying the need for prostate cancer research, as it turns out, is easily done. And that leads to action.
Earlier this year, Gerald Rustad, 71, who is living with a very aggressive form of metastatic prostate cancer, found himself trying to explain his heath condition to 10-year-old granddaughter Aurora.
He told her that his cancer couldn’t be cured, but that scientists at City of Hope were busily conducting research so they could help patients like himself. His doctor, for example, Sumanta Pal, M.D., co-director of City of Hope’s Kidney Cancer Program, was working with other City of Hope researchers to develop a drug that could treat metastatic prostate cancer without targeting testosterone.
The targeting of testosterone is too arcane for most 10-year-olds, but the need for scientific answers isn’t. Aurora asked if there were any way she could help. » Continue Reading
The American Cancer Society’s annual statistics show the death rate from cancer in the U.S. is down significantly from its peak more than a decade ago – certainly a reason to celebrate. But before the kudos give way to complacency, be forewarned: A number of increasingly serious public health issues could send cancer deaths and cancer incidence climbing again.
That’s the sobering perspective provided by City of Hope’s provost and chief scientific officer, Steven T. Rosen, M.D.
He added some context to the annual statistical analysis from the American Cancer Society. That analysis found that the death rate from cancer has dropped 22 percent from its peak in 1991; amounting to about 1.5 million deaths from cancer avoided. Between 2007 and 2011 – the most recent five years with data available – new cancer cases dropped by 1.8 percent per year in men and stayed the same in women. Cancer deaths decreased 1.8 percent per year in men and 1.4 percent in women for that same period of time.
Rosen attributed the overall decline in deaths to a number of factors, namely prevention, early detection and better therapies. » Continue Reading
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 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.