Does hormone therapy for prostate cancer raise dementia risk?

by Steven Reinberg, Healthday Reporter

When men with prostate cancer have to take drugs that block the testosterone fueling their tumors, they can suffer a host of side effects that include impotence, bone loss, heart trouble and obesity.

12 may 2019--But new research uncovers yet another possible downside to the treatment: These men may be at greater risk for dementia.

For any type of dementia, that risk increased 17%; for Alzheimer's disease, it increased 23%, the researchers said.

Common side effects of so-called androgen-deprivation therapy include hot flashes, unstable mood, trouble sleeping, headaches, high blood sugar, allergic reactions and impotence.

"Androgen-deprivation therapy may not only cause physical changes —such as osteoporosis, cardiovascular disease or obesity—but may also cause changes in cognition," said researcher Dr. Karl Tully, a research fellow at Brigham and Women's Hospital in Boston.

But Tully cautioned that this study cannot prove that such hormone therapy caused dementia, only that the two are associated.

The investigators also found that men on this type of therapy had a 10% greater risk of seeking psychiatric services.

The risk for dementia increased as the length of therapy increased, the researchers noted. Men on androgen-deprivation therapy for six months had a 25% increased risk for any kind of dementia and a 37% increased risk for Alzheimer's, the findings showed.

Being on hormone therapy longer than six months increased the risk for dementia and using mental health services even more, Tully said.

For the study, Tully and his colleagues collected data on more than 100,400 men enrolled in Medicare. The men were diagnosed with prostate cancer between January 1992 and December 2009.

Given these findings, "physicians should be telling their patients about that risk and should probably perform regular screening," Tully said.

One urologist, however, doesn't think patients need to be told about this tenuous association.

"I don't think it's a fair discussion to have," said Dr. Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York City.

In this population, the increase in dementia may not be from hormone therapy at all, Kavaler said. As people live longer, the odds of developing dementia naturally increase.

Moreover, many of these patients probably had other medical conditions that might increase their risk for dementia and Alzheimer's, Kavaler added.

"Earlier generations were all worried about cancer—we're worried about dementia," she said.

In addition, patients with prostate cancer may not have a good option whether to start hormone therapy or not, she noted.

"We really don't have a choice. Androgen-deprivation therapy is what can be offered to men with recurring or advanced prostate cancer. It's a matter of treating a deadly disease versus the risk of developing a non-life-threatening condition," Kavaler said.

"How do you ask somebody to choose between losing your mind or not treating their high-risk disease," she said. "It's a hard position to put a patient in. I wouldn't even bring it up."

The findings were scheduled to be presented Sunday at the American Urological Association annual meeting, in Chicago. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information: Karl Tully, M.D., research fellow, Brigham and Women's Hospital, Boston; Elizabeth Kavaler, M.D., urology specialist, Lenox Hill Hospital, New York City; May 5, 2019, presentation, American Urological Association, Chicago

Visit the American Cancer Society for more on prostate cancer.

Study finds upsurge in 'active surveillance' for low-risk prostate cancer

by Dana-Farber Cancer Institute

A section of a prostate gland containing numerous cancer cells. Credit: Dana-Farber Cancer Institute

Many men with low-risk prostate cancer who most likely previously would have undergone immediate surgery or radiation are now adopting a more conservative "active surveillance" strategy, according to an analysis of a new federal database by scientists from Dana-Farber Cancer Institute.

13 feb 2019--The use of active surveillance increased from 14.5 percent to 42.1 percent of men with low-risk prostate cancer between 2010 and 2015, said the researchers, led by Brandon Mahal, MD, from the department of radiation oncology at Dana-Farber/Brigham and Women's Cancer Center who led the study published by JAMA.

During that same period, the percentage of men undergoing radical prostatectomy (removal of the prostate gland) declined from 47.4 percent to 31.3 percent. The use of radiotherapy for low-risk disease dropped from 38.0 percent to 26.6 percent.

"What we know from high level evidence is that conservative management of low-risk prostate cancer is associated with a very favorable prognosis," said Mahal. "Many men with low-risk disease are able to be spared the toxicity of treatment so it's an important discussion to have between clinicians and patients."

National guidelines advocating conservative management rather than immediate "definitive treatment" with surgery or radiotherapy were established in 2010 for men with low-risk prostate cancer. Low-risk disease is defined as a small tumor confined to the prostate gland that is assigned a grade of 6 on the Gleason scale following a biopsy; an early pathological stage, and a low PSA (prostate-specific antigen) blood level. 

Brandon Mahal, MD from the department of radiation oncology at Dana-Farber/Brigham and Women's Cancer Center explains research findings on conservative management for low-risk prostate cancer. Credit: Dana-Farber Cancer Institute

"This encouraging finding suggests that clinicians are better adhering to current recommendations and guidelines for men with low-risk prostate cancer, as the use of active surveillance in appropriately selected men will reduce rates of overtreatment," said Howard Soule, Ph.D., executive vice president and chief science officer of the Prostate Cancer Foundation.

Mahal said men with low-risk tumors have a "very, very low risk of dying" from prostate cancer, and that invasive treatments don't necessarily improve survival odds. In the current study, Mahal and his colleagues, including senior author Paul Nguyen, MD, a Dana-Farber/Brigham and Women's Cancer Center radiation oncologist, made use of a federal database that for the first time specified whether patients made use of watchful waiting or active surveillance. (Patients adopting a watchful waiting approach are told to report symptoms such as changes in urinary habits, pain, or irritation, or bone pain that could reflect metastatic progression. Active surveillance involves periodic follow-up tests for PSA levels, repeat biopsies, and exams by a doctor every six to 12 months).

The study also revealed changes in treatment for high-risk prostate cancer from 2010 to 2015—though the researchers were somewhat surprised by the findings. The use of radical prostatectomy increased from 38 percent to 42.8 percent during that period, while radiotherapy decreased from 60.1 percent to 55 percent.

"This shift in management patterns away from radiation therapy and toward more radical prostatectomy is not supported by any recent high-level studies," said Mahal. "This finding is provocative and may be a focal point of debate."

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More information: JAMA (2019). DOI: 10.1001/jama.2018.19941

Provided by Dana-Farber Cancer Institute

Final verdict on finasteride: Safe, effective prevention for prostate cancer

by SWOG Cancer Research Network

Ian Thompson, MD, SWOG principal investigator of the Prostate Cancer Prevention Trial. Credit: SWOG Cancer Research Network

Finasteride, a generic hormone-blocking drug, was found to reduce the risk of prostate cancer by 25 percent in the landmark Prostate Cancer Prevention Trial (PCPT). Long- term data, published today in the New England Journal of Medicine, show that reduction in prostate cancer risk has continued and fewer than 100 men on the trial died from the disease.

23 jan 2019--SWOG Cancer Research Network, an international cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health, opened the PCPT for enrollment 25 years ago. The PCPT enrolled 18,882 men from 1993 to 1997, making it one of the largest prostate cancer clinical trials ever conducted. New results, which reported participant deaths over two decades, show that finasteride has the lasting effect of reducing prostate cancer risk. Results also eliminate concerns over initial findings of a possible risk of more aggressive cancers with finasteride use.

"Finasteride is safe, inexpensive, and effective as a preventive strategy for prostate cancer," said Ian Thompson, Jr, MD, principal investigator of the PCPT for SWOG. "Doctors should share these results with men who get regular prostate-specific antigen tests that screen for the presence of prostate cancer. The drug will have its greatest effect in this group of men."

Thompson is chair of SWOG's genitourinary cancer committee and serves as president of CHRISTUS Santa Rosa Hospital—Medical Center in San Antonio, Texas and as emeritus professor at the University of Texas Health Science Center. Along with SWOG biostatisticians Catherine Tangen, DrPH, and Phyllis Goodman, MS, of Fred Hutchinson Cancer Research Center, Thompson sought to determine whether the increased number of high-grade cancers detected through the PCPT years ago would result in more prostate cancer deaths over time.

SWOG published the first PCPT results in 2003. Investigators reported a significant, positive result: finasteride reduced prostate cancer risk by 25 percent. But the study also cast a shadow on the drug, the first 5-alpha-reductase inhibitor which targets and blocks the action of androgens like testosterone and is commonly used to treat lower urinary tract problems in men and also male pattern baldness. The results showed that finasteride increased the number of high-grade prostate cancers—a finding that resulted in a drug label warning posted by the U.S. Food and Drug Administration. That warning persists to this day.

So is finasteride safe in the long run? Thompson, Tangen, and Goodman matched participants to the National Death Index, a centralized database of death record information managed by the U.S. Centers for Disease Control and Prevention. This analysis allowed the SWOG team to determine if a trial participant had died, and if so, the cause of death. With almost 300,000 person-years of follow-up and a median follow-up of 18.4 years, they found 42 deaths due to prostate cancer on the finasteride arm and 56 on the placebo arm. Thus, there was no statistically significant increased risk of prostate cancer death with finasteride.

In the NEJM letter, the team notes that a cheap, reliable prostate cancer prevention drug will have a big impact on public health. Due to a rise in screening for the disease, prostate cancer diagnoses are on the rise, with the American Cancer Society estimating that 164,690 American men would be diagnosed in 2018. While many of these cancers will be slow-growing, and not life-threatening, they are still often treated with surgery and radiation, resulting in common complications such as impotence and incontinence.

"There are significant negative consequences to patients' health and quality of life that can result from prostate cancer treatment, as well as to their finances and their peace of mind," Thompson said. "If we can save people from surgeries, and scores of examinations and tests, and spare them from living for years with fear, we should. The best-case scenario for patients is prevention, and this trial has found an inexpensive medication that gets us there."

Provided by SWOG Cancer Research Network

Surgery for early prostate cancer may not save lives

Gerald L. Andriole, M.D., (right) director of Washington University's Division of Urologic Surgery, performs surgery on a patient with prostate cancer. New research provides further evidence that surgery is unnecessary for early-stage prostate cancer, although some men whose disease is further along may benefit.

15 july 2017--A major 20-year study provides further evidence that prostate cancer surgery offers negligible benefits to many men with early-stage disease. In such men, who account for most cases of newly diagnosed prostate cancer, surgery did not prolong life and often caused serious complications such as infection, urinary incontinence and erectile dysfunction.
The study, by a national research team including Washington University School of Medicine in St. Louis, was led by the Minneapolis Veterans Administration Health Care System. It is published July 13 in The New England Journal of Medicine.
In men with early prostate cancer, the study compared surgery with observation. With the latter, men only were treated if they developed bothersome symptoms, such as urinary difficulty or bone pain. Such symptoms may indicate progression of the cancer. Many men in the observation group received no treatment at all because early-stage prostate cancer often grows slowly and rarely causes symptoms.
"The findings will go a long way in helping to improve prostate cancer care," said co-author Gerald L. Andriole, MD, director of Washington University's Division of Urologic Surgery. "About 70 percent of patients newly diagnosed with prostate cancer cases are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors. As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary. We hope the findings will steer doctors away from recommending surgery or radiation to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it's necessary."
The American Cancer Society ranks prostate cancer as the second most common cancer in men and the third-leading cause of cancer deaths among men, after lung and colorectal cancer. In 2017, about 161,360 men will be diagnosed with prostate cancer, and 26,730 will die from it.
The study, known as the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, is one of the largest and longest involving cancer patients. It got underway in 1994 just as the prostate-specific antigen blood test for prostate cancer became routine. With many more men diagnosed with prostate cancer, the standard treatment for all prostate cancers became surgery or radiation, with the thinking that removing or irradiating the tumor would increase survival. But over the next decade, reports of treatment-related complications raised concerns, as did data indicating that most early-stage cancers grew so slowly they were unlikely to cause health problems.
To evaluate any potential benefits of surgery, the researchers randomly assigned 731 men in the U.S. with localized prostate cancer to receive either surgery or observation at one of 44 Department of Veteran Affairs Health Care Centers or eight academic medical centers, including Washington University. The average age of men in the study was 67 at the time of enrollment.
Of the men who had prostate cancer surgery, 223 (61 percent) died of other causes after up to 20 years of follow-up, compared with 245 men (66 percent) in the observation group - a difference that is not statistically different. Further, 27 (7 percent) men in the surgery group died of prostate cancer, compared with 42 men (11 percent) in the observation group, but that difference also is not statistically significant.
However, the data show that surgery may have a mortality benefit in some men, particularly those with a long life expectancy and intermediate-risk prostate cancer. (Such men generally have PSA scores of 10-20 ng/ml and a Gleason score of seven. The latter score signifies tumor aggressiveness.)
"It would be a disservice to dismiss surgery as a viable option for patients with intermediate-risk prostate cancer," said Andriole, the School of Medicine's Robert K. Royce Distinguished Professor of Urologic Surgery. He treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. "For these patients, and for some men with high-risk prostate cancer, surgery is often beneficial, as are other other treatments such as radiation."
Technology has advanced since the study began, allowing physicians to more accurately classify tumors and avoid overtreating patients who have prostate cancer.
Of the 364 men treated with surgery, 53 (15 percent) suffered from erectile dysfunction, and 63 (17 percent) reported having incontinence. Another 45 developed other complications.
"The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often," said senior author Timothy Wilt, MD, a physician-researcher with the Center for Chronic Disease Outcomes Research at the Minneapolis VA Health Care System and a professor of medicine at the University of Minnesota. "Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer."

More information: New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1615869


Provided by Washington University in St. Louis

Prostate cancer—what you need to know

Men should discuss health history with their family and physician. Credit: University of Alabama at Birmingham

In 2016, more than 180,890 men will be diagnosed with prostate cancer, the second leading cause of cancer death in men. Next to skin cancers, prostate cancer is the most common cancer diagnosed in American men.

27 nov 2016--"Men's health and prostate cancer are topics that many tend to shy away from, but they need to be discussed more openly," said Soroush Rais-Bahrami, M.D., assistant professor at the University of Alabama at Birmingham in the Department of Urology and co-director for the UAB Program for Personalized Prostate Cancer Care. "One out of eight men will be diagnosed with prostate cancer in his life."
The prostate is a reproductive gland in men located between the bladder and the penis. The fluid from the prostate is discharged into the urethra at the time of ejaculation as part of the semen to nourish and stabilize sperm for reproductive purposes.

Prevention

Men ages 50 and older should be screened during their annual physical exam with a discussion regarding prostate cancer risk. A routine blood test can measure a biomarker called prostate-specific antigen or PSA, which can identify a man's risk of prostate cancer along with a digital rectal exam. Concern based on the PSA blood test level or digital rectal exam can prompt a biopsy of the prostate gland, which can be further evaluated to determine the presence of prostate cancer and, if found, the aggressiveness of the cancer.
"Many men do not know their family history of prostate cancer because men tend not to talk about their health concerns, even with children and other family members," Rais-Bahrami said. "It is important to discuss family history due to the significantly higher risk for men with a first-degree relative who has been diagnosed with prostate cancer."
Certain men may have a higher risk of prostate cancer based on family history or ethnicity, race, and ancestry, and should receive their first screening discussions at the age of 40.

Diagnosis

Symptoms of prostate cancer are rare, and many men show no symptoms before being diagnosed. Once a blood test shows signs of higher PSA levels, a tissue biopsy is required to help determine the grade and stage of the prostate cancer.
In advanced stages, symptoms may affect quality of life, ranging from pain in the bones to bloody urine, blood in the semen, blockage in the urinary tract and renal failure.
Once a man has been diagnosed with cancer, Rais-Bahrami recommends asking these questions to learn more about a path toward a cure:

• How will my personal health be affected?
• What grade or level of aggressiveness is my specific cancer?
• What stage or level of progression does my cancer have?
• Are there any additional staging studies that should be done for me?
• What are my treatment options?
• What are the side effects of each treatment option?

"When a patient has received a positive prostate cancer diagnosis, it is important he communicates with his family and his doctor about the different types of treatment and understands what will be faced through this journey of treatment," Rais-Bahrami said.

Treatment

The patient and physician should look at the options available to treat his prostate cancer and develop a personalized road map to manage symptoms and cure his cancer.
"Treatment is based on the patient's overall health and what works best in treating the patient to ultimately cure the cancer and help the patient preserve an excellent quality of life," Rais-Bahrami said.
In the earliest stages of low-grade prostate cancer, and with the consultation of a physician, men can opt for active surveillance, which is when the doctor does not prescribe immediate treatment, but watches the cancer cells closely to postpone treatment with curative intent, perhaps for years. Other treatment options include:

• Surgery, which includes removing the entire prostate gland and occasionally regional lymph node tissues
• Radiation therapy, or beams of radiation focused on the prostate
• Hormone therapy, which reduces levels of male hormones to stop them from affecting prostate cancer cells
• High-intensity, focused ultrasound therapy, or high-energy sound waves that destroy cancer cells
• Cryosurgery, or the use of extreme cold temperatures to freeze and kill cancer cells

"Prostate cancer is a treatable disease and can be cured if caught in early stages," Rais-Bahrami said. "This is why it is important to receive routine screenings and have early detection when present."
If the cancer is diagnosed in later stages and has spread to other parts of the body, it becomes more aggressive and more difficult to treat in most cases.
To help with personalized care of patients, UAB offers magnetic resonance imaging and ultrasound fusion-guided biopsy. The image fusion allows doctors to target a direct tissue sampling of an individual based on imaging areas of concern that can be tested for prostate cancer.

Current research

New research for prostate cancer is on the horizon, including the ongoing search for better biomarkers that indicate the presence of prostate cancer. Researchers are now searching for prostate cancer biomarkers that have specific implications for improved diagnosis and prediction of cancer aggressiveness and patient prognosis.
"With the serum PSA, a red flag is raised as a potential prostate cancer diagnosis; but it is not specific in diagnosing an individual's prostate cancer," Rais-Bahrami said. "Serum PSA can detect abnormalities with the prostate that are not exclusive to prostate cancer. Biomarker research is important to achieve a more individualized diagnosis."
At UAB, prostate cancer research is focused on advanced imaging and biomarker development, and hopes of defining the best way toward focal therapy of prostate cancer . UAB has become one of two beta sites in the United States to receive the iSR'obotTM Mona Lisa machine. This machine helps surgeons diagnose prostate cancer in earlier stages with imaging guidance and provides precise location mapping to help with targeting cancer cells for treatment.


Provided by University of Alabama at Birmingham

Impact of 2012 USPSTF guideline against PSA screening explored

05 jan 2016—Patients undergoing prostate needle biopsies after the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen-based screening for prostate cancer for men of any age are more likely to be diagnosed with high-risk disease, according to research published in the January issue of The Journal of Urology.

John S. Banerji, M.D., from the Virginia Mason Medical Center in Seattle, and colleagues reviewed data from a prospective database of patients undergoing prostate needle biopsies from 2004 to 2014. The authors compared patients seen before and after the USPSTF recommendations.
The researchers found that, compared with the 1,416 patients in the pre-USPSTF group, the 310 patients in the post-USPSTF group had a higher prostate-specific antigen (P < 0.001); they were also more likely to be diagnosed with higher clinical stage (2b, P = 0.003; 2c-3a, P = 0.027) and D'Amico high-risk prostate cancer (P = 0.036), with an adjusted relative risk of 1.25 for high-risk prostate cancer. Similar results were seen when the pre-USPSTF group was limited to 448patients seen in the 30 months before the draft guidelines. There was a 31 percent decrease in the absolute number of biopsies performed, with most of the decrease occurring in the detection of intermediate-risk tumors.
"Future focus on informed application of screening techniques may prevent the reversal of decades of improvement in the prostate cancer mortality rate," the authors write.

More information: Abstract

Full Text

Football improves strength in men with prostate cancer

Some of the participants in the FC Prostate Cancer research project after a training session. Credit: 'Copenhagen Centre for Teamsport and Health'.

20 jun 2014--Men with prostate cancer aged 43‒74 achieve bigger and stronger muscles, improve functional capacity, gain positive social experiences and the desire to remain active through playing football for 12 weeks. These are the findings of the "FC Prostate" trial, jointly conducted by the University Hospitals Centre for Health Care Research at The Copenhagen University Hospital, Rigshospitalet and the Copenhagen Centre for Team Sport and Health at the University of Copenhagen.

Some of the participants in the FC Prostate Cancer research project after a training session. Download free press photo here. Credit: 'Copenhagen Centre for Teamsport and Health'.

The acclaimed Scandinavian Journal of Medicine & Science in Sports is today publishing two articles on recreational football (soccer) for 43‒74-year-old men with prostate cancer. The first article shows that twice-weekly 1-hour football training sessions for 12 weeks produce an increase in muscle mass and muscle strength despite concurrent androgen deprivation therapy. The second article describes how recreational football is a promising novel approach for health promotion in prostate cancer patients as the participants regain pride in their bodies, develop team spirit and mutual concern increasing their motivation for long-term participation in sport.

Regained body pride and strong social cohesion

"This is the first study of its kind in the world, and the results clearly show the potential of recreational football in the rehabilitation of prostate cancer patients," says project leader Julie Midtgaard, a psychologist at The Copenhagen University Hospital Rigshospitalet. "Just 12 weeks of football training resulted in the men regaining control and developing a unique exchange of feelings and recognition centered around the sport."

The attendance rate was high over the 12 weeks, and many of the participants are still playing football two years after the project began.

"The provision of football proved to be a good way of developing friendships between the men and a unique model for men with prostate cancer to take responsibility of their own health without giving up their claim to feel and behave like men," concludes Midtgaard.

Bigger and stronger muscles in spite of anti-hormone treatment

"Androgen deprivation therapy through medical castration is an effective treatment of prostate cancer patients but has adverse effects in the form of reduced muscle mass, higher fat percentage and reduced physical activity," explains Professor Peter Krustrup, who co-initiated the study with Midtgaard and has been studying the effects of recreational football for the past 10 years.

"Twelve weeks of football training increased muscle mass by half a kilo in the football group in spite of the anti-hormone treatment and contributed to a 15% increase in muscle strength. The players in the FC Prostate team thus achieved excellent gains in functional capacity as a result of 12 weeks of football training, measured among other things as a 8% improvement in performance in the stand-sit test," says Krustrup.

"Our study also showed that recreational football was fun and inclusive for the participants in FC Prostate, and for every training session the intensity was high, with an average heart rate of 85% of the participants' maximum heart rate," says Krustrup.

Football is good rehabilitation for prostate cancer patients

"Previously, we showed that recreational football is effective for preventing and treating lifestyle diseases. With this study, we can add that recreational football can also be used for rehabilitation of a large group of cancer patients," says Krustrup.

Midtgaard concludes: "The study indicates that men with prostate cancer benefit greatly from recreational football, both physically and mentally. It has also proved to be easy to keep the men involved in physical activity once they have started playing football. They look forward to going to training and enjoy it tremendously when they get there. The next step is to evaluate the effectiveness of football in a more natural setting. Therefore we are delighted that we have received the necessary funding to pursue an even bigger project in collaboration with the Danish Football Association in which more than 300 prostate cancer patients will be invited to play football in local football clubs in Denmark."

More information: The two articles are today being published in a special issue of the Scandinavian Journal of Medicine & Science in Sports on the topic of football for health.

Provided by University of Copenhagen

New early detection test for prostate cancer: Mi-Prostate Score test improves on PSA for predicting cancer

Arul Chinnaiyan, M.D., Ph.D., and Scott Tomlins, M.D., Ph.D.

More than 1 million men will undergo a prostate biopsy this year, but only about one-fifth of those biopsies will result in a cancer diagnosis.

27 sept 2013--The reason is that the traditional prostate cancer screening test – a blood test to measure prostate specific antigen, or PSA – does not give doctors a complete picture.

Now, the University of Michigan Health System has begun offering a new urine test called Mi-Prostate Score to improve on PSA screening for prostate cancer. The test incorporates three specific markers that could indicate cancer and studies have shown that the combination is far more accurate than PSA alone.

"Many more men have elevated PSA than actually have cancer but it can be difficult to determine this without biopsy. We need new tools to help patients and doctors make better decisions about what to do if serum PSA is elevated. Mi-Prostate Score helps with this," says Scott Tomlins, M.D., Ph.D., assistant professor of pathology and urology at the University of Michigan.

Researchers validated the new test on nearly 2,000 urine samples. Mi-Prostate Score, or MiPS, was significantly more accurate than PSA alone for predicting cancer as well as predicting aggressive prostate cancer that is likely to grow and spread quickly.

Mi-Prostate Score developed from a discovery in the lab of Arul Chinnaiyan, M.D., Ph.D., in 2005 of a genetic anomaly that occurs in about half of all prostate cancers, an instance of two genes changing places and fusing together.

This gene fusion, T2:ERG, is believed to cause prostate cancer. Studies in prostate tissues show that the gene fusion almost always indicates cancer.

The new urine test looks for the T2:ERG fusion as well as another marker, PCA3. This is combined with serum PSA measure to produce a risk assessment for prostate cancer. The test also predicts risk for having an aggressive tumor, helping doctors and patients make decisions about whether to wait and monitor test levels or pursue immediate biopsy.

"This combination test is not designed to say definitively at diagnosis whether a man has aggressive prostate cancer, but it can provide a more accurate estimate of the likelihood of having cancer and the likelihood of that cancer being aggressive," Tomlins says.

Provided by University of Michigan

Nearly half of all deaths from prostate cancer can be predicted before age 50

Focusing prostate cancer testing on men at highest risk of developing the disease is likely to improve the ratio between benefits and the harms of screening, suggests a paper published today in BMJ.

25 april 2013--Prostate specific antigen (PSA) screening is widely used for the early detection of prostate cancer, but remains highly controversial, as it became widespread long before evidence to prove its value. There is now evidence that PSA screening can reduce prostate cancer mortality in men who would not otherwise be screened. However, this can come at considerable harm.

As there is little evidence to support many aspects of screening guidelines, researchers from Sweden and the USA carried out a case-control study taking data from the Malmo Preventative Project (MPP) cohort, in an attempt to develop an evidence-based scheme for prostate cancer testing. A previous study from the MPP, published in the BMJ in 2010, demonstrated that PSA level at age 60 is strongly predictive of the risk of death from prostate cancer by age 85.

The Malmo cohort included 21,277 men aged 27 to 52 who participated in the MPP between 1974 and 1984. All these men gave a blood sample. A smaller group of these men were then invited to provide a second blood sample about six years later: 4922 (72%) of those re-invited complied.

The researchers focused their studies on men close to age 40, mid-to-late forties (45-49) and early-to-mid fifties (51-55).

Within 25 to 30 years, 44% of deaths from prostate cancer occurred in those with the top 10% of PSA levels at age 45-49, a PSA of about 1.5 ng / ml or more. The risk of prostate cancer death was more than 10 times greater in this group compared to men with the lowest 25% of PSA levels.

The researchers questioned whether PSA screening should start at age 40, mid-to-late 40s or early 50s: they found that even for men with PSA in the top decile at age 40, the risk of metastatic prostate cancer was very low at 0.6%, after 15 years of follow-up. The researchers say that due to this, it would be difficult to justify initiating PSA testing at age 40 for men with no other significant risk factor.

In contrast, the risk of developing metastatic prostate cancer within 15 years is close to three-fold higher for men in the top level PSA at age 45-49 (1.7%) and close to ten-fold higher at age 51-55 (5.2%). This suggests that initiating PSA screening after age 50 would leave a significant proportion of men at elevated risk of later being diagnosed with an incurable cancer.

The researchers also looked at screening intervals: results showed that the absolute risk of metastatic cancer remains very low within 15 years follow-up for men with PSA in the low deciles and as such, a screening interval less than five years for these men is unnecessary.

The researchers conclude that PSA levels are informative of the current risk of cancer as well as being "predictive of the future risk of prostate cancer" and any cancer-specific death. They say that screening programmes can be designed so as to "reduce the risk of over-diagnosis whilst still enabling early cancer detection for men at highest risk of death from prostate cancer". As it turns out, the best way to determine risk is a single PSA before the age of 50.

More information: Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study, BMJ, 2013.

Provided by British Medical Journal

Scientists identify genetic signatures for aggressive form of prostate cancer

Scientists have discovered two separate genetic 'signatures' for prostate cancer that appear to be able to predict the severity of the disease, leading to hopes that in future, accuracy of prognosis and treatment of the disease could be greatly improved. Two Articles published in The Lancet Oncology reveal distinctive patterns of RNA—the genetic material that helps turn DNA into proteins—which appear to be able to predict whether patients have an aggressive prostate cancer, or whether they have a milder form of the disease.

09 oct 2012--Prostate cancer shows enormous variation between patients, with some people never showing symptoms, some responding well to treatment, and others developing resistance and progressing. Clinicians refer to the form of the disease which does not respond to standardandrogen deprivation therapy as castration-resistant prostate cancer. Castration-resistant prostate cancer also shows wide variation in patient survival times, though the reasons for this are unclear.

Although tests to determine whether a patient has a more aggressive form of prostate cancer do currently exist, they are only moderately accurate. A more accurate way of determining whether a patient has a more dangerous form of prostate cancer would not only allow doctors to offer more accurate prognoses, but also enable better clinical trials for potential new treatments, as patients could be more effectively stratified into groups with aggressive or less aggressive disease.

The authors of one Article, led by Professor Johann de Bono at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust in the UK, identified a set of genes which were able to predict whether patients had castration-resistant prostate cancer. Further, the signature stratified patients with castration-resistant prostate cancer: patients who were identified as having a distinctive nine-gene pattern characteristic of aggressive prostate cancer survived for an average of 9.2 months after referral for treatment, as opposed to 21.6 months in the group who did not test positive for the RNA signature under study.

In the other Article, researchers led by Professor William Oh at the Tisch Cancer Institute of Mount Sinai School of Medicine in the USA, identified a different set of genes with similar predictive properties to those identified by de Bono and colleagues. In this case, the researchers identified a set of six genes characteristic of a more aggressive form of prostate cancer, in a group of 62 patients at the Dana-Farber Cancer Institute in Boston. The signature divided patients into two groups: one with a median survival time of 7.8 months (the high-risk group), the other with a median survival of at least 34.9 months (the low-risk group). A validation cohort of 140 patients confirmed these findings.

Genetic signatures for different forms of cancer have been identified previously, but they have only been used for classification purposes – these studies are the first to show that they might have potential prognostic use. Previously, genetic tests like this were based on obtaininggenetic material from the tumour itself, but these can be difficult to obtain and may not show the complete picture as there is evidence that patient prognosis may depend not only on the disease biology but also the individual's response to the disease. Furthermore, the genetic signatures identified from normal blood cells in these papers can be detected via a simple blood test, which could eventually lead to huge improvements in providing patients with prostate cancer with an accurate prognosis.

In a linked Comment, Dr Karina Dalsgaard Sørensen at Aarhus University Hospital in Denmark welcomes the findings, writing that, "Scarcity of prognostic markers presents a major challenge for the clinical management of castration-resistant prostate cancer. These results suggest that a few selected genes in blood samples from patients with castration-resistant prostate cancer can significantly improve the prediction of outcomes. However, the biological relevance of these prognostic signatures, which are the first of their kind, is largely unknown and further investigation into the underlying biological mechanisms at work here could greatly advance our understanding."

More information:
de Bono et al: www.thelancet.com/… 2-8/abstract
Oh et al: www.thelancet.com/… 3-2/abstract

Provided by Lancet

Use of vitamin E associated with increased risk of prostate cancer

In a trial that included about 35,000 men, those who were randomized to receive daily supplementation with vitamin E had a significantly increased risk of prostate cancer, according to a study in the October 12 issue of JAMA.

12 oct 2011--Men who took 400 international units (I.U.) of vitamin E daily had more prostate cancers compared to men who took a placebo, according to an updated review of data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT). The findings showed that, per 1,000 men, there were 76 prostate cancers in men who took only vitamin E supplements, vs. 65 in men on placebo over a seven-year period, or 11 more cases of prostate cancer per 1,000 men. This represents a 17 percent increase in prostate cancers relative to those who took a placebo. This difference was statistically significant and therefore is not likely due to chance. The results of this update appeared Oct. 12, 2011, in the Journal of the American Medical Association.

SWOG, an international network of research institutions, carried out SELECT at more than 400 clinical sites in the United States, Puerto Rico, and Canada. SELECT was funded by the National Cancer Institute (NCI) and other institutes that comprise the National Institutes of Health.

"Based on these results and the results of large cardiovascular studies using vitamin E, there is no reason for men in the general population to take the dose of vitamin E used in SELECT as the supplements have shown no benefit and some very real risks," said Eric Klein, M.D., a study co-chair for SELECT, and a physician at the Cleveland Clinic. "For now, men who were part of SELECT should continue to see their primary care physician or urologist and bring these results to their attention for further consideration."

The SELECT study began in 2001 and included over 35,000 men. It was started because earlier research had suggested that selenium or vitamin E might reduce the risk of developing prostate cancer. However, based on an independent safety monitoring review in autumn 2008, participants were told to stop taking their study supplements because it had become clear that the trial would never produce the 25 percent reduction in prostate cancer the study was designed to show with the use of these supplements. In 2010, the study sites were closed and over half of the participants consented to have their health monitored via mail questionnaires. Now, because of this latest finding, researchers are encouraging all participants to consider taking part in long-term study follow-up so investigators can continue to track outcomes.

SELECT was undertaken to substantiate earlier, separate findings from studies in which prostate cancer risk was not the primary outcome. A 1998 study of male smokers in Finland who took 50 I.U. of vitamin E daily to prevent lung cancer, showed 32 percent fewer prostate cancers in men who took the supplement. A 1996 study of men and women with a history of skin cancer who took selenium for prevention of disease recurrence showed that men who took the supplement had 52 percent fewer prostate cancers than men who did not take the supplement.

Based on these and other findings, men were recruited to participate in SELECT. They were randomly assigned to take one of four sets of supplements or placebos, with more than 8,000 men in each group. One group took both selenium and vitamin E; one took selenium and a placebo that looked similar to vitamin E; one took vitamin E and a placebo that looked similar to selenium; and the final group received placebos of both supplements. Men who took selenium alone or vitamin E and selenium together were also more likely to develop prostate cancer than men who took a placebo, but those increases were small and possibly due to chance.

"SELECT has definitively shown a lack of benefit from vitamin E and selenium supplements in the prevention of prostate cancer and has shown there is the potential for harm," said Lori Minasian, M.D., study co-author and acting director of NCI's Division of Cancer Prevention. "Nevertheless, this type of research has been critically important to understanding the potential benefits and risks from supplements."

SELECT researchers are now measuring the amount of vitamin E, selenium, and other nutrients in the blood of participants when they joined the trial, to see if the effect of the supplements depended upon this baseline level of micronutrient. Other researchers are looking at single nucleotide polymorphisms, which are DNA changes known as SNPs, to see if a change in one or more genes could affect cancer risk or perhaps increase a man's risk of developing prostate cancer while taking vitamin E.

The participant samples come from the study biorepository of blood and toe nail clippings which, when coupled with the extensive clinical information on participants, is a vital resource for further study. "SWOG is soliciting proposals from researchers nationwide to use the SELECT biorepository to help answer the biological question of why vitamin E increased risk instead of decreasing it," said Laurence Baker, D.O., study co-author and chairman of SWOG. "There are many more questions raised by these study results than we have answers for, and thus the need for further investigation."

Except for skin cancer, prostate cancer is the most common type of cancer in men in the United States. The current lifetime risk of prostate cancer for American men is 16 percent. In 2011, there will be an estimated 240,890 new cases of prostate cancer and 33,720 deaths from this disease in the United States.

More information: JAMA. 2011;306[14]:1549-1556

Provided by JAMA and Archives Journals

Coffee may reduce risk of lethal prostate cancer in men

Men who regularly drink coffee appear to have a lower risk of developing a lethal form of prostate cancer, according to a new study led by Harvard School of Public Health (HSPH) researchers. What's more, the lower risk was evident among men who drank either regular or decaffeinated coffee.

18 may 2011--The study will be published May 17, 2011, in an online edition of the Journal of the National Cancer Institute.

"Few studies have specifically studied the association of coffee intake and the risk of lethal prostate cancer, the form of the disease that is the most critical to prevent. Our study is the largest to date to examine whether coffee could lower the risk of lethal prostate cancer," said senior author Lorelei Mucci, associate professor of epidemiology at HSPH. Lethal prostate cancer is cancer that causes death or spreads to the bones.

Prostate cancer is the most frequently diagnosed form of cancer and the second leading cause of cancer death among U.S. men, affecting one in six men during their lifetime. More than 2 million men in the U.S. and 16 million men worldwide are prostate cancer survivors.

"At present we lack an understanding of risk factors that can be changed or controlled to lower the risk of lethal prostate cancer. If our findings are validated, coffee could represent one modifiable factor that may lower the risk of developing the most harmful form of prostate cancer," said lead author Kathryn Wilson, a research fellow in epidemiology at HSPH.

The researchers chose to study coffee because it contains many beneficial compounds that act as antioxidants, reduce inflammation, and regulate insulin, all of which may influence prostate cancer. Coffee has been associated in prior studies with a lower risk of Parkinson's disease, type 2 diabetes, gallstone disease, and liver cancer or cirrhosis.

The study examined the association between coffee consumption and the risk of prostate cancer, particularly the risk for aggressive prostate cancer among 47,911 U.S. men in the Health Professionals Follow-Up Study who reported their coffee consumption every four years from 1986 to 2008. During the study period, 5,035 cases of prostate cancer were reported, including 642 fatal or metastatic cases.

Among the findings:

• Men who consumed the most coffee (six or more cups daily) had nearly a 20% lower risk of developing any form of prostate cancer.
  
• The inverse association with coffee was even stronger for aggressive prostate cancer. Men who drank the most coffee had a 60% lower risk of developing lethal prostate cancer.
  
• The reduction in risk was seen whether the men drank decaffeinated or regular coffee, and does not appear to be due to caffeine.
  
• Even drinking one to three cups of coffee per day was associated with a 30% lower risk of lethal prostate cancer.
  
• Coffee drinkers were more likely to smoke and less likely to exercise, behaviors that may increase advanced prostate cancer risk. These and other lifestyle factors were controlled for in the study and coffee still was associated with a lower risk.

The results from this study need to be validated in additional populations that have a range of coffee exposure and a large number of lethal prostate cancer cases. If confirmed, the data would add to the list of other potential health benefits of coffee. The authors currently are planning additional studies to understand specific mechanisms by which coffee may specifically lower the risk of lethal prostate cancer.

More information: "Coffee Consumption and Prostate Cancer Risk and Progression in the Health Professionals Follow-up Study," Kathryn M. Wilson, Julie L. Kasperzyk, Jennifer R. Stark, Stacey Kenfield, Rob M. van Dam, Meir J. Stampfer, Edward Giovannucci, Lorelei A. Mucci, Journal of the National Cancer Institute, online May 17, 2011.

Provided by Harvard School of Public Health

Obesity linked to higher risk of prostate cancer progression

Even when treated with hormone therapy to suppress tumor growth, obese men face an elevated risk of their prostate cancer worsening, researchers at Duke University Medical Center have found.

16 may 2011--The research, reported at the American Urological Association annual meeting Sunday (May 15, 2011), advances the link between obesity and prostate cancer, which has generated research interest in recent years as the incidence of both conditions remains high and often overlaps.

"Over the past decades, there has been increasing prevalence of obesity in the U.S. and Europe, and a high rate of prostate cancer that is the second-most lethal cancer for men," said Christopher J. Keto, M.D., a urologic fellow at Duke University Medical Center and lead author of the study.

An estimated one in six U.S. men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society; additionally, one in three U.S. men are obese.

To examine the role obesity may play in prostate cancer, Keto and colleagues at Duke identified 287 men whose diseased prostates had been removed at five U.S. Department of Veteran Affairs hospitals from 1988-2009.

Because their cancers had reappeared, the men had also been given androgen deprivation therapy (ADT). The chemical inhibits production of the male hormone testosterone, which fuels prostate tumors.

Men in the study group who were overweight or obese had a three-fold increased risk of cancer progression compared to normal-weight men, despite receiving the same treatment.

Additionally, overweight men had more than a three-fold increased risk of their cancer spreading to the bone compared to normal-weight men, while obese men had a five-fold increase in the risk of metastases.

Keto said additional studies are needed to determine why heavy men fare worse than normal-weight men, even when treated similarly. One area of scrutiny may be the dosage of ADT.

"We think perhaps obese men may require additional ADT," Keto said. "The dose is the same regardless of weight, while most drugs are dosed according to weight."

Stephen J. Freedland, M.D., associate professor of urology in the Duke Prostate Cancer Center and senior author of the study, said the findings build upon the Duke group's broader research efforts into the connection between obesity and prostate cancer.

"By being thematic in our research we can really get to the bottom of something," Freedland said. "The study supports a growing body of literature showing that obese men with prostate cancer do worse. Our next step is to figure out why."

Freedland said knowing that heavy men are at higher risk for bad outcomes could lead to better interventions. He said the Duke group has launched a new trial to test the effects of diet and exercise on overweight and obese men whose prostate cancer treatment includes hormone therapy.

"If obesity is bad for prostate cancer, we may have to be more aggressive in our treatment," he said. "Ultimately, we aim to learn why, which in turn can lead us to better treatments for these men."

Provided by Duke University Medical Center

Prostate cancer treatment linked to higher rate of colon cancer, study finds

Men treated with hormone-based therapy for prostate cancer faced a 30 percent to 40 percent higher risk of colorectal cancer, compared to patients who did not receive this treatment, according to a new study.

17 nov 2010--The study looked at use of androgen deprivation therapy, a common type of treatment for prostate cancer that involves blocking the male hormone testosterone through either surgical removal of the testicles or a series of injections. It's been shown to benefit men with advanced cancers, but its benefit for less-advanced disease is unclear. Still, more than half a million men in the United States currently receive this therapy.

Researchers looked at data from 107,859 men aged 67 and older with prostate cancer, identified through the Surveillance, Epidemiology and End Results and Medicare linked database, which provides information about older adults with newly diagnosed cancer. Results of the study were published online in the Journal of the National Cancer Institute.

The study is the first to link androgen deprivation therapy for prostate cancer to an increased risk of colorectal cancer. The researchers found that the risk increased the longer a man received androgen deprivation therapy. Patients who had their testicles removed, a procedure called orchiectomy, had the highest rates of colorectal cancer.

Overall, the risk of colorectal cancer was still low – less than 1 percent per year even among orchiectomy patients. But any increased risk should be carefully considered when using androgen deprivation therapy in cases when its benefit is not clear, the researchers say.

"Androgen deprivation therapy still continues to be used in situations where there are not evidence-based studies showing its benefit. When androgen deprivation therapy is clearly known to be beneficial, people should not shy away from using it. But where there's not solid evidence, this is potentially another harm," says lead study author Vahakn B. Shahinian, M.D., M.S., assistant professor of internal medicine at the University of Michigan Medical School and a member of the U-M Comprehensive Cancer Center.

Shahinian stresses that androgen deprivation therapy can be lifesaving for certain men with prostate cancer, and those patients should not hesitate to use it. The study authors suggest that continued routine preventive care, including colorectal cancer screening, is important during prostate cancer treatment.

More information: Journal of the National Cancer Institute , doi:10.1093/jnci/djq419, published online Nov. 10, 2010

Provided by University of Michigan Health System

'Watchful Waiting' Often Best Strategy for Slow-Moving Prostate Cancer

21 june 2010-- For patients with prostate cancer that has a low risk of progression, active surveillance, also known as "watchful waiting," may be a suitable treatment option, according to a large-scale study from Sweden.

The issue of how (or whether) to treat localized prostate cancer is controversial because, especially for older men, the tumor may not progress far enough to cause real trouble during their remaining expected lifespan. In those cases, deferring treatment until there are signs of disease progression may be the better option.

The researchers looked at almost 6,900 patients from the National Prostate Cancer Registry Sweden, age 70 or younger, who had localized prostate cancer and a low or intermediate risk that the cancer would progress. From 1997 through December 2002, over 2,000 patients were assigned to active surveillance, close to 3,400 underwent radical prostatectomy (removal of the prostate and some surrounding tissue), and more than 1,400 received radiation therapy.

After a median follow-up of just over 8 years, the surveillance group had a much higher death rate from causes other than prostate cancer -- 19.2 percent, compared with 6.8 percent in the prostatectomy group and 10.9 percent in the radiation therapy group.

This suggests that patients with a shorter life expectancy were more often selected for active surveillance rather than surgery or radiation therapy, the researchers said.

The patients who underwent surgery for prostate cancer had a lower risk of dying from prostate cancer than those in the active surveillance group. However, the difference in absolute risk of patients dying from prostate cancer was very small -- only 1.2 percent after 10 years of follow-up.

The researchers concluded that, based on these findings, active surveillance is the best strategy for many patients with low-risk prostate cancer.

"With a 10-year prostate cancer-specific mortality of less than three percent for patients with low-risk prostate cancer on surveillance, this strategy appears to be suitable for many of these men," wrote Dr. Par Stattin, of Umea University, and colleagues.

The study was published online June 18 in the Journal of the National Cancer Institute.

Should older men be screened for prostate cancer?

31 mar 2010-– Experts generally recommend against routinely using PSA blood tests to screen elderly men for prostate cancer, but using a strict age cutoff for when to stop screening may not be the best route either, a new study suggests.

Right now, there are conflicting opinions as to when men should stop being screened for prostate cancer using PSA, or prostate-specific antigen, tests.

Certain medical groups, like the American Urological Association and the American Cancer Society, say that PSA screening should be an option -- though not a routine procedure -- for any man whose health is good enough that he can expect to live at least 10 more years.

But 2008 guidelines from the U.S. Preventive Services Task Force (USPSTF) -- an independent panel of medical experts appointed by the federal government -- recommend against screening any man age 75 or older, regardless of his health.

The central problem with prostate cancer screening is that most prostate tumors are slow-growing and would not be deadly even without treatment. So screening can lead to unnecessary treatment of cancers that would never had been life-threatening, along with treatment's side effects.

According to the USPSTF's 2008 statement, there is "moderate certainty" that for men age 75 or older, the potential harms of prostate cancer screening outweigh the benefits.

For the new study, researchers looked at whether, before the 2008 guideline, U.S. doctors were appropriately using elderly men's health and life expectancy in recommending PSA testing.

Using data from 718 men age 75 and up who responded to a 2005 national health survey, the researchers found that 52 percent said they had had a PSA test in the past two years. Men who rated their own health as "fair" or "poor" were half as likely to have been tested as those who described their health as "very good" or "excellent."

Still, a substantial number of men who would not be expected to benefit from PSA screening were being tested nonetheless. Of the 182 men expected to live less than five years -- based on their age and reported health status -- 42 percent had had a recent PSA test.

That compared with 65 percent of the 214 men expected to live more than 10 years.

The findings, reported in the Journal of Urology, suggest that limiting PSA screening to men younger than 75 would prevent unnecessary testing of some men who would not benefit from treatment, according to lead researcher Dr. Karen E. Hoffman, of the University of Texas M.D. Anderson Cancer Center in Houston.

"However," she told Reuters Health by email, "the results also suggest a strict age cutoff may preclude the early detection of biologically aggressive prostate cancer in older men with a long life expectancy who may benefit from early detection and treatment of high-grade (aggressive) prostate cancer."

The study has its limits, Hoffman and her colleagues acknowledge -- including the fact that it relied on men's self-reported health and PSA screening history. Still, they say, the findings point to pros and cons of setting a strict age cutoff for PSA screening.

More research, the investigators write, is needed to understand the impact of using an age limit when it comes to screening healthy men.

The bottom line for older men, Hoffman said, is that they should talk with their doctors about the risks and benefits of PSA screening "in the context of their overall health status and their individual preferences."

But while doctors might recommend PSA screening to some men age 75 or older, there is no evidence yet that it lowers their risk of dying from the disease or extends their life expectancy overall.

Past clinical trials on prostate cancer screening have not included men in that age group, Hoffman said.

SOURCE: Journal of Urology, May 2010.

ACS Updates Prostate Cancer Screening Guidelines

American Cancer Society's updated guidelines reaffirm that shared decision making is key

07 mar 2010-- Men should participate in shared decision-making over whether or not they undergo screening for prostate cancer, according to updated guidelines for prostate cancer screening from the American Cancer Society, published online March 3 in CA: A Cancer Journal for Clinicians. These guideline updates are the first since 2001.

Andrew M.D. Wolf, M.D., of the University of Virginia School of Medicine in Charlottesville, and colleagues write that a series of systemic reviews of evidence were undertaken by the American Cancer Society Prostate Cancer Advisory Committee in 2009 to facilitate the updating process.

The evidence showed that men without symptoms of prostate cancer and at least 10 years' life expectancy can and should make an informed decision about the pros and cons of prostate cancer screening. Men at average risk should be given the information they need to fully participate in the decision-making process at the age of 50, while men at higher risk should be educated about prostate cancer screening earlier. Annual screening is recommended for men who choose to be tested and who have a prostate-specific antigen (PSA) level of 2.5 ng/mL or higher. Men with a PSA under that threshold can be safely screened every two years, per the new recommendations, while men with a PSA level of 4.0 ng/mL or higher should consider getting further evaluation.

"Two decades into the PSA era of prostate cancer screening, the overall value of early detection in reducing the morbidity and mortality from prostate cancer remains unclear," Wolf, chair of the advisory committee, said in a statement. "While early detection may reduce the likelihood of dying from prostate cancer, that benefit must be weighed against the serious risks associated with subsequent treatment, particularly the risk of treating men for cancers that would not have caused ill effects had they been left undetected."

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Coffee, Exercise Fight Prostate Cancer

12 dec 2009- Having a few more cups of coffee and running that extra mile each day can reduce a man's risk of dying of prostate cancer, two studies indicate.

The case for coffee and physical activity as prostate cancer preventatives is far from proven, according to the research reported Tuesday at an American Association for Cancer Research meeting in Houston. But data from the Health Professionals Follow-Up Study show a clear association with both daily activities.

"I wouldn't recommend that people change their coffee-drinking habits based on this study," said Kathryn M. Wilson, a research fellow in epidemiology at the Harvard School of Public Health, and lead author of one report. "But if you like coffee, there is no compelling reason to cut back at this point."

Her data on the nearly 50,000 men in the study showed how common a diagnosis of prostate cancer has become since widespread screening began. In the 20 years from 1986 to 2006, 4,975 cases of prostate cancer were diagnosed, affecting just about 10 percent of the men in the study.

But only 846 of those cancers were life-threatening, because they had spread beyond the prostate gland or were growing aggressively, Wilson said. And while the study found just a weak relationship between consumption of six or more cups of coffee a day and a reduced risk of all forms of prostate cancer (down about 19 percent), the reduction for the aggressive form was much more marked -- 41 percent.

And there was a clear relationship between the amount of coffee consumed and prostate cancer risk, Wilson said: "The more coffee you drank, the more effect we saw."

The caffeine in coffee doesn't seem to be the link, since the same reduction was seen for consumption of decaffeinated coffee, she said. Instead, "it has something to do with insulin and glucose metabolism," Wilson said. "A number of studies have found that coffee is associated with a reduced risk of diabetes."

This study is just a starting point for establishing a relationship between coffee and prostate cancer, Wilson stressed. "At this point, we would just like to confirm whether it exists in different populations," she said. "We hope that this study drives more research so that we really know what is going on."

The other study, by Stacey A. Kenfield, a research associate at the Harvard School of Public Health, looked at the levels of physical activity among 2,686 men in the study who were diagnosed with prostate cancer. It found, as many other studies have, that exercise is good for overall health, with a 35 percent lower death rate for men who reported three or more hours a week of vigorous physical activity, such as jogging, biking, swimming or playing tennis.

And the death rate from prostate cancer for men who exercised vigorously was 12 percent lower than for those who didn't -- a figure that did not quite reach the level of statistical significance because the numbers were small, Kenfield explained.

Nevertheless, "this is the first study to show an effect of physical activity not only on overall survival, but on prostate cancer survival," she said.

It's already well known how physical activity reduces overall mortality, Kenfield said. "It affects immune function and reduces inflammation, among the major processes involved. But it's not clear yet how it is related to prostate cancer and survival."

More information

Details on prostate cancer are provided by the U.S. National Cancer Institute.