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A quarter of men drop out of prostate cancer monitoring, casting doubt on safety of "active surveillance"

A long-term follow up of prostate cancer patients shows that the option of monitoring slow-growing prostate cancer may not be as safe as thought, due to a quarter of men dropping out of the monitoring programme.

Prostate cancer is the most common cancer in men, with a European incidence rate of 214 cases per 1000 men, outnumbering lung and colorectal cancer. Research shows that with advancing age, most men are likely to have a cancer of the prostate, although for many the cancer will be so slow growing that it does not create a real problem. Recently there has been significant visibility given to the risk of prostate-cancer “overdiagnosis” – treatment when it is not justified by a serious health threat.

Given that treatment for prostate cancer involves either radiotherapy or major surgery, and that this can have significant side-effects, such as incontinence and impotence, there has been an increasing tendency to keep low-risk men under “active surveillance”; in other words not to treat the cancer immediately by surgery or radiotherapy, but to monitor the cancer regularly to see if it worsens. However, there have been very few studies showing how this surveillance works in real life.

Now a group of researchers from Baden in Switzerland have presented a long-term study to the European Association of Urology Congress in Stockholm which raises concerns regarding the safety of active surveillance. The study was based in a normal-sized hospital rather than in an academic medical centre, so is

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Chronic inflammation may be linked to aggressive prostate cancer

The presence of chronic inflammation in benign prostate tissue was associated with high-grade, or aggressive, prostate cancer, and this association was found even in those with low prostate-specific antigen (PSA) levels, according to a study published in Cancer Epidemiology, Biomarkers Prevention, a journal of the American Association for Cancer Research.

An analysis of prostate tissue biopsies collected from some participants of the placebo arm of the Prostate Cancer Prevention Trial (PCPT) found that those whose benign prostate tissue had chronic inflammation had 1.78 times higher odds of having prostate cancer, and 2.24 times higher odds of having an aggressive disease (characterized by Gleason sum of seven to 10), compared with those whose benign prostate tissue had no inflammation.

“We had the unique opportunity to investigate biopsy tissue from patients who had no indication to prompt a biopsy,” said Elizabeth A. Platz, Sc.D., MPH, professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md. “Participants in the PCPT who were not diagnosed with prostate cancer during the trial were recommended to undergo prostate biopsy at the end of that trial, which meant that prostate tissue was available not just for men who had the diagnosis of prostate cancer, but also for those who did not have the diagnosis.

“We found that men who had at least one biopsy core with inflammation had a higher likelihood of having high-grade prostate cancer compared with those who

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Men with blood type O have lower recurrence of prostate cancer

Prostate cancer is the most common cancer in men, and in 2010, it was responsible for over 28,000 deaths in the US. Now, a new study presented at the European Association of Urology congress in Sweden suggests men with blood type O have a significantly lower chance of the cancer recurring.

According to the Centers for Disease Control and Prevention (CDC), prostate cancer is the second most common cause of death from cancer among white, African American, American Indian/Alaska Native and Hispanic men.

Though many men with prostate cancer die of other causes without signs or symptoms of the disease, there are certain symptoms that the CDC advise should be looked into if present. Some of these include:

  • Difficulty urinating, or a weak flow of urine
  • Pain or burning during urination
  • Blood in the urine or semen
  • Pain in the back, hips or pelvis
  • Painful ejaculation.

For the latest research, Dr. Yoshio Ohno, of Tokyo Medical University, and colleagues studied 555 patients with localized prostate cancer who underwent radical prostatectomy (RP) between 2004 and 2010.

RP, which is surgery to remove the prostate gland, is essentially the “gold standard” treatment for localized prostate cancer, the researchers say. But around 30% of patients show a rising level of prostate specific antigen (PSA) after surgery, which means they experience biochemical recurrence.

Findings could pave way to new treatment plans

The team notes that, in the past, variations in ABO blood groups have been associated with different risks for developing cancers such as gastric and

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Half of aggressive prostate cancers ‘missed’

Half of aggressive prostate cancers ‘missed’

screening does not reduce prostate cancer deaths

11th April 2014 — Around half of men diagnosed with slow growing prostate cancer have the severity of their condition underestimated, according to new research.

Like other cancers, the severity of prostate cancer and whether it has spread to other parts of the body is ‘staged’ using a system called the Gleason scale.

Prostate cancer is the most common cancer in men in the UK leading to around 10,800 deaths a year.

Experts say the findings highlight an urgent need for better tests to define how aggressive a prostate cancer is.

Checking staging decisions

Cancer Research UK scientists from the University of Cambridge looked at the staging and grading of 848 men in England with prostate cancers before and after they had an operation to remove the prostate, called a radical prostatectomy.

In the 415 men who had a biopsy and had been classed as having slow growing cancer confined to the prostate, 209 had more aggressive cancer than had been originally thought. And for 131, the cancer had spread beyond the prostate.

Active surveillance

The study is published in the British Journal of Cancer. One of the authors, urological surgeon Mr Greg Shaw says in a statement: “This highlights the urgent need for better tests to define how aggressive a prostate cancer is from the outset, building on diagnostic tests like MRI scans, and new biopsy

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Radical treatment for advanced prostate cancer may herald major survival advantage over conventional treatment

Controversial new research may overturn the standard treatment of men with advanced prostate cancer. Work presented at the European Association of Urology Annual Meeting 2014 indicates that men with advanced prostate cancer could have a better chance of surviving if they undergo treatment directed specifically at the prostate (so-called “radical” therapy) as well as hormonal treatment.

Prostate cancer is the second leading cause of cancer death in Western men. Advanced prostate cancer (where aggressive tumours have spread outside the prostate) usually results in death of the patient. The current standard method of treating advanced prostate cancer is with Androgen Deprivation Therapy (ADT). Androgen hormones, such as testosterone, are known to promote the growth of prostate cancer, and ADT reduces the level of these hormones in the body. Men with advanced prostate cancer who are treated with ADT on average survive around 5 years.

Men with advanced prostate cancer tend not to be offered Radical Prostatectomy (surgery to remove the whole prostate) or Radiotherapy, because their cancer will have already spread outside the primary tumour in the prostate, so ADT has been seen as a better “whole body” solution.

Now, new research from an international team led by Professor Peter Wiklund of the Karolinska Institute in Stockholm may lead to a significant revision of the standard treatment. The team analysed the records from the National Prostate Cancer Registry of Sweden, which contains virtually complete information on more than 98% of all prostate cancer cases in Sweden

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