Prostate Health

The risks of active surveillance for men with intermediate-risk prostate cancers

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

Many men with prostate cancer benefit from active surveillance, in which treatment doesn’t begin unless the cancer spreads. There has been some debate about whether this strategy is safe for men with intermediate-risk prostate cancer. A new study suggests that this type of cancer is more likely to spread than previously thought — but active surveillance can still be a good option for many intermediate-risk men.

Long-term hormonal therapy benefits men with locally advanced prostate cancer

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

Long-term hormonal therapy, which blocks the effect of testosterone on prostate tumors, was once reserved for prostate cancer that has spread. But recent research has found that it had enormous benefits for men with earlier stages of prostate cancer, slashing their risks of metastasis and death from prostate cancer. However, some questions remain — for example, exactly how long to use “long-term hormonal therapy” is still up for debate.

Promising results for a targeted drug in advanced prostate cancer

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

The same BRCA mutations that increase a woman’s risk of breast and ovarian cancers can also increase a man’s risk of dying from prostate cancer. Recently, an ovarian cancer drug intended for BRCA-positive women has shown impressive results in BRCA-positive men with metastatic prostate cancer. This drug, and others like it, could provide another, much-needed treatment option for men with advanced prostate cancer.

Does fewer PSA tests mean less prostate cancer?

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

Fewer men are being given PSA tests to screen for prostate cancer. As screening rates have fallen, so have the number of prostate cancer diagnoses. This probably also means that fewer men are receiving potentially unnecessary treatment, with its attendant negative side effects. At the same time, it isn’t yet clear whether that comes at the cost of more aggressive cancers being caught at an incurable stage. Better screening tests may make the difference in helping strike the right balance between limiting harm and preventing prostate cancer deaths.

Active surveillance is safe for low-risk prostate cancers

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

A new study confirms that active surveillance is a safe and reasonable alternative to immediate treatment for prostate cancer. In recently published study that followed 1,300 men, the prostate cancer survival rate after 10-15 years of active surveillance, was 99%. For some men, a strong discomfort with “living with cancer” may steer them away from postponing treatment in favor of careful monitoring.

Following low-risk prostate cancers before starting treatment becoming more common

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

Treatment decisions are complicated for men with low-risk prostate cancer that grows slowly. These cancers may never become deadly during a man’s expected lifespan. And there is no conclusive evidence showing that treatment in these cases extends survival. So cancer specialists have been leaning toward monitoring low-risk prostate cancer carefully and starting treatment only when it begins to spread. This approach was once used only in academic cancer centers, but new research suggests that this strategy is becoming more common in urology practices throughout the United States and other countries as well.

Selenium, vitamin E supplements increase prostate cancer risk

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Taking supplements of selenium or vitamin E, once thought to prevent prostate cancer, seems to do just the opposite. A new report shows that men who take vitamin E or selenium are at higher risk for developing prostate cancer. Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.

New study adds caution to testosterone therapy for “low T”

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now. A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone. Neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution. Given the uncertainly over the benefits and risks of testosterone therapy, what’s a man to do? Take a cautious approach, advises the Harvard Men’s Health Watch.

Prostate cancer lives as it is born: slow-growing and benign or fast-growing and dangerous

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. Instead of embarking on immediate treatment, a growing number of men choose active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men. If confirmed, then prompt treatment can be reserved for the cancers most likely to pose a threat, while men with slow-growing, benign prostate cancer—which is unlikely to cause problems in a man’s lifetime—can reasonably choose active surveillance.

Fish oil: friend or foe?

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

News out of Seattle is sure to fuel confusion about fish oil supplements. A study by scientists at the Fred Hutchinson Cancer Research Center in Seattle linked eating a lot of oily fish or taking potent fish oil supplements to a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer. Fish oil loaded with omega-3 fatty acids, which play important roles in health. Deficiencies in them have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention. Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. Twice a week is a good goal.