Prostate Cancer Archive

In the journals

Excess weight not only raises your risk of prostate cancer, it can also mean more aggressive and fatal cancer, according to a study published online June 10, 2019, by Cancer.

Scientists found that the accumulation of visceral fat (the hidden kind that lies deep in the abdomen and surrounds the major organs) and subcutaneous fat in the thighs (which lies just under the skin) were both associated with a greater chance of developing advanced prostate cancer as well as dying from the disease.

News briefs

New findings show a dramatic increase in the number of men taking a conservative approach to low-risk prostate cancer. According to a Harvard-led study published Feb. 19, 2019, in JAMA, use of active surveillance — which involves monitoring the cancer and delaying treatment unless it progresses — almost tripled from 2010 to 2015. The data come from the records of 165,000 men with prostate cancer. Researchers found that among men with low-risk prostate cancer (slow-growing cancer that's not considered life-threatening), active surveillance jumped from 15% in 2010 to 42% in 2015, surgery fell from 47% to 31%, and radiation dropped from 38% to 27%. Other studies also have also shown increasing rates of active surveillance in low-risk cases.

Why the shift? The authors point to national guidelines that now recommend active surveillance in such cases, as well as favorable research findings. "Emerging evidence has shown that active surveillance for low-risk prostate cancer is an effective alternative to surgery or radiation, associated with similar and excellent chances at long-term survival," notes Dr. Brandon Mahal, the study's lead author and a radiation oncologist with Harvard-affiliated Dana-Farber/Brigham and Women's Cancer Center.

When a man reaches about age 25, his prostate begins to grow. This natural growth is called benign prostatic hyperplasia (BPH) and it is the most common cause of prostate enlargement. BPH is a benign condition that does not lead to prostate cancer, though the two problems can coexist.

Although 50% to 60% of men with BPH may never develop any symptoms, others find that BPH can make life miserable. The symptoms of BPH include:

There's a lot you can do to improve your outcome if you're taking an active surveillance approach to your diagnosis.

 Image: © Nastasic/Getty Images

About 90% of men diagnosed with prostate cancer have the localized kind, which means the cancer is confined to the prostate gland. And for many, a reasonable approach is active surveillance, in which men choose to monitor their cancer instead of going straight into invasive treatments, such as surgery or radiation therapy.

Active surveillance includes a doctor visit about every six months, most often with a prostate-specific antigen (PSA) blood test and digital rectal exam.

On call

Q. I was recently diagnosed with prostate cancer. Does the occurrence of one type of cancer indicate a greater risk of developing other kinds?

A. Prostate cancer is the most common cancer among men, and almost every man will get prostate cancer if he lives long enough. In general, prostate cancer that develops after age 60 probably does not increase the risk of getting a different kind of cancer. However, there are some exceptions.

In the journals

 Image: © jarun011/Getty Images

The U.S. Preventive Services Task Force recently updated its guideline for prostate-specific antigen (PSA) screening for prostate cancer.

The group now recommends that for men ages 55 to 69, screening should be an individual choice, and a man should discuss the pros and cons with his doctor before making a decision. The report, published online May 8, 2018, by The Journal of the American Medical Association, differs from the 2012 guidelines that recommended against screening for all men.

In the journals

Only a biopsy can determine for certain whether prostate cancer is present, but a new study suggests that using magnetic resonance imaging (MRI) can help to better identify patients who are more likely to need a biopsy versus those who aren't.

The study, published online Feb. 22, 2018, by JAMA Oncology included 651 men screened for prostate cancer with blood tests and digital rectal exams. Everyone underwent three procedures: an MRI scan, a biopsy guided by transrectal ultrasound (TRUS), and a biopsy guided by both MRI and TRUS.

In the journals

Men with intermediate-risk prostate cancer may benefit more from a shorter duration of hypofractionated radiation therapy (HRT) than from standard radiation therapy. With both types of radiation therapy, the total amount of radiation is given in multiple sessions over a set period. Compared with standard radiation therapy, HRT uses larger doses over a shorter period of time.

A study in the Nov. 4, 2017, European Urology Focus analyzed data of 3,553 men with prostate cancer, 65% of whom had intermediate-risk prostate cancer. The men were randomized to get either a one-month program of HRT or the standard radiation treatment regimen given over two months. After an average of five to six years, the intermediate-risk men who had HRT were less likely than men who got standard radiation therapy to have their prostate cancer return.

In the journals

Observation only may be the best medicine for men with early-stage prostate cancer, suggests a 20-year study published online July 13, 2017, by The New England Journal of Medicine. Early-stage prostate cancer means the cancer is small, confined to the prostate gland, and can only be detected with a biopsy.

Researchers randomly assigned 731 men, average age 67, with localized prostate cancer to receive either surgery or observation only. At the 20-year follow-up, 62% of the men who had prostate cancer surgery had died of other causes, while only 7% died from prostate cancer. In comparison, 67% of the men assigned to observation died from other causes and 11% from prostate cancer. The absolute differences in mortality were not significant.

In the journals

A study of almost 31,000 men whose prostate cancer had not spread found that the use of androgen deprivation therapy (ADT) was not associated with a higher risk of Alzheimer's disease. This counters previous studies that suggested a possible link. The results were published in the January 2017 Journal of Clinical Oncology.

ADT is used in prostate cancer treatment to eliminate testosterone, since the hormone can fuel the disease. Testosterone levels also are traditionally lower in men with Alzheimer's compared with control groups, which suggests there may be a connection between lowering testosterone and an increased risk of Alzheimer's. Previous studies that have explored this connection found that a low testosterone level caused by ADT was associated with a higher probability of developing Alzheimer's. But these studies often covered a shorter time period — for instance, one year or less — and it is doubtful that men were on ADT long enough to cause Alzheimer's.