Prostate Cancer Archive

In the journals

Prostate-specific antigen (PSA) tests are used to help identify men who may have a higher risk of prostate cancer. But a study published online Jan. 12, 2017, by JAMA Oncology, describes a new way to use PSA that may pinpoint men who are likely to die early from prostate cancer that returns after initial treatment.

The researchers used data from a randomized trial of 157 men whose localized cancer was treated with either radiation alone or radiation along with six months of androgen deprivation therapy. The men were then followed for 16 years.

Biomarkers are molecular signatures of both normal and abnormal processes in the body. Here is a more formal definition proposed by a "definitions" working group associated with the National Institutes of Health: "A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacological responses to a therapeutic intervention."

Proteins, fragments of proteins, enzymes, DNA, the RNA molecules that "read" DNA—they all can serve as biomarkers. Blood is an ideal source material because it's easy to collect and examine, but biomarkers can also be found in other body fluids, like urine, and in tissue itself. Biomarkers can inform decisions before, during, and after treatment.

Researchers have mapped patterns of prostate cancer recurrence following surgery, which may help doctors find the best way to treat men whose cancer has returned. About 30% of men who have prostate cancer surgery will have a recurrence, according to the study in the Journal of Urology. 

A new study found that men with low-risk prostate cancer may be able to undergo a shortened course of radiation therapy that cuts treatment by weeks and offers similar outcomes and quality-of-life results as longer treatment courses.

A mindfulness-based stress reduction program (MBSR) can help control anxiety among men who follow active surveillance for prostate cancer. The wait-and-see approach can make men feel so uneasy about their condition that they opt for treatment with radiation therapy or surgery when it is unnecessary. MBSR not only eases anxiety levels, but also inspires men to be more proactive about their health and adopt lifestyle changes like a proper diet and exercise.

Once you've completed treatment, adjusting to a "new normal" can be challenging.

Image: RuslaGuzov/ Thinkstock

Completing cancer therapy can feel like a graduation. You've done some hard work, it's paid off, and you may be ready to celebrate. But saying goodbye to treatment can arouse many of the emotions and uncertainties associated with beginning a new chapter in life.

Dr. Larissa Nekhlyudov is a general internist who works with cancer survivors at two Harvard affiliates, Brigham and Women's Hospital and Dana-Farber Cancer Institute. She acknowledges that cancer survivors have a lot to deal with. "Once you've had your final chemotherapy infusion or swallowed the last pill, you may find yourself facing a new set of challenges—monitoring yourself for signs of recurrence, getting recommended follow-up care, adjusting to the long-term effects of treatment, psychologically adapting to normal life, and working to stay in good health," Dr. Nekhlyudov says.

Researchers believe that a non-invasive screening test that can identify genetic markers for high-grade prostate cancer in urine may eventually reduce the number of prostate biopsies needed. However, experts also caution that while the number of non-invasive tests for prostate cancer diagnosis is growing, these are still early days in their development.

Used alone or with hormone therapy, radiation can be a viable option for men at any stage of prostate cancer.

 Image: BigStock

Nowadays, men diagnosed with prostate cancer are often given two treatment choices, on opposite ends of the spectrum. First is active surveillance, where you forgo immediate treatment and monitor the cancer's growth. The other is surgery to remove the cancerous prostate.

But an in-between option might be a better choice for men who do not want the anxiety of wait-and-see or the physical hardship of surgery: radiation therapy.

Low levels of vitamin D may help predict aggressive prostate cancer, according to new research. While it only showed an association, the researchers believe low D levels could be used as a valuable biomarker, and help men and their doctors decide whether to consider active surveillance, in which the cancer is monitored for changes.  

Image: Thinkstock

A research letter published online Jan. 21, 2016, in JAMA Oncology suggests that many older adults are getting unnecessary cancer screenings. Researchers looked at questionnaire answers from about 150,000 seniors (ages 65 or older) across the country, and found that about half had received prostate-specific antigen (PSA) testing or mammography in the past year. But a third of those screened did not have a 10-year life expectancy, a major guideline for screening. Unnecessary screening rates varied by state—for example, 11% in Colorado and about 20% in Georgia. "Undergoing a screening test may actually cause more harm than good, especially with older patients or those with significant medical conditions," says Dr. Marc Garnick, an oncologist at Beth Israel Deaconess Medical Center and editor in chief of Harvard's Annual Report on Prostate Diseases. So talk to your doctor about the guidelines. Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend routine mammograms every two years for women ages 55 to 74. The ACS does not recommend mammograms in this age group if a woman has a life expectancy of less than 10 years.

For all men, the USPSTF recommends against routine PSA testing. The ACS suggests that men 50 or older (at average risk for prostate cancer) make the decision about screening with their doctor, but only if they have a life expectancy of at least 10 years, and only if they have been advised about the uncertainties, risks, and potential benefits of prostate cancer screening.