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Monthly Archives: March 2017

Study Reveals Quality of Life Concerns Paramount in Prostate Cancer Treatment Options

For many men newly diagnosed with early-stage prostate cancer, concerns about potential quality-of-life issues often guide treatment decisions. A new study led by UNC Lineberger Comprehensive Cancer Center researchers identifies distinct patterns of side effects that patients could use to guide their choices.

In the Journal of the American Medical Association, the study examines quality-of-life outcomes for the treatment choices most patients will face. Those choices include active surveillance, radical prostatectomy, external beam radiation treatment, and brachytherapy, a treatment that involves inserting radioactive seeds into the prostate. “Patients diagnosed with early-stage prostate cancer — and that’s the vast majority of patients with this disease — face many treatment options that are thought to be similarly efficacious,” said Ronald C. Chen, MD, MPH, UNC Lineberger member and associate professor in the UNC School of Medicine Department of Radiation Oncology. “Therefore, the quality-of-life differences among these options become an important consideration when patients are trying to make their decisions.”

The study is needed as prostate cancer treatment technologies have advanced, and as active surveillance has emerged as an important strategy for sparing low-risk prostate cancer patients unnecessary side effects. Active surveillance involves regular testing to check for cancer growth rather than immediate treatment, and many patients with low-risk prostate cancer on active surveillance may be able to avoid treatment for several years or altogether. The American Society of Clinical Oncology has endorsed active surveillance for most men with low-risk prostate cancer.

“There has not been a large-scale comparison of the quality-of-life impact for these modern options, until now,” Chen said. “Existing quality of life studies have studied older types of surgery and radiation that are no longer used, and patients need updated information regarding the impact of modern treatment options so they can make informed decisions about the choices they face today.”

For the study, UNC Lineberger researchers surveyed 1,141 men who were diagnosed with early-stage prostate cancer between January 2011 and June 2013. They compared patients’ self-reported quality of life related to bowel, urination, and sexual function across four strategies: active surveillance; prostatectomy; external beam radiotherapy; and brachytherapy. Almost all prostatectomy patients received robotic surgery, and almost all external beam radiotherapy patients received intensity-modulated radiation, reflecting modern treatment technologies.

Prostatectomy was linked to higher sexual dysfunction and urinary leakage than the other options. At two years after treatment, more than 57 percent of men who had normal sexual function prior to treatment reported poor sexual function after surgery, compared with 27 percent who reported poor sexual function after external beam radiation, 34 percent after brachytherapy, and 25 percent after active surveillance. “With modern robotic surgery, sexual dysfunction and urinary incontinence continue to be some of the side effects that surgery can cause,” Chen said. “While we do see improvement over time, even at the two-year point, surgery still causes more of these issues than other treatments.”

Meanwhile, other treatment choices were linked to worse scores for other side effects. External beam radiotherapy and brachytherapy caused more short-term urinary tract obstruction and irritation, while external beam radiotherapy was linked to more short-term bowel symptoms.

For the group of men who chose active surveillance, urinary issues and sexual function worsened over time. This is likely partly due to aging, and partly due to some men who experienced cancer progression that necessitated treatments that caused these side effects.

“At the two-year time point, patients who chose radiotherapy or brachytherapy actually had quality-of-life results similar to patient who chose active surveillance, and that may be surprising to some patients,” Chen said. “With advances in treatment technologies for both surgery and radiation, patients and physicians today must base their decisions on the quality-of-life results of modern treatments, not on results for outdated treatment modalities that caused much more side effects historically.” Overall, Chen said the data can help patients weigh their treatment options based on their own baseline health and on their priorities.

“With all of the modern treatment options, patients should have accurate and realistic expectations about the frequency of side effects from treatment,” Chen said. “We found that the different treatment options have trade-offs in side effects. Each patient can look at these data to see what they care about most.”


Story Source:

Materials provided by University of North Carolina Health Care System. Note: Content may be edited for style and length.


Journal Reference:

  1. Ronald C. Chen et al. Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer. JAMA, March 2017 DOI: 10.1001/jama.2017.1652

See this article on ScienceDaily: 21 March 2017. www.sciencedaily.com/releases/2017/03/170321124231.htm.
By | March 27th, 2017|Dr. Michael Lazar, News|0 Comments

Study reveals genetic connection to aggressive prostate cancer

An international study published in the Journal of the National Cancer Institute has identified a genetic connection to the aggressive form of prostate cancer. The study showed a threefold increase in the risk of aggressive prostate cancer for men with the genetic mutation. The frequency of the gene variants varied from 6 to 14% of the population of men with prostate cancer.

Much like the association between BRCA gene mutation and the risk for breast cancer in women changed the approach to treatment/ prevention, the identification of the Kallikrein 6 gene region may change the course of prostate cancer care through a blood test developed by the Lunenfeld-Tanenbaum Research Institute.

The study was led by Dr. Alexandre Zlotta, Director of Uro-Oncology at Mount Sinai Hospital, and researcher with the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health System in Toronto, Canada, and Dr. Paul Boutros, Principal Investigator, Informatics and Bio-computing, Ontario Institute for Cancer Research (OICR). The first author of the paper was Dr. Laurent Briollais, Senior Investigator, Lunenfeld-Tanenbaum Research Institute.

These findings are important because it is well established that most men will die with prostate cancer, and not from the disease. Dr. Zlotta was the lead author of a study in 2013 which revealed the unexpected high prevalence of indolent prostate cancer in men. Diagnosing the aggressive form of the disease is an important unmet need.

“As an oncologist I know firsthand how valuable it would be to have a genetic tool that could help choose the best course of action with my patients,” explains Zlotta. “It would help spare patients with indolent disease from unnecessary treatments and their side effects and aid in the diagnosis and directing patients with aggressive disease to the appropriate treatment.” Up until now, no single test could predict the severity of the cancer type- the current PSA test (Kallikrein 3), which is located near Kallikrein 6, only identifies the risk of prostate cancer, not the severity.

To identify the relevant mutations the scientists analyzed the blood samples of 1,858 men from three independent cohorts in Europe and North America: the Swiss arm of the European Randomized Study for Prostate Cancer Screening, the large American Screening trial, Prostate, Lung, Colorectal, and Ovarian (PLCO), Princess Margaret Cancer Centre (University Health Network) and Mount Sinai Hospital (Sinai Health System) in Toronto. The KLK6 variants also independently predicted treatment failure after surgery or radiation for prostate cancer in an independent cohort of 130 men from the International Cancer Genome Consortium (ICGC).


Story Source:

Materials provided by Lunenfeld-Tanenbaum Research Institute. Note: Content may be edited for style and length.


Journal Reference:

  1. Laurent Briollais, Hilmi Ozcelik, Jingxiong Xu, Maciej Kwiatkowski, Emilie Lalonde, Dorota H. Sendorek, Neil E. Fleshner, Franz Recker, Cynthia Kuk, Ekaterina Olkhov-Mitsel, Tristan Juvet, Ioannis Prassas, John Trachtenberg, Ants Toi, Michael Fraser, Theodorus van der Kwast, Robert G. Bristow, Bharati Bapat, Eleftherios P. Diamandis, Paul C. Boutros, Alexandre R. Zlotta. Germline Mutations in the Kallikrein 6 Region and Predisposition for Aggressive Prostate Cancer. JNCI: Journal of the National Cancer Institute, 2017; 109 (4) DOI: 10.1093/jnci/djw258

Read this article on ScienceDaily:

“Genetic association with aggressive prostate cancer discovered: Study showed a threefold increase in the risk of aggressive prostate cancer for men with the genetic mutation..” 16 March 2017. www.sciencedaily.com/releases/2017/03/170316141120.htm.

By | March 21st, 2017|Dr. Michael Lazar, HIFU, News, Prostate Cancer|0 Comments

Dr. Michael Lazar Offers Free HIFU Presentation Online

Dr. Michael Lazar of California HIFU recently gave a presentation in Santa Rosa discussing the benefits of high-intensity focused ultrasound for prostate cancer and now offers the presentation online.

A public presentation recently held in Santa Rosa for a group gathered to learn more about high-intensity focused ultrasound (HIFU) provided an overview of how this exciting new prostate cancer treatment works, and included comparisons to other treatment options, as well as HIFU patient outcomes. The event also offered people a chance to meet Dr. Lazar who is a four-time board certified urologist and prostate cancer specialist providing HIFU to patients in California. It also gave attendees a chance to learn more prostate cancer and to ask important questions.

During the presentation, Dr. Lazar discussed how HIFU offers hope for prostate cancer patients by targeting cancer cells through a focused precision technology with minimal to no side effects. The procedure is accomplished in a one to four-hour session and patients return to their normal routines fairly quickly. “Our recent presentation was so well received, we wanted to be able to offer it to a wider audience,” explained Dr. Lazar. “By providing this information to patients online we hope to be able to educate men who currently have prostate cancer about HIFU as a treatment option, and to perhaps provide some important answers to unasked questions.”

About HIFU

Although relatively new to the U.S. Sonablate® technology has been used around the world on more than 15,000 patients in over 30 countries for more than 15 years. Approximately 4,000 U.S. men have received HIFU treatment outside the U.S. prior to FDA approval.

“I started treating with HIFU in 2007 and since receiving FDA approval in 2015 began offering the treatment in San Francisco,” Dr. Lazar said.  Prior to FDA approval Dr. Lazar explained that he performed outpatient procedures at a U.S. Joint Commission approved bilingual hospital in Mexico – helping to bring this innovative prostate cancer treatment to hundreds of men diagnosed with the disease. During that time, Dr. Lazar also served as a HIFU instructor for other physicians and is now actively training doctors in HIFU for prostate cancer in San Francisco.

Serving as Medical Director for HIFU Prostate Services (HPS) Dr. Lazar founded California HIFU to provide HIFU services in the San Francisco area, the first such facility on the west coast. Since that time HIFU using Sonablate® technology has become available in more than 40 locations across the nation.

For patients with prostate cancer, HIFU treatment is most effective in the early stages, where it is localized to the prostate. Performed on an out-patient basis, the procedure is able to preserve healthy tissue and nerves, so urine flow and erectile function is maintained in a high percent of cases. “This is an extremely well tolerated procedure,” said Dr. Lazar. “Patients return to normal activity very quickly. There is no blood loss and very little pain when compared to other treatments for prostate cancer.”

Dr. Lazar explains how all prostate cancer treatments can have side effects. But with HIFU the side effects are lower than with any of the other treatments for prostate cancer. “Unique to HIFU, if you have an HIFU treatment and still require additional treatment, patients can opt to have a second HIFU treatment, or any other treatment they decide to pursue,” he says.

The presentation is free and available online on the California HIFU YouTube Channel accessible by following this link: HIFU YouTube Channel.

About Dr. Lazar

Dr. Lazar is part of Northern California Medical Associates and operates California HIFU in Santa Rosa. He is the medical director of HIFU Prostate Services, LLC, a leading provider of minimally-invasive prostate cancer treatments using High Intensity Focused Ultrasound (HIFU). Dr. Lazar is also a clinical partner with HPS with the HIFU San Francisco Surgery Center of Excellence, a state-of-the-art facility that is convenient to hotels and the airport.  For more information about Dr. Lazar, HIFU treatment for prostate cancer visit the HIFU website or to make an appointment call: (707) 546-5553.

 

 

By | March 6th, 2017|HIFU, News|0 Comments

Researchers target cholesterol to stop prostate cancer

Advanced prostate cancer and high blood cholesterol have long been known to be connected, but it has been a chicken-or-egg problem.

Now a team led by researchers at the Duke Cancer Institute have identified a cellular process that cancer cells hijack to hoard cholesterol and fuel their growth. Identifying this process could inform the development of better ways to control cholesterol accumulation in tumors, potentially leading to improved survival for prostate cancer patients.

The findings are published online this month in the journal Cancer Research.

“Prostate cancer cells, as well as some other solid tumors, have been shown to contain higher cholesterol levels than normal cells,” said senior author Donald McDonnell, Ph.D., chairman of the Department of Pharmacology and Cancer Biology at Duke. “All cells need cholesterol to grow, and too much of it can stimulate uncontrolled growth.

“Prostate cancer cells somehow bypass the cellular control switch that regulates the levels of cholesterol allowing them to accumulate this fat,” McDonnell said. “This process has not been well understood. In this study, we show how prostate cancer cells accomplish this.”

McDonnell and colleagues began by identifying genes involved in cholesterol regulation in prostate tumors. They homed in on a specific gene, CYP27A1, which is a key component of the machinery that governs the level of cholesterol within cells.

In patients with prostate cancer, the expression of the CYP27A1 gene in tumors is significantly lower, and this is especially true for men with aggressive cancers compared to the tumors in men with more benign disease. Downregulation of this gene basically shuts off the sensor that cells use to gauge when they have taken up enough cholesterol. This in turn allows accumulation of this fat in tumor cells. Access to more cholesterol gives prostate cancer cells a selective growth advantage.

“It remains to be determined how this regulatory activity can be restored and/or whether it’s possible to mitigate the effects of the increased cholesterol uptake that result from the loss of CYP27A1 expression,” McDonnell said.

He said statin use alone might help, but perhaps not enough, since tumors could simply rev up the regulation of the cholesterol manufacturing process in tumors to compensate.

McDonnell said is lab is continuing the research, including finding ways to induce cells to eject cholesterol, reverse the inhibition of CYP27A1 activity, or introduce compounds that interfere with cholesterol-production in the tumor.


Story Source:

Materials provided by Duke University Medical Center. Note: Content may be edited for style and length.


Journal Reference:

  1. Mahmoud A Alfaqih, Erik R Nelson, Wen Liu, Rachid Safi, Jeff S Jasper, Everardo Macias, Joseph Geradts, Laura G Dubois, Will Thompson, Michael R Freeman, Ching-yi Chang, Jen-Tsan Chi, Donald P McDonnell, Stephen J. Freedland. CYP27A1 loss dysregulates cholesterol homeostasis in prostate cancer. Cancer Research, 2017; canres.2738.2016 DOI: 10.1158/0008-5472.CAN-16-2738

Duke University Medical Center. “Prostate cancer cells grow with malfunction of cholesterol control in cells: Shutting down this source at the root cause could improve cancer survival.” ScienceDaily. ScienceDaily, 21 February 2017. www.sciencedaily.com/releases/2017/02/170221130703.htm.
By | March 1st, 2017|Dr. Michael Lazar, News, Prostate Cancer|0 Comments