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New blood test better at predicting prostate cancer risk than PSA

A new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease. By identifying molecular changes in the PSA protein, the findings of this study suggest that once validated, use of IsoPSA may reduce the need for biopsy, and may lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.

A team of researchers from Cleveland Clinic, Louis Stokes Cleveland VA Medical Center, Kaiser Permanente Northwest, and other clinical sites have demonstrated that a new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease.

By identifying molecular changes in the prostate specific antigen (PSA) protein, the findings, published online last month by European Urology, suggest that once validated, use of IsoPSA may substantially reduce the need for biopsy, and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.

The research team, led by Cleveland Clinic’s Eric Klein, M.D., conducted a multi center prospective study of 261 men scheduled for prostate biopsy at five academic and community centers in the U.S. enrolled between August 2015 and December 2016.

“Despite criticism, PSA has transformed the landscape of early detection, screening, and management of prostate cancer in the last few decades,” said Dr. Klein, chair of Cleveland Clinic’s Glickman Urological & Kidney Institute. “Unfortunately, PSA is tissue-specific but not cancer-specific, leading to overdiagnosis and overtreatment of biologically insignificant cancers, which is widely recognized as a key limitation in its clinical utility.”

The study directly compared the clinical performance of a new test based on PSA, called IsoPSA, to PSA itself with patients already scheduled for prostate biopsy. IsoPSA proved significantly superior to PSA in two key indications: discriminating between prostate cancer and benign conditions; and identifying patients with high-grade disease. The former indication is potentially useful for using IsoPSA for screening by primary care physicians, while the second is helpful for urologists in identifying patients who would benefit from curative intent therapy and other applications.

The results show that if validated and adopted clinically, IsoPSA could significantly reduce the rate of unnecessary biopsies by almost 50 percent. “The methodology used in the IsoPSA assay represents a significant departure from conventional ways to define biomarkers in blood, and may be applicable to improving other cancer biomarkers,” said Dr. Klein.

“Due to its inherent simplicity, requiring only a blood draw and presenting information to the physician in familiar context using a single number — just like PSA itself — we are quite hopeful in IsoPSA’s future utility after further validation studies,” said Mark Stovsky, M.D., co-author and staff member, Cleveland Clinic Glickman Urological & Kidney Institute.


Story Source: Materials provided by Cleveland Clinic.

Journal Reference: Eric A. Klein, Arnon Chait, Jason M. Hafron, Kenneth M. Kernen, Kannan Manickam, Andrew J. Stephenson, Mathew Wagner, Hui Zhu, Aimee Kestranek, Boris Zaslavsky, Mark Stovsky. The Single-parameter, Structure-based IsoPSA Assay Demonstrates Improved Diagnostic Accuracy for Detection of Any Prostate Cancer and High-grade Prostate Cancer Compared to a Concentration-based Assay of Total Prostate-specific Antigen: A Preliminary Repo. European Urology, 2017; DOI: 10.1016/j.eururo.2017.03.025

Read this article on Science Daily. “New blood test is more accurate in predicting prostate cancer risk than PSA: IsoPSA assay can help in determining the need for prostate biopsy for patients.” ScienceDaily. ScienceDaily, 15 May 2017. www.sciencedaily.com/releases/2017/05/170515122149.htm.

By | May 16th, 2017|Dr. Michael Lazar, HIFU, News, Prostate Cancer|0 Comments

Doctors believe it’s important to discuss pros and cons of prostate cancer screening with patients

A new study finds that while a blood test that helps to screen for prostate cancer remains common, only 30 percent of men in a large national survey reported having a balanced discussion of the advantages and disadvantages of the screening with their doctor. Moreover, having such a discussion of both pros and cons has become less likely since the U.S. Preventive Services Task Force issued a recommendation against performing prostate-specific antigen (PSA) testing in 2012.

“That only about a third of patients reported having a discussion of advantages and disadvantages is an alarming statistic,” said study lead author Dr. George Turini III, clinical instructor in medical science at the Warren Alpert Medical School of Brown University and a urologist with the Southcoast Physician Group.

Co-author Dr. Joseph Renzulli, associate professor of surgery and a urologist at the Minimally Invasive Urology Institute at Miriam Hospital, added, “The concept of ‘shared decision making’ for prostate cancer screening is not occurring in the community.”

For example, in 2014 out of a sample of 111,241 men who responded to the national Behavioral Risk Factor Surveillance System survey, 29.5 percent reported discussing both advantages and disadvantages, 33.9 percent discussed neither, 35.7 percent reported discussing only advantages of PSA, and 0.8 percent reported discussing only disadvantages. In data from 2012, before the task force made its recommendation against the test, out of 105,812 men who responded to the survey, 30.1 percent discussed both, 30.5 percent discussed neither, 38.5 percent discussed only advantages, and 0.8 percent discussed only disadvantages.

Meanwhile, 63.0 percent of the men in 2012 had PSA tests, as did 62.4 percent of the men in 2014, according to the study published online in the journal Urology. In each year thousands of men had the test without having a discussion of how it could either benefit them, for instance via early detection of cancer, or lead to unnecessary adversity, such as a side effects from biopsy or unneeded treatment. They either got no information or only one side of the story.

In addition, the researchers found, men who have low incomes, did not finish high school, lack insurance, or are Hispanic were significantly less likely than men overall to report hearing about the pros and cons of screening via the PSA test, the study found.

“The most vulnerable men are getting less counseling,” said co-author Annie Gjelsvik, assistant professor of epidemiology in the Brown University School of Public Health.

A controversial topic

The PSA test reveals blood levels of a protein naturally secreted by the prostate. Levels could become elevated for a number of reasons including the normal enlargement of the prostate as men age, Turini said. But cancer could also elevate them.

When the task force in 2012 discouraged PSA testing, Turini said, it was because there are risks to what follows from screening. If cancer is suspected, it can only be confirmed with a biopsy and that could cause problems such as infection, bleeding or discomfort.

Beyond those concerns, if prostate cancer is confirmed, the risks inherent in treatment options such as surgery, radiation or hormonal alteration, can be “truly life altering,” he said.

“In some cases, a low volume of less aggressive prostate cancer may not necessitate treatment, but even in those cases where a ‘treatment’ is not performed in favor of active surveillance, the emotional distress of a cancer diagnosis shouldn’t be underestimated,” Turini said.

But whenever a cancer does present a threat to health, there are also clear advantages to catching it early. Therefore many urologists still believe that doctors and their patients should weigh these pros and cons of screening. For that reason, the authors wrote, the American Urologic Association and the American Cancer Society advocate thorough discussion and decision-making between doctors and patients.

The study authors sought to understand the state of those discussions and how the task force recommendation may have changed them. Gjelsvik noted that it’s important to measure and track the full spectrum of effects of public health actions, such as the new national recommendations.

The findings could be explained by factors independent of the U.S. Preventive Services Task Force recommendation, the authors acknowledged, but they concluded the paper with this concern: “We believe our findings may be indicative of a shift in practice patterns away from detailed pre-screening discussions among health care providers who have implemented the [USPSTF] recommendation into their care giving. Long-term evaluation of this trend is necessary, particularly to ensure that men who are given an order for a PSA test receive the absolutely necessary counseling required to allow them to appreciate the important consequences associated with the decision to pursue screening.”

Amid all the findings of concern, including the overall trend and disparities of income, education, insurance and ethnicity, the researchers did find one bright spot: Black men, who are known to be at higher risk for prostate cancer incidence and death, were more likely to report having discussed advantages and disadvantages than men on average.

Turini said the study suggests that urologists may be able to do more to help their primary care physician colleagues have balanced and informative conversations with their patients. Primary care physicians are increasingly pressed for time with each patient and it can seem easy to order an additional test if blood is going to be drawn for other purposes anyway, Turini said. But the moment when a PSA test comes back with an elevated reading is not the ideal moment to only begin the conversation of what that could mean.

“It’s our job in the urology community to make it as easy as possible for the primary care physicians and other general practitioners to comfortably disseminate as complete and balanced information as possible,” he said.


Story Source:

Materials provided by Brown University. Note: Content may be edited for style and length.


Journal Reference:

  1. George A Turini, Annie Gjelsvik, Joseph F Renzulli. The State of Pre-Screening Discussions About PSA Testing Following Implementation of the 2012 USPSTF Task Force Statement. Urology, 2017; DOI: 10.1016/j.urology.2016.12.069

Read this article on science daily: www.sciencedaily.com/releases/2017/03/170328132148.htm.

By | April 24th, 2017|Uncategorized|0 Comments

Common Prostate Cancer Therapy May Trigger Dementia

A new analysis of patients who have undergone treatment for prostate cancer shows a connection between androgen deprivation therapy (ADT) — a testosterone-lowering therapy and a common treatment for the disease — and dementia, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. Their previous studies have shown men who undergo ADT may be at an increased risk of dementia, including Alzheimer’s disease, compared to men who were not treated with the therapy.

This new analysis — the largest of its kind ever performed on this topic — shows that all existing studies taken together support the link to dementia and show a possible link to Alzheimer’s. The findings are published this week in Prostate Cancer and Prostatic Diseases. “Since publishing our initial findings, there has been a lot of other research on this topic, and we wanted to see what that research was saying,” said the study’s lead author Kevin Nead, MD, MPhil, a resident in Radiation Oncology at Penn. “This analysis tells us that the composite message of existing studies is that androgen deprivation therapy is associated with dementia.”

The team compiled data from four different global databases looking at studies on ADT patients and dementia and Alzheimer’s. An analysis of more than 50,000 patients worldwide showed a consistent statistical link between men who underwent ADT for prostate cancer and men who developed dementia. Nead says the numbers show correlation, not causation at this point, but that there is evidence of a direct connection.

“Research shows androgens play a key role in neuron maintenance and growth, so the longer you undergo this therapy to decrease androgens, the more it may impact the brain’s normal functions,” Nead said.

The analysis was less conclusive on the question of Alzheimer’s. While there was still a connection, it was not as clearly defined as the link to dementia. Nead says evidence for a link between ADT and neurocognitive dysfunction is growing and should be part of the conversation between doctors and patients.

“There’s enough evidence of these links that patients should know about them when considering their options,” Nead said.


Story Source:

Materials provided by University of Pennsylvania School of Medicine. Note: Content may be edited for style and length.

Journal Reference:

K T Nead, S Sinha, P L Nguyen. Androgen deprivation therapy for prostate cancer and dementia risk: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 2017; DOI: 10.1038/pcan.2017.10

Read this on Science Daily: University of Pennsylvania School of Medicine. “Link between common prostate cancer treatment, dementia detailed in new study: Analysis elaborates on correlation between dementia and testosterone-lowering therapy.” ScienceDaily, 30 March 2017. www.sciencedaily.com/releases/2017/03/170330114954.htm.


HIFU has many proven advantages over traditional treatment modalities for prostate disease. More: www.californiahifu.com #prostatecancer #HIFU #prostate #menshealth #cancerresearch

By | April 4th, 2017|News, Prostate Cancer|0 Comments

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

Prostate Cancer Rates Take a Nose Dive Per Latest Statistics

Dr. Michael Lazar of California HIFU, Urologist and Prostate Cancer expert reflects on the latest American Cancer Society statics

The results from the American Cancer Society’s newest report on cancer rates is good news for everyone and particularly good news for prostate cancer patients: incidents of cancer is down as is the likelihood of prostate cancer patients dying from the diagnosis.

According to the report the cancer death rate has dropped from its peak of 215.1 in 1991 to 161.2 in 2014 (per 100K population), the most recent year for which data was available to analyze. Overall the decline in cancer is linked with decreases in smoking and advances in early detection and treatment. The four major cancer drops are:

  • lung (- 43% between 1990 and 2014 among males and -17% between 2002 and 2014 among females)
  • breast (-38% from 1989 to 2014)
  • prostate (-51% from 1993 to 2014)
  • colorectal (-51% from 1976 to 2014)

“This is really exciting news for anyone who specializes in prostate cancer,” says Michael Lazar, M.D. “And its particularly good news for our patients. When a man is diagnosed with cancer, whether it’s prostate cancer or some other cancer – the news is always difficult to accept. With the number of people being diagnosed with prostate cancer dropping steadily along with the expected death rates, patients are now more empowered to be optimistic about their treatment options.”

According to the American Cancer Society, the decline in new cancer rates for men can be attributed to the recent drop in prostate cancer diagnoses. This has to do with the fact that routine screening with the PSA blood test is no longer recommended out of concerns for over-diagnosis and treatment of positive results that are best left untreated. Therefore, fewer cases of prostate cancer are now being detected. But this does not need to lessen the importance of getting screened for prostate cancer when symptoms are apparent.

“Although this is really good news, men who are concerned about prostate cancer, and anyone in the high-risk group still needs to be to screened early and at regular intervals,” says Dr. Lazar. “Once cancer has advanced beyond the prostate gland, available treatment options become more radical.”

The highest risk groups for prostate cancer are men over the age of 50, African-American men, and men who have a father, brother or son who has had prostate cancer.

About Prostate Cancer

Most prostate cancers tend to grow slowly, and don’t cause obvious health problems for men who have received a diagnosis. In certain situations, prostate cancer can be managed conservatively, especially in elderly men. But one treatment that stands out among more invasive options for prostate cancer is High-intensity focused ultrasound (HIFU) and it is most effective for men who have been diagnose and are in the early stages of the disease. Therefore, this is one technology that requires vigilance at the early stages when HIFU would be most effective for prostate cancer eradication.

“For patients with prostate cancer, HIFU treatment is most effective in the early stages,” explains Dr. Lazar. “When the cancer is localized to the prostate treatment by HIFU is extremely effective. Unlike other treatments, this procedure preserves healthy tissue and nerves, so urine flow and erectile function is maintained in a high percent of cases, as compared to radical surgery or radiation.”

The oncological results for HIFU is comparable to more traditional prostate cancer treatments including radical surgery or radiation. But the side effects for HIFU patients have proven to be much less debilitating than more radical procedures.

About Dr. Lazar

Dr. Michael Lazar is the only Northern California physician recognized as a leader in the use of high-intensity focused ultrasound (HIFU) for prostate cancer. He has been successfully treating patients with HIFU since 2007. Dr. Lazar formed California HIFU to offer minimally invasive prostate cancer treatment to men with the Sonablate.

For more information about HIFU treatment which is now available in San Francisco, or to make an appointment call: (707) 546-5553. Visit us online to learn more.