Prostate Cancer Archive

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.

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.

We can thank the Greeks for the name doctors apply to male hormones. Androgen comes from the words meaning "man-maker," and it's a well-chosen term. Testosterone is the most potent androgen, and it does make the man. It's responsible for the deep voice, increased muscle mass, and strong bones that characterize the gender, and it also stimulates the production of red blood cells by the bone marrow.

In addition, testosterone has crucial, if incompletely understood, effects on male behavior. It contributes to aggression, and it's essential for the libido or sex drive, as well as for normal erections and sexual performance. Testosterone stimulates the growth of the genitals at puberty, and it is one of the factors required for sperm production throughout adult life.

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.