Archive for the ‘News’ Category

Cautionary Yellow Light for Advanced Prostate Patients

Friday, April 11th, 2014

The drug Enzalutamide marketed as Xtandi has had great success in the treatment of metastatic castration resistant in advanced prostate cancer. Xtandi is an androgen receptor antagonist drug developed by the pharmaceutical company Medivation.  ( The drug is also administered in some instances to inhibit breast cancer cell growth. )

However, at the annual meeting of the American Association for Cancer Research (April, 2014) in San Diego, California a cautionary note was sounded by Dr. Emmanuel Antonarakis of Johns Hopkins Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland.

In a recent study Dr. Antonarakis and colleagues identified a genetic biomarker called AR-V7 that can be found in circulating tumor cells and that predicts resistance to Enzalutamide in men with advanced prostate cancer!

The marker AR-V7 was found in nearly 40 percent of patients tested.  Meaning, it is fairly common Dr. Antonarakis says.  “Patients considering treatment with Enzaltamide could have a blood test taken in advance to determine if their (particular) cancer contains AR-V7.  If (the answer is) yes, then these patients should seek alternative therapies because Enzalutamide will not be effective.”  In these instances, Dr. Antonarakis suggests therapies such as chemotherapy should be considered.

 

  

 

 

 

New Scan Finds Dormant Cancer Cells

Thursday, March 6th, 2014

Researchers in Britain have hit upon a dramatic new imaging technique that lights up cancer’s sleeping or dormant cells.  When cancer cells stop growing they can go into a dormant stage and store energy for future use.  That means they can become resistant to killer drugs and escape detection.  Up to now, invasive techniques are used to find them and most have been able to evade detection.  Now  a radioactive molecule has been discovered that can pinpoint these sleeper cells that may eventually wake up and create havoc in the body.

 

The lead scientist at Imperial College London, Professor Eric Aboagye,says this new technique called PET SCAN  (positron emission tomography)  has the immediate potential in the clinic to assess how well drugs are working for patients and to warn of potential relapses of treatment. And it is non-invasive!

 

 The research so far has been used on mice and Professor Aboagye says the technique shows real promise as a tool for telling doctors how much of the cancer can possibly be escaping treatment.  He says the technique can be translated to work in humans and can be adapted for the clinic to help save more lives.  This is a remarkable new development that the researchers are convinced can be used in the future to treat an entire array of cancers beyond prostate.

Prostate Cancer in African Americans drops for the first time!

Saturday, March 1st, 2014

The  American Cancer Society reports that for the first time ever there has been a 20 percent decline in the number of deaths of African Americans from prostate cancer.  African Americans have for decades been the number one target for the disease and still are.  They are, in fact, 60 percent  more likely to get the disease than any other racial group.  But early detection has certainly helped  turn the corner on the number of deaths.  More and more African American men are obviously heeding the caution–getting tested instead of waiting until they discover they have advanced cases that are difficult or impossible to cure.  In short, the word is out in the African American community and more and more black men are paying attention.  The word is simple enough: you don’t have to die from prostate cancer; you should be screened when you reach 40 years of age. Men who have male family members diagnosed with the disease are especially at risk. Early detection can be a life-saver!

Major Breakthrough! Genetic predictor of aggressive nature of prostate cancer

Friday, February 21st, 2014

Once a man is diagnosed with prostate cancer the big looming question is how aggressive is the cancer?  Is it likely to present a mild case that may never cause harm or is it a deadly cancer that can threaten life?  It’s a question that has led to countless debates because current tests have been unable to differentiate with any degree of certainty whether the cancer will be a “pussy cat” or a “tiger.”  So the oncological experts are put on the spot and left to cross their fingers, make predictions—decide whether to treat the disease or not– and hope for the best outcomes. 

 

 The latest thinking is that the key to deciding on the aggressiveness of prostate cancer lies in genetic testing.  Scientists at Britain’s Institute of Cancer Research and The Royal Marsden NHS Foundation in London have discovered 13 mutations in the genes of men that are accurate predictors of the development of the disease.  That is a major finding and it demonstrates not only that some men have a genetic profile that puts them at higher risk of prostate cancer, but that mutations in certain genes will lead to a much more aggressive form of the disease.

 

 The study reported in the British Journal of Cancer involved testing 191 men with  prostate cancer who had at least 3 relatives who were affected with the disease.

 

Results showed that  14 carried mutations with “loss of functions” in the DNA that stopped a gene from working.  The researchers say a patient with any one of these flaws dramatically increases the chances they will develop invasive, spreading prostate cancer.

 

 The co-lead investigator, Dr. Ros Eeles said their study “shows the potential benefit of putting prostate cancer on a par with cancers such as breast cancer when it comes to genetic testing…We proved that testing for known cancer mutations can pick out men who are destined to have a more aggressive form of prostate cancer.”

 

 ( Genes identified in predicting breast cancer and ovarian cancer in women are BRCA1 and BRCA2.  Variant forms of these genes have been found to be associated with men who have died of prostate cancer.)

 

 The study is in its first stage and more testing is being carried out.  But the scientists involved believe their cutting edge work in DNA sequencing will lead to screening tests that will make it possible to step in early and treat men with developing, dangerous cancers before they progress too far.  This could signal a major step forward in treating and defeating prostate cancer.

 

 

 

 

 

 

 

 

Advanced Prostate Cancer Linked to Lack of Sleep

Monday, January 20th, 2014

A new study at Harvard’s School of Public Health in Boston suggests that sleeping soundly may help protect men from advanced prostate cancer.  The lead investigator, Sarah Markt, says her group of scientists have linked together higher levels of the night time hormone melatonin with a 75% reduced risk of the advanced disease. 

 

 Melatonin is a hormone is produced by the pineal gland, a small gland in the brain, that helps control sleep and wake cycles.  The hormone is produced in the dark at night and regulates the body’s sleep-wake 24-hour clock—called circadian rhythm.

 

What the researchers found is that low levels of melatonin are typically associated with disrupted sleep.

 

 In this study, 928 Icelandic men were selected and questioned about their sleep patterns and had urine samples tested for levels of a melatonin breakdown product. The subjects who reported taking medication for sleep problems, and difficulty falling and staying asleep, had lower amounts of the melatonin marker.  Research took place over a period of 7 years.

 

 Over this period, 111 men were diagnosed with prostate cancer including 24 with advanced disease.  The men whose melatonin marker levels were higher than the middle range were 75% less likely to develop advanced prostate cancer than those with lower values of the hormone.

 

 Markt says “ Sleep loss can influence the amount of melatonin secretion or block it altogether, and health problems associated with low melatonin, disrupted sleep, and the disruption of the circadian rhythm are broad, including a potential risk for cancer….We found that men who had higher levels of melatonin had a 75% reduced risk for developing advanced prostate cancer compared with men who had lower levels of melatonin.”

 

More studies are needed, Markt added, to investigate the interplay between sleep duration, sleep disturbance and melatonin levels on risk for prostate cancer.

 

 

 

Coming Soon: a simple blood test to locate genes associated with cancer?

Saturday, January 11th, 2014

Scientists at The University of Texas MD Anderson Cancer Center believe they are on the track of locating gene mutations that cause pancreatic cancer without the need of finding and testing tumor tissue.  If successful, it could open the path for determining other kinds of cancers.  At present there is no single blood test that can screen for all cancer related DNA defects.  Present protocols require a tumor sample to see if there are gene mutations and whether a tumor is benign or cancerous. Still it requires that the sample is accessible. And the procedure carries with it risks and is not inexpensive.

The finding comes following the discovery that a person’s entire double-stranded genomic DNA spanning all chromosomes can be detected in what are called “exosomes.” These are tiny particles that are shed by cancer cells into the blood and they are said to contain the entire genetic blueprint of cancer cells.  By decoding this genomic data researchers can find mutations associated with cancer.  The lead investigator, Raghu Kalluri, MD, PhD, said the discovery of these exosome particles means the way may be translated into a test to help physicians detect cancer and treat patients.  The president of MD Anderson Dr. Ronald A. DePinho says,  “This seminal discovery paves the way for highly sensitive screening for driver mutations of cancer in the blood without the need for biopsy of tumor tissue and importantly lays the foundation for a new method for the early detection of cancer when the chance for a cure is greatest.”

Full report of these findings can be found in the current issue of the Journal of Biological Chemistry.

 

NEW TRACKS:: Molecular IEDs for Cancer Cells

Sunday, December 8th, 2013

A deadly weed with a nearly unpronounceable name—Thapsia garganica—grows wildly in the Mediterranean.  Ancient Greeks called it “the plant of death.”  Camels who ate it died almost immediately.  In the late 70’s a Danish chemist isolated its toxin and gave it the name.  Not long ago a researcher at Johns Hopkins—John Isaacs—-collaborated with the Danish chemist in hopes of harnessing the toxicity of the plant  to kill prostate cancer cells.  A pure leap of faith!

 

 Isaacs did indeed discover that the toxin could kill prostate cancer cells.  That was the good news.  The bad news, however, was that it killed surrounding cells—heart cells and brain cells in mice.  Isaacs was undeterred.  He had a keen understanding of cellular life and death and recruited help from Hopkins’ fellow researcher and clinician Dr. Samuel Denmeade.  For more than a decade the two worked intensively to chemically modify the toxic weed so as to safely target solely prostate cancer cells. 

 

 They found  that thapsigargin kills by making the cells think they need calcium when in fact they do not. As a result, cells are flooded with unending amounts of calcium and die.  To do this, the two devised a new compound they called G202.  It remains inactive until it comes in contact with cells that secrete a protein known as the prostate-specific membrane antigen (PSMA).  Their modified compound meant that the toxin would now selectively target the prostate and would leave heart cells and brain cells and other normal cells alone! 

 

 The G202 compound works by blocking the function of an essential protein that keeps calcium levels in cells at the correct level.  In other words, it causes tumor cells to overdose on calcium and die.  At the same time, it shuts down the blood vessels that feed prostate tumors.

 

To date, the Hopkins team, together with collaborators from the University of Wisconsin and the University of Texas-San Antonio has treated 29 patients with advanced cancer in a clinical trial and are assessing the safety of the drug.  The next step is to evaluate the effectiveness of G202 in patients with prostate and liver cancers

Prostate Cancer Biomarker Can Predict Aggressive Cells

Friday, December 6th, 2013

Collaboration of researchers at Vanderbilt University Medical Center and the University of Alberta in Canada has discovered a biomarker that can accurately predict whether a prostate cancer patient will have recurring or spreading disease.  They say the biomarker acts like a switch.

 Here’s how it works: A protein called CD151 is normally adhesed or partnered with another protein  that allows the cell to stick to surrounding tissue. But when a cancer is formed—at that precise moment—CD151 breaks “free” and that functionally allows the cancer to spread.  One of the lead scientists, Dr. Andries Zijlstra, says “We’re not talking about changing protein expression…we’re talking about a protein that changes its molecular state and detection of that molecular state is an indication of disease progression.” Dr. Zilstra and his lead colleague,  Dr. John Lewis,  along with their respective team members, determined that if  patients tested  positive for CD151 free, their cancers recurred and spread earlier than in patients without any detectable CD151 free. 

Preliminary work in other solid tumors besides prostate cancer suggests that this may be a universal mechanism that is important for cancer progression. The importance of this discovery is that it may well be a new tool useful in the treating cancer management.

 

 The study will be published in an upcoming issue of Cancer Research.

 

NEW TRACKS… Vigra : Nightly or When Needed?

Tuesday, November 5th, 2013

NEW TRACKS…Viagra:  Nightly or When Needed?

 

 

Skilled surgeons performing prostatectomies do everything in their power to preserve the neurovascular bundles surrounding the prostate.  Assuming the are not diseased, the vast majority of these fragile nerve bundles will recover.  But in some cases—even with meticulous nerve sparing techniques– they don’t fully recover.  (Dr. Burnett is attempting to find ways to prevent their failures.)  Viagra and similar drugs (known as phosphodiesterase-5 inhibitors ) are prescribed and do help many men attain better erectile function following the surgery.  But here’s the question for doctors:  Would it be more helpful for the recovery of sexual function if the patient takes the medication every night or just when he needs it?

 

 

At Hopkins, two studies of Viagra and Levitra –two short acting drugs in this category—were investigated.  But both studies conflicted!  The randomized trial with Viagra taken every night compared with placebo showed that the nightly use was beneficial when compared with placebo.  But a larger trial with Levitra showed Levitra was most effective when take on demand—instead of nightly.  The majority of urologists appear to be prescribing taking these drugs nightly after radical prostatectomy.  That, however, increases the expense of the drugs and at the same time increases the potential side effects in recovering patients. 

 

 

Recently, investigators at Brady—urologist Christian Pavlovich, Dr.Bruce Trock and colleagues decided to address the issue. Their findings: Their study provided more evidence that taking short-acting drugs like Viagra and Levitra every night does not confer any advantages compared to their taking them on demand following prostatectomy.  Every erectile function turned out to be similar or better in men who took Viagra as needed compared with those who took the med every night. They also found that the recover of both erectile function and urinary function was much improved by better degrees of nerve-sparing.  They say they were surprised to learn that urinary quality of life was adversely affected by nightly does of Viagra in the first months after radical prostatectomy. 

 

 

With regard to the long acting pohosphodiesterase-5 inhibitors—drugs like Cialis?  These are currently being evaluated in trials. The Hopkins surgeons concluded tht the most important thing a surgeon can do is to improve a patient’s quality of life is to take the greatest care possible in the part of the operation dealing with nerve sparing.  The discussion on this subject can be found in the British Journal of Urology International. There’s also a follow up analysis in Urology soon to be published.

 

 

African American Men: Is Active Surveillance Too Risky?

Tuesday, November 5th, 2013

African American men in the U.S. have the highest incidence of prostate cancer in the entire world!  How can that be?  The answers have eluded and frustrated researchers for years.  We can say that progress in coming up with explanations has been slow for a lot of complex reasons. For one thing, not enough African American men have come forward to participate in studies that can save their lives.  There is a growing body of evidence that suggests the problem is of genetic origin. And we also know for certain that there is a strong hereditary link in prostate cancer among males in black families.

That said, we have been told by many doctors that if a patient has minimum low risk cancer, he need not go for treatment and can safely elect active surveillance and not subject himself to outcomes like urinary incontinence and sexual dysfunction. That’s the position taken by the  U.S. Preventive Task Force Service.  So what does that say about African American men?  If you are African American and have a low grade prostate cancer, is it safe for you to choose Expectant Management (active surveillance)?  Well, the answer is “not so fast.”

Four researcher MD’s at Johns  Hopkins—H. Ballentinen Carter, Edward Schaeffer, Ashley Ross and Debasish Sundi—set out to find out. They studied 1, 801 men—including 1,473 white men, 256 black men and 72 men of other races.  They  investigated pathologic and cancer-specific outcomes in these men and discovered striking results:  African Americans  had three times the number of advanced, aggressive forms of the disease with poorer outcomes compared to the others. Meaning, even though these men had been considered very low risk, their cancers turned out to be much more aggressive and extensive than the initial biopsies and physical exams suggested! 

 

More than that,  pathologist Jonathan Epstein found that the tumors in the African American men were bigger and  of higher grade and much  harder to find in the initial biopsy procedures.  That in itself was significant. Because the disease was largely found at the top of the prostate, almost impossible to reach in the biopsy treatment.  This finding suggests that there may be biologic differences in the prostates of African Americans and research must be done to find out why these large tumors develop in a location different from other men. 

 

 Bottom line: Because “very low risk” cancers in African American men seem different from other men in location and composition, Dr. Schaeffer believes we may need what  he calls “race-specific” recommendations for the treatment of very low risk cancer.  African American men, then, need to understand, says the Hopkins research team, that that if they decide on active surveillance, aggressive cancer may be missed.”