2017 Blog

Biomarker Test Could Reduce Unnecessary Biopsies to Detect Prostate Cancer

bjgabrielsen : July 18, 2017 3:53 am : 2017

Testing for two biomarkers in urine may help some men avoid having to undergo an unnecessary biopsy to detect a suspected prostate cancer, findings from a new study show.

In the NCI-supported study, researchers from Emory University in Atlanta and M.D. Anderson in Houston tested urine samples from men referred for a prostate biopsy for elevated levels of two biomarkers (RNA biomarkers called PCA3 and T2:ERG) that studies have shown are associated with aggressive prostate cancer. Restricting biopsies to only those men with elevated levels of either of the biomarkers would have reduced the number of these unnecessary biopsies by an estimated one-third to one-half, the researchers report May 18 in JAMA Oncology.

At the same time, this pre-biopsy screening approach would still “preserve the ability to detect the more aggressive cancers,” explained the study’s lead investigator, Martin Sanda, M.D., of the Emory University Winship Cancer Institute.

The PCA3 gene is expressed at high levels in prostate cancers, and a urine test for PCA3 RNA is commonly used in clinical practice to monitor for potential disease in men who have a negative biopsy following an abnormal PSA test or digital rectal exam, Dr. Sanda explained. There is also a urine test for T2:ERG, which is the result of a fusion, or translocation of parts of two different genes, TMPRSS2 and ERG. This translocation is found in approximately half of advanced prostate cancers. Currently, the T2:ERG test is only available at a few academic cancer centers.

Currently, there are hurdles to implementing this testing in everyday care, Dr. Sanda cautioned. But the study findings “clearly demonstrate” that testing for these biomarkers could help to address some of the limitations of the current paradigm for prostate cancer screening and early detection, he said. Implementing this pre-biopsy testing in clinical practice may not yet be practical because of the limited availability of the T2:ERG test.

One of the biggest challenges for researchers has been identifying a way to screen for prostate cancer that can differentiate between indolent and potentially life-threatening cancers. One approach being tested is to develop ways to better triage care decisions following an abnormal PSA test, including making more informed decisions about whether to pursue a biopsy. Prostate biopsies have risks, including pain, bleeding, and potentially serious infections. The resulting oversiagnosis and overtreatment of indolent prostate cancers identified via biopsy have their own harms and costs.

You may find it useful to discuss this article and genetic testing with your urologist if you are contemplating a prostate biopsy. For a full description of the study methodology, see the full article which appeared in the June Cancer News Bulletin published by the National Cancer Institute (NCI) of the National Institutes of Health (NIH).

 


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Antioxidants and Their Colors

bjgabrielsen : July 11, 2017 2:14 am : 2017

According to the Prostate Cancer Foundation, antioxidants play a role in the fight against cell damage and cancer development. Consuming them is highly recommended for men with prostate cancer. Different types of antioxidants can be grouped by color. For example, antioxidants in red tomatoes are identical to those in red watermelons or pink grapefruits. Antioxidants fall under six main color categories.

1) Tomatoes, pink grapefruits and watermelons contain the red antioxidant, lycopene.

2) Grapes, plums, assorted berries and pomegranates contain the red-purple antioxidant, anthocyanin.

3) Carrots, mangoes, apricots, cantaloupes, pumpkins and sweet potatoes contain the orange antioxidants alpha and beta carotenes.

4) Oranges, peaches, papaya and nectarines contain the orange-yellow antioxidant beta-cryptoxanthin.

5) Spinach, collard, yellow corn, green peas and avocados contain the yellow-green antioxidants lutein and zeaxanthin.

6) Broccoli, brussel sprouts, cabbage, kale and bok choy contain the green antioxidants sulforaphane, isothiocyanates and indoles.

7) Garlic, onions, asparagus, leeks, shallots and chives contain the white-green antioxidants allyl sulfides.

 


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A Simplified Guide to the Immune System and How Immunotherapy Can Fight Prostate Cancer

bjgabrielsen : July 3, 2017 5:19 am : 2017

The last post discussed the concept of vaccines for prostate cancer. The second part of the PCF trilogy is an overall simplified view of the immune system, including the various cell types and how they work under both normal and cancerous conditions. This section also describes checkpoint inhibitors and how they are being developed to fight prostate cancer among other types. I again will not summarize the article here but refer the reader to the well-written review in the following link.

The third section describes checkpoint inhibitors in detail focusing on successful applications as well as those scenarios wherein their effects were less than desired. While prostate cancer is the main focus, application to other cancers is also discussed.


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A Must-Read Cutting-Edge Review of Immunotherapy for Prostate Cancer

bjgabrielsen : June 30, 2017 3:58 am : 2017

I just received an e mail from the Prostate Cancer Foundation (PCF) which consisted of a three-part review of immunotherapy as applied to prostate cancer. The review consists of three parts: a) Immunotherapy, a Vaccine for Prostate Cancer; b) Who’s Who in the Immune System; and c) Immunotherapy and Prostate Cancer. The review is so enlightening that I will focus only on part (a) here. The first part discusses how vaccines and checkpoint inhibitors work; when and how they are best administered; specific immune stimulators such as Provenge, PROSTVAC and GVAX; and, combining vaccines and checkpoint inhibitors. I urge the reader to take time and read these sections. There is so much useful information here. Carefully review and digest each section as it applies to your specific cancer issue. You can follow the link above or right here.


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To Be Delivered From Pressure, Trust in Jesus, Not In Yourself

bjgabrielsen : June 23, 2017 4:29 am : 2017

Jesus said, “The birds of the air do not sow or reap, yet God feeds them. Are not you worth more than they? “Matthew 6:26;
Photo; BJ Gabrielsen

The great apostle Paul wrote that he and his colleagues were under great pressure, “burdened excessively beyond our strength so that we despaired even of life; indeed we had the sentence of death within ourselves” (as in the case of many cancer patients), “in order that we should not trust in ourselves, but in God who raises the dead.” (2 Corinthians 1:8-9).

“Under great pressure.” Can we identify with that? We all know the feeling when it seems the weight of the world is upon us. We can’t imagine how we’ll ever get through. We may even reach the point of thinking we would rather die and be done with it than have to endure any longer.

“But this happened that we might not rely on ourselves but on God.” Paul’s explanation can be ours too. Of course, we do not know the workings of God’s purposes in allowing suffering in our lives, pain that can even take us to the breaking point. However, we can always know we are to rely on Him and not ourselves while going through circumstances. That is the reason we can accept whatever circumstances we are in: God is with us.

Paul concludes (v.10) God “delivered us from so great a peril of death, and will deliver us, He on whom we have set our hope. And he will continue to deliver us.” God is our hope and deliverer, not just now in this situation. He was there in the past, and He will continue to be.

If you are unsure of your personal relationship with God, you can know for certain. See the following link.

The above was an excerpt from the Haven Ministries daily devotional, “Anchor” from May 9th, 2017.


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Game-Changer: Newly Diagnosed with Metastatic Cancer and Have Not Had Hormone Therapy? Ask for Abiraterone (Zytiga).

bjgabrielsen : June 19, 2017 1:33 am : 2017

It isn’t often that information on a “game-changing” treatment is published on four cancer websites. But such is the case herein from the National Institutes of Health MedLinePlus, Prostate Cancer Foundation, the June 12 issue of Prostate Cancer News Today and Reuters Health News.

If you have just been diagnosed with metastatic prostate cancer and your doctor wants to start you on hormone (androgen) deprivation therapy (ADT, such as Lupron), which shuts off the supply of testosterone and other male hormones, ask for abiraterone (Zytiga®) as well.  It could extend your life for years.

About 3% of the 161,000 new cases of prostate cancer diagnosed annually are metastatic where the cancer has spread beyond the original tumor. These hormone-naive men (who are just starting ADT) are often treated with a combination of the chemotherapy drug docetaxel (taxotere®) and hormone therapy. According to two recent studies (LATITUDE and STAMPEDE) presented at the 2017 meeting of the American Societyof Clinical Oncology (ASCO), chemotherapy with its undesirable side effects may now be replaced by the FDA-approved anti-testosterone pill abiraterone acetate (Zytiga®) in addition to prednisone. The studies will shortly be published in the New England Journal of Medicine. The two studies found that abiraterone lowered patients’ risk of death by nearly 40 percent when added to standard androgen deprivation therapy and prednisone. It also appeared to more than double the average time it took for a man’s prostate cancer to progress, one of the studies reports, extending the average time of progression from 14.8 months to 33 months.  It also lowered the risk of the cancer getting worse by 53 percent. Researchers state that this may represent one of the biggest survival gains ever reported in a trial in adults with solid tumor and could change then standard clinical practice overnight. For further details, see the following link to the June 5th report from MedLinePlus published by the U.S. National Library of Medicine.

Testosterone fuels prostate cancer growth, so doctors use androgen deprivation (hormonal) therapy (ADT) to prevent the testicles from producing the male hormone. However, ADT drugs do not prevent the adrenal glands and prostate cancer cells from continuing to produce small amounts of testosterone. Abiraterone, a pill taken once daily, blocks an enzyme that converts other hormones to testosterone, essentially halting production of testosterone throughout the body. The U.S. Food and Drug Administration previously approved abiraterone for patients with metastatic prostate cancer that didn’t respond to regular androgen deprivation hormonal therapy.

One of the researchers stated “what’s dramatic is how much better abiraterone works when it’s given earlier. I have never seen a treatment where you could, five years later, see no progression in some men. There are some extreme responders who get a very significant remission. It may be that abiraterone does not just stop cancer from proliferating, but it also stops, or significantly delays, cancer from mutating and becoming more resistant to treatment. The side effects of abiraterone are minimal, if you take your prednisone.”  (Low-dose prednisone is necessary with abiraterone to help the adrenal gland make sufficient amounts of cortisol.) Unfortunately, most insurance companies may not immediately realize that this is going to be the new standard of care. They may not want to pay for abiraterone, and that’s a problem, because the drug, Zytiga®, made by Janssen, is not cheap.  It costs $9,000 a month; however, a generic form of abiraterone is expected to come on the market within the next two years.


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The Secret of Being an Overcomer (in spite of any physical issues).

bjgabrielsen : June 4, 2017 6:33 am : 2017

One of my favorite and most applicable Bible passages is from 2 Corinthians 12:9-10. The apostle Paul had a “thorn in the flesh”, a physical problem (like we may have prostate cancer) which God chose not to alleviate at this point. After pleading with God three times to remove the thorn, God told Paul (and us) that “my grace is sufficient for you, for  (God’s) power is perfected in (our) weakness”; to which Paul replied “most gladly therefore, I will rather boast about my weaknesses that the power of Christ may dwell in me. Therefore I am well content with weaknesses, insults, distresses, persecutions and difficulties (like prostate cancer) for Christ’s sake; for when I am weak, then I am strong.”

Paul learmed the secret of being an overcomer. Maintain God’s perspective on the ups and downs of life and access His power. Paul was firmly convinced that having the person of the Holy Spirit living in him meant that God’s power was available to him. (Note: when a person places their entire faith in Jesus’ death and resurrection for forgiveness of their sins and the gift of eternal life, and submits their will to follow God’s direction, then the Holy Spirit comes to live within that person and a personal relationship with God and Jesus is established and empowered.)

Therefore, we too can learn to be at peace while the storms of life rage around us. The first step is to know and believe that the power of God is within us through the presence of His Spirit. We must then accept that God’s priority for us is our transformation into Christ’s image and not necessarily comfortable circumstances. Diligently seeking to maintain Jesus’ perspective on trials is also important. He said in John 16:33, “these things I have spoken to you that in me you may have peace. In the world you have tribulation, but take courage, I have overcome the world.” Until we settle such matters of faith, true contentment will evade us.

Having embraced these truths, we can learn to use the divine power of the risen Christ. The key lies in submitting our will to His. Then instead of reacting to life based on our own weaknesses and desires, we will switch to responding on the basis of God’s will and the fact that we belong to Christ. We will be able to consciously surrender ourselves to the Lord and His pattern for our life. Yielding control to the Holy Spirit allows God’s perfect will to be done and enables us to accept it. When we can honestly say “God whatever You chooses to send will be all right with me”, then we will experience the inner peace Jesus promised to us. (“Peace I leave with you. My peace I give to you, not as the world gives do I give to you. Let not your heart be troubled nor let it be fearful.” John 14:27).

Divine perspective, surrender and firm faith- these are the ingredients for the victorious, overcoming life.

The preceding was adaped from In Touch Ministries devotionals, April 17th, 2017, by Dr.Charles Stanley.

 


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A Testimonial to Treating a Gene Involved in Metastatic Prostate Cancer

bjgabrielsen : June 3, 2017 2:43 am : 2017

This linked article is an excellent personalized example of treating a man with metastatic prostate cancer and a mutated genetic defect in his BRCA2 gene. He was treated with the PARP inhibitor olaparib which is approved for ovarian cancer. The story itself needs little comment so I urge you to read the following link from the Prostate Cancer Foundation.


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Why Cruciferous Vegetables Like Broccoli Are Recommended for Prostate Cancer

bjgabrielsen : May 29, 2017 7:58 pm : 2017

Researchers at Oregon State University have discovered one of the reasons why broccoli may be good for your health. They found that sulforaphane, a dietary compound from broccoli that’s known to help prevent prostate cancer, may work through its influence on long, non-coding RNAs. This is another step forward in a compelling new area of study on the underlying genetics of cancer development and progression. The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.

The research provides more evidence for how these lncRNAs, which were once thought to be a type of “junk DNA” of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread. Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or “expressed” to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated (uncontrolled) they can contribute to multiple disease processes, including cancer. The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.

Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells. “This could be a turning point in our understanding of how cancer may be triggered and spreads,” said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute. “It’s obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control.” For more information, see the following link.

It is a good idea to add cruciferous veggies to your diet. However, while cruciferous extracts from broccoli, kale, cabbage etc. containing small amounts of sulforaphane are commercially available as supplements, it should be noted that the amounts of sulforaphane needed for activity against prostate cancer in men is not known and usually requires considerable amounts of the extract or vegetable to be ingested. Therefore, before taking any extracts, please consult with your health provider.

 


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A Concise Prostate Cancer Resource Starting With Early Detection and Screening.

bjgabrielsen : May 25, 2017 11:23 pm : 2017

The Prostate Cancer Foundation published a fairly comprehensive yet concise e mail resource describing various facets of prostate cancer beginning with early screening and detection. The reader is urged to spend some time perusing this article. There is so much information here that I am simply linking the article at this point. The initial portion of the article deals with screening and biopsy.

A section entitled “For Patients- Recently Diagnosed? Read This Section First,” describes finding a doctor and treatment center, treatment options, side effects, clinical trials, financial resources, guides and even videos. Information by stage is also provided which includes information on screening, detection and diagnosis, active surveillance, recurrence and advanced disease. A section entitled “Understanding Prostate Cancer” describes risk factors, symptoms and prevention among others.


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One Study Comparing Urinary and Sexual Outcomes for Robotic Prostatectomy Versus Brachytherapy.

bjgabrielsen : May 19, 2017 2:24 am : 2017

 Men with low-risk prostate cancer have similar recurrence-free survival rates when treated with surgical robotic prostatectomy or brachytherapy, but those who received surgery had fewer urinary or sexual problems two years after treatment, a randomized trial in Italy has concluded. The study was recently published in the April 2017 issue of the Canadian Journal of Urology [Claudio et al, 24 (2), 8728-8733].

Treatment of early-stage or low-risk prostate cancer relies on active surveillance, surgery or radiation therapy.  In particular, both robot-assisted radical prostatectomy (RARP) and brachytherapy (BP) — a type of internal radiation therapy in which radioactive seeds are placed inside or near a tumor — have been shown to effectively treat prostate cancer. However, until now little was known about their long-term effects. “Treatment decisions that men with low-risk prostate cancer have to make can be difficult, as a lot of it depends on what the patient is looking for and what type of experience their physician has to offer,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at New York’s Lenox Hill Hospital

Italian researchers at Milan’s San Paolo Hospital conducted the single-center, prospective study from January 2012 to January 2016 to compare the outcomes of 165 patients randomly assigned to receive either RARP or BT. They followed all patients for up to two years after treatment, including clinical evaluation and determination of prostate-specific antigen (PSA) levels.

Researchers also evaluated urinary and erectile functions, and found that overall biochemical recurrence-free survival rates were similar among the two groups. Patients undergoing RARP had a 97.4 percent recurrence-free survival rate, compared to 96.1 percent reported in the BT-treated group. Biochemical recurrence is the term used when a patient’s PSA levels start rising again. “This was actually expected,” said Dr. Samadi. “A two-year follow-up is a short period of time to ascertain much difference between the two procedures.”

While the recurrence-free survival was similar in both groups, researchers saw different outcomes when analyzing sexual or urinary symptoms. Men undergoing BT regained continence faster than those who received RARP during the first six months of follow-up. But this difference was no longer significant after 12 months and 24 months. Interestingly, men in the BT group had more urinary symptoms during the two-year follow-up.

Regarding sexual function, both groups showed a decreased ability to maintain an erection right after treatment. However, RARP-treated men recovered potency much more quickly than their BP-treated counterparts. By the final follow-up, 90 percent of RARP-treated men were back to normal, compared to only 60 percent of men in the BT group. “These are factors any doctor and the men they see with low-risk prostate cancer need to take into consideration when making any treatment decision,” Dr. Samadi said. “When they make the comparison between RARP and BT, RARP clearly shows the upper hand in treating prostate cancer effectively and managing symptoms better at this stage.”

It must be noted that these results may vary somewhat with the experience of the medical personnel involved and should be discussed with one’s physician if applicable.


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