Mutations in DNA-repair genes, including the breast cancer genes BRCA1 and BRCA2, are involved in an inherited high risk of prostate cancer and, potentially, the risk of an aggressive cancer, according to researchers at Fred Hutchinson Cancer Research Center and the University of Washington.
The study, “Inherited DNA -Repair Gene Mutations in Men with Metastatic Prostate Cancer” published in The New England Journal of Medicine, (see the following link) found the mutations in about 12 percent of men with the cancer — and found that men with metastatic prostate cancer were five times more likely than most people to have these DNA-repair gene mutations. Results suggest that screening for such mutations could help tailor their treatment and encourage family members to consider their own cancer risk.
Because BRCA1 and BRCA2 mutations have long been associated only with breast and ovarian cancers, it was thought that the mutations only affected women.
The team analyzed 20 DNA-repair genes in metastatic prostate tumors and healthy tissues of 692 men. They found that 16 of the genes were mutated in both malignant and healthy cells in 12 percent of the metastatic cancer patients — much higher than researchers ever suspected, said first author Dr. Colin Pritchard.
The findings are also important because men with advanced prostate cancer who have the mutations in DNA-repair genes could be treated with PARP inhibitors or platinum chemotherapy (cis-platin) which is commonly used in breast cancer patients. Although not yet approved for prostate cancer treatment, the treatments are on fast-track review by the U.S. Food and Drug Administration.
“For men with metastatic disease who are found to have these mutations, there are very clear treatment implications that would not otherwise be considered for prostate cancer. It would essentially expand [the patients’] toolbox of treatments,” Cheng said. The researchers hope the findings will lead to future coverage by insurance companies.
The study authors state that it may be of interest to routinely examine all men with metastatic prostate cancer for the presence of germline mutations in DNA-repair genes. Future work by investigators will focus on determining which mutations predispose patients to the most aggressive type of prostate cancer.
The National Cancer Institute (NCI ) of the National Institutes of Health (NIH) also recently published a Cancer Currents Blog on the same subject. See the following link.
In an article published in the journal Cancer Epidemiology, Biomarkers & Prevention (2016, Jan. 25), researchers at the National Cancer Institute (NCI) of the National Institutes of Health (NIH) document an association between higher serum levels of vitamin D and an increased chance of surviving prostate cancer. The current investigation included 1,000 participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study who were diagnosed with prostate cancer following enrollment. Just over 360 subjects died from their disease over 23 years of follow-up from the time of diagnosis. Serum 25-hydroxyvitamin D levels and other factors were measured upon enrollment and questionnaires concerning diet and medical history were completed by all participants. Among men whose vitamin D levels were among the top 20% of subjects, there was a 28% lower average adjusted risk of dying from prostate cancer compared to those whose levels were among the bottom 20%. The effect was stronger among those who survived more than 3.3 years. If these conclusions are validated, vitamin D supplementation could eventually be considered for men diagnosed with prostate cancer.
Prostate cancer patients who undergo radiation treatment, especially brachytherapy, are at increased relative risk of bladder cancer according to new study findings presented at the American Urological Association 2016 annual meeting by researchers from Albert Einstein College of Medicine in New York. This increased relative risk occurs predominantly after 10 years. Bladder tumors found in men following prostate radiotherapy are generally lower stage but higher grade than tumors found in patients without a history of prostate cancer the study showed. Compared with men without a history of prostate therapy, brachytherapy was associated with a 3.5-fold, 2.9-fold, and 5.5-fold increased risk of bladder cancer after 10 years in Caucasians, African Americans, and patients of other or unknown races, respectively. Albert Einstein researchers arrived at their conclusion by analyzing data from the 1973–2011 Surveillance, Epidemiology and End Results (SEER) database to ascertain the observed and expected number of bladder cancer cases after prostate cancer radiotherapy. Radiation cystitis, often manifested years later, is another potential undesirable side effect of radiotherapy. For further details, see the following link.
Still another large cohort study published in the journal Cancer showed that the risk of colorectal cancer (CRC) is increased following a diagnosis of prostate cancer. This suggests CRC screening should be considered following a prostate cancer diagnosis, especially among those undergoing radiotherapy.
Sunset over Gulf of Mexico at Boca Grande, Southwest Florida coast; Photo: BJ Gabrielsen
I have written quite a few blogs on this website the purpose of which was to encourage men with prostate cancer. Personally at the time I wrote them, I found them to be an encouragement to me as well. However, at this moment in time, I find myself in the role of “encouragee” as opposed to “encourager”. Hence I am asking myself some hard questions. I have a serious but non-life threatening condition related to prostate cancer. I was told it could be “cured” with 40-60 specific treatment sessions. I also believed that God had opened the doors for me to receive these treatments at this particular time. But after about 40 treatment sessions, I found my condition worsening. It would improve after a few treatments, getting my hopes up, only to have them dashed when my condition worsened somewhat. I found myself questioning why God was not delivering me from this condition as He seemingly promised or at least I had anticipated. Perhaps some of you who read this have found yourself in a similar situation related to prostate cancer or other conditions. So I asked myself, “do I really believe all the things I have written?” and the Biblical references (“spiritual medicines”) I have quoted? When I don’t see God’s hand working in my situation as I had hoped or hear His encouraging words, do I still trust Him? I am not alone in this situation as famous Biblical men such as Abraham, David, Job and Elijah asked the same question many times. For example, early on Abraham struggled with doubt. His efforts to produce a son by his servant instead of his wife was a less-than-successful effort to bring about God’s promise through human effort. But in the end, when his son Isaac was conceived through Sarah his wife, Abraham was strengthened in his faith and gave glory to God being fully persuaded that God had power to do what He promised. God waited until Abraham and Sarah were too old to have children by any other means than divine intervention to show that the promise came from God. Meanwhile, as I continue my multi-week therapy. what have I learned over these weeks?
As stated above, these weeks have been a roller coaster of worry, anxiety, and the “what if” fear that I might have to live my entire life with this condition. Worry defeats us when it replaces needed rest with fearful emotion. Reacting in fear based only on emotion or incomplete facts will detract from our present quality of life status while doing nothing to prepare us for the future. The Bible treats “worry” as an emotion of choice that impedes our relationship with our heavenly Father. The primary New Testament word for “worry” (merimnao) means “to be anxious, distracted or have a divided mind”. It is an emotion or state of mind in direct opposition to “trust”. Anxiety becomes our alternative to relying on the faithful presence and provisions of God. Merimnao is the word Jesus used when He said “do not worry about your life” (Matthew 6:25). Paul also used it when he wrote “Be anxious for nothing” (Philippians 4:6). A familiar hymn states “day by day and with each passing moment, strength I find to meet my trials here. Trusting in my Father’s wise bestowment, I’ve no cause for worry or for fear.”
Over the weeks, I have come to realize, practice and rely on the following four-discipline solution to “worry” namely to “read, pray, trust and submit (obey).” The first discipline “read” means to read at least a small portion of God’s Word daily asking God to specifically show how His Word applies to my individual situation. The second discipline “pray”, basically means to communicate with God, telling Him exactly how I feel and sense my current situation. Pour out my heart and hopes before God. However, it also includes a time to “be still and know that I am God” (Psalm 46:10) thereby allowing God to speak to me through His Spirit. The third discipline “trust”, is often the most difficult. It demands that we trust God for things we cannot control; releasing them, not into thin air, but to God. But who else could we trust other than God for the things we cannot control? The fourth principle is “submit or obey”, laying our burden totally down at Jesus’ feet. Set the burden down and step back from it. God wants us to submit our burdens and obey Him in all things we can control as He reveals them to us.
The four disciplines, reading , praying, trusting and obeying interact with one another. This interaction means that there are some things for us to do. But as we do them, it sets God free to do the things only He can do. So we find less and less reason to worry.
These four disciplines cultivate a more intimate relationship with God through Christ, developing more confidence in Him. He begins to prove His sufficiency at small levels leading to trusting Him more and more. God can do more for us than anything we are feeling at a given moment. We are able to root ourselves in God’s love and promises even when our feelings and emotions are telling us something different.
Great pain often drives us to God. Holding on to hope can be difficult when miserable circumstances show no signs of improving. For believers, this can be even more discouraging because we know God could have fulfilled our hopes but didn’t. Sometimes what we strive to hold can be kept only by surrendering it to God. This applies to our hopes as well as to our very lives (Luke 9:24). He alone can fulfill our desires or change them to match His will.
The bottom line is when “push comes to shove”, medical help carries us just so far for which we are grateful; but God, His Son Jesus and the Holy Spirit may be all we have but are all we need now and forever. Read, pray, trust, obey! Don’t drift but stay anchored in God’s Word and promises. “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 neither let it be afraid.” ( John 14:27).
Zero, the Project to End Prostate Cancer, is sponsoring a videocast on July 13th from 3-4 PM. The video conference will discuss various treatment options for treating localized prostate cancer. These include surgery, external radiation, brachytherapy, high-intensity focused ultrasound (HIFU), cryotherapy, active surveillance and other options. The speakers are Dr. Kelvin Moses from Vanderbilt University Medical Center and Dr. Eric Shinohara from Vanderbilt Ingram Cancer Center. To participate in this video event, see the following link for information and registration.
An April 4th, 2011 website post described two studies from Johns Hopkins and UCLA which concluded that pomegranate extract increased PSA doubling time (PSADT) in men with prostate cancer. Recently, the National Cancer Institute (NCI) has updated its information from human studies of pomegranate extract. In a study reported in 2006, researchers observed the effects of pomegranate juice (PJ) on PSA values in prostate cancer patients who had rising PSA levels following treatment with surgery or radiation. The study participants drank 8 ounces of juice daily (570 mg/day total polyphenol gallic acid equivalents) for up to 33 months. Drinking PJ was associated with statistically significant increases in PSA doubling time (PSADT). After 33 months of follow-up, the median PSADT increased from 11.5 months to 28.7 months (P < .001).
A phase II study evaluated 1-g and 3-g doses of pomegranate extract in 104 men with rising PSA values following initial therapy for localized prostate cancer. The study reported that pomegranate extract was associated with an increase of at least 6 months in PSADT in both treatment arms, without adverse effects. However, a phase III placebo-controlled trial of 183 patients who were randomly assigned to the pomegranate juice, pomegranate extract, or placebo did not significantly prolong PSADT in prostate cancer patients with rising PSA after primary therapy. Some data from this study suggest that a subgroup analysis should be done to further investigate a potential unique sensitivity.
Personally, I had taken pomegranate extract daily supplied by POM Wonderful for years. I was recently informed that the makers of POM Wonderful are no longer providing the extract capsules. I cannot say for sure whether the extract is helping me but I have no averse effects to my knowledge. However, if you are considering taking pomegranate in any form, you should share this information in discussions with your physician. The National Cancer Institute (NCI) publishes extensive information on studies of the effects of various supplements and vitamins on prostate cancer. See the following link.
Several positron emission tomography (PET) scans (including C-11 choline and acetate PET scans) exist whose purpose is to detect the location of recurrent prostate cancer when the PSA is at low levels. Within the last few days, the U.S. Food and Drug Administration approved another scan using an injected radioactive agent called Axumin. The following link from the FDA provides additional information concerning the reliability of the new scan and its comparison with existing PET scan reagents. Axumin is marketed by Blue Earth Diagnostics, Ltd., Oxford, United Kingdom.
In a very informative seven minute video clip recently posted on Prostate Cancer News Today, Dr. Alicia K. Morgans, an Assistant Professor of Medicine in the subject of hematology and oncology, at the Vanderbilt-Ingram Cancer Center discusses prostate cancer and bone metastasis. She discusses what these diseases entail, how they spread, where in the body they spread, how they are detected and treated and how patients are affected.
Prostate Cancer News Today is a weekly e mail from Bayer Healthcare that contains 3-4 articles referencing various aspects of prostate cancer. An e mail received May 16th, 2016 contained an article called “Finding Out About Prostate Cancer Clinical Trials.” The article was one of the best references I have seen to provide information about the benefits of clinical trials and how to find institutions sponsoring them including the U.S. government National Institutes of Health / National Cancer Institute at https://clinicaltrials.gov. The article also discussed what a patient should ask his physician about trials as well as an article describing reasons to participate and benefits received in trials. Lastly, the weekly e mail also contained details about a specific clinical trial involving a cutting-edge therapy called stereotactic body radiotherapy (SBRT) as a means of delivering radiation to the exact area affected by prostate cancer instead of irradiating the entire gland.
In addition, the May 30th e mail from Prostate Cancer News Today contained an excellent review entitled “How Prostate Cancer Clinical Trials Work, from Research & Development to Human Trials.” Please check out this brief but informative link.
I also strongly suggest that you subscribe directly to this valuable e mail service.
Peace and tranquility in the midst of danger; Photo by BJ Gabrielsen
On Friday May 13th, I posted this most important blog. However, when I received the e mail version by subscription, I saw it was impossible to read. Therefore, I am re-sending it hopeful that it can be read as an e mail as well as on the website. I apologize as I am not very proficient with the WordPress technology.
The word “prostate cancer” evokes anxiety and often fear in every man with whom I have ever spoken. “Is my PSA value normal?” “Do I need a prostate biopsy?” If cancer is detected, what can be done to rid me of it?” “If I have metastatic cancer, what is my life expectancy?” All these questions are understandable. Life is filled with uncertainties. In addition, there are the “what if” questions. “What if I undergo a specific treatment, will it cure me or will there be undesirable side effects?” Sometimes we don’t even need a current stressful situation in order to worry. We can borrow from the future and carry anxiety for what may or may never happen. Personally, I have often found myself conceiving the worst possible scenario figuring any actual result could only be better. Prostate cancer can evolve into a lifestyle of anxiety. It can become a constant companion, hovering over us like a cloud, stealing any peace, contentment or joy of life.As Christians, this is not what God desires for His children and He has made every provision for us to live in contentment and peace. The apostle Paul said in Philippians 4:11 that he learned to be content in whatever circumstance he was facing even death and that the power to do so came through Christ who strengthened him. If we have a personal relationship with God through Christ, our confidence is also found in Him and we will not be swayed by our circumstances. True contentment is based on a Person, and not what’s going on around us.
Many people feel that prayer is the solution because Paul tells us to pray about everything and not be anxious about anything. While such prayers are good, we may simply want God to solve the problem without digging up its root. However, if we know the source of our anxiety, we can actually discover the key to overcoming it.
Dr. Charles Stanley, a well-known pastor and author, identifies three roots of anxiety that feed into our worry. The first root is fear and the key to overcoming it is faith in God’s Word. Fear might be the dread of our current situation or what could happen in the future. “Will my cancer be cured or what happens if it comes back?” The problem is our focus and God’s Word has been written that we may have hope. On more than one occasion, Christ’s disciples were faced with an impossible situation such as feeding 5,000 men not counting women and children with a five loaves of bread and two fish. Jesus’ answer to them and to us is the same; “with people this is impossible, but with God all things are possible” (Matt. 19:26). The Word of God is filled with examples, promises, commandments, and principles that reveal our Lord is bigger than any problem we may encounter.
The second root of anxiety is doubt and the key to contentment is trust in God’s ways. We may know in our mind that God is capable of dealing with our need but we are not sure if He will do it. We may acknowledge His limitless power, yet He doesn’t seem to be doing anything to change our current situation. We would readily trust Him if He’d jump the first time we called and did exactly as we asked or hoped. But He’s the one in control, not us. True contentment comes when we are willing and able to lay our burden at His feet, trusting in His plans and perfect timing. Proverbs 3:5-6 states we are to “trust in the Lord with all our heart and lean not to our own understanding. In all our ways, we are to acknowledge Him and He will direct our paths.” After all, God loves us more than we know.
The third root of anxiety is control, and the key to overcoming it is surrender to God’s will and plan. When circumstances are going well, there is a calm sense of security. A surgeon may tell you, “we got all the cancer and you can consider yourself cured”. In fact, my cancer was found so early that I was told “if we can’t cure you, we can’t cure anyone”. I felt secure and confident till it came back eight years later. In cases like this, the balance is upset and we feel out of control. In reality, we were never in charge of our body. Psalm 103:9 says “the Lord has established His throne in the heavens and His sovereignty rules over all.” That includes all the details of our lives. When we know the Lord and trust in His goodness and love, surrendering to His will and letting go of our desire to control, then we will experience the contentment that comes with knowing we are safely held in His hands, no matter what conditions rage around us. Like a child being led by a loving parent crossing a dangerous street, our security is not simply dependent on our holding God’s hands, it rests in the fact that He is holding ours.
Peace and contentment can become a reality in your life even as you face prostate cancer. It has nothing to do with circumstances and everything to do with God Himself. In the midst of storms, His peace is like a shelter around you, guarding your heart and mind in Christ Jesus (Philippians 4:7). Nothing comes your way without His permission, and if He’s allowed something difficult, you can be sure that He will use it to strengthen your faith and build your character. God desires to give you peace in every circumstance.
The message above is applicable to anyone whose life is based on experiencing a personal relationship with God through faith in Jesus Christ. If you are not sure of your own personal relationship with Him, consider making such a decision. God truly loves each one of us and has a unique plan for our lives. But we are all sinful beings and none of us match up to God’s character and requirements of true holiness. We have all violated His laws at one time or another. Therefore a penalty has to be paid to satisfy God’s character as a just and impartial judge. God’s Son, Jesus came to this earth to do just that, namely give His life as an payment for the sins of each one of us. By placing our faith in Christ’s sacrifice alone and not our own works, God’s requirement is fulfilled and He then sees us as righteous, forgiven and justified through the filter of Christ’s death on a cross. God’s spirit then comes to live within each of us as our divine guide and “helper”. Through Christ’s resurrection from the dead, we are also given the gift of eternal life in a new heaven and a new earth with a new perfect cancer-free body. So if you have never done so, please consider placing your faith in Christ alone and submitting your life to the plans the Creator Himself has formulated. Then the promises in God’s Word as described above become your very own.
