2014 Blog

Two Blood Tests That Can Help Determine the Need for a Biopsy.

bjgabrielsen : July 13, 2014 10:29 pm : 2014, Diagnostics, Genetics, Imaging

The latest edition of the Johns Hopkins Health Alerts (July 9th) cites two blood tests that can provide important information which, when coupled with a physician’s clinical judgment, can more accurately predict the need for a biopsy to confirm or deny the presence of prostate cancer.  The Prostate Health Index (phi test) measures blood levels of PSA, free PSA and an early precursor of PSA called proPSA or p2PSA. The 4Kscore measures total, free and intact PSA and in addition, measures an enzyme called human kallikrein2 (hK2) which is elevated in men with prostate cancer. The significance of these test results in discussed in the linked article.  One must keep in mind that these tests are new and do not have a long track record of results. They can also be marketed without proof of benefit. For more information, see the April 24th, 2014 blog post on this website.


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TAK-700 Development Halted Due to Poor Phase III Trial Results.

bjgabrielsen : July 12, 2014 11:32 pm : 2014, Treatment Information

Takeda Oncology Company and Millenium announced recently that they are halting the development of TAK-700 (Ortoronel) due to poor Phase III trial results in men with metastatic prostate cancer who have not had previous chemotherapy. The drug failed to extend survival time. TAK-700 has been previously discussed in blogs published on this website on June 3rd and November 21st, 2011. TAK-700 is an oral, non-steroidal, androgen (e.g. testosterone) synthesis inhibitor. End points of the clinical studies also included delay in disease progression in addition to extending survival time.


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New Prostate Cancer Drug, ODM-201, to Enter Phase III Clinical Trials.

bjgabrielsen : July 7, 2014 1:27 am : 2014, Treatment Information

It was recently announced that the Finnish drugmaker Orion Corporation and Bayer Pharmaceuticals have entered an agreement to jointly develop Orion’s ODM-201, an oral, androgen receptor inhibitor. Bayer and Orion plan to jointly start the clinical Phase III program in 2014 to further evaluate the efficacy and safety of ODM-201 in patients with non-metastatic castration (hormone)-resistant prostate cancer.  These patients are at high risk of developing metastatic disease and can be identified due to rapid Prostate Specific Antigen (PSA) increases. Phase II clinical studies of ODM-201 demonstrated it to be efficacious and well-tolerated. Eighty-six percent of patients who had not received earlier chemotherapy or abiraterone (Zytiga) experienced a greater than 50% PSA decrease at week 12 on a dose level of 700 mg twice a day. ODM-201 disrupts a tumor cell’s ability to use testosterone by binding with high affinity to the androgen (testosterone) receptor (AR) protein on cells, thereby inhibiting its cellular function. The AR normally binds to testosterone (which fuels prostate cancer) inside the cell and ushers it into the cell nucleus where it enhances cell growth. ODM-201 has similar activity to the anti-androgen drug enzalutamide.


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1) MRI or Ultrasound-Guided Biopsies; 2) Effect of Diet on Prostate Cancer; and, 3) Two Genes Linked to Aggressive Prostate Cancer.

bjgabrielsen : June 27, 2014 4:12 am : 2014, Diagnostics, Genetics, Imaging, General Patient Information

1) A recent article was published from the Washington University School of Medicine which compared the results of prostate cancer biopsies as guided by magnetic resonance imaging (MRI) with those obtained via ultrasound guidance. It was concluded that MRI-guided biopsies were more likely to find aggressive tumors than those that rely on ultrasound. For specific details, see the following link.

2) Another article published in Medline Plus, described a Duke University study of the effects of diet and lifestyle on prostate cancer. A diet rich in complex carbohydrates and lower in protein and fat is associated with a 60 percent to 70 percent reduced risk of prostate cancer according to the researchers. In addition, a fiber-filled diet reduced the risk of aggressive prostate cancer by 70 percent to 80 percent. The presence of metabolic syndrome factors also increased the cancer risk. Metabolic syndrome consists of a group of risk factors that increase a person’s risk of heart disease, diabetes and stroke. They include obesity, high blood pressure, elevated blood sugar levels, elevated levels of triglycerides (blood fats) and reduced levels of “good” HDL cholesterol.

3) Lastly, Columbia University researchers have identified two genes that they claim “are likely driving the most aggressive cases of prostate cancer. Other scientists had linked the genes, FOXM1 and CENPF, to cancer, but had not connected them to prostate growths. And more importantly, it was observed that the two genes’ cancer-causing effects only occurred if they are turned on at the same time. These two genes individually don’t do anything, or very little, but only when they are co-active do they produce aggressive forms of the disease.”  The presence of activity in these two genes could be determined at the time of a biopsy.  “If both genes are turned on and highly active, then men would be advised to get immediate treatment such as surgery, radiation or tumor-targeting drugs, or some combination of these. If neither gene, or only one is active, then doctors might recommend less intensive therapy while they monitored the tumors” according to the researchers.

Prostate biopsies performed using magnetic resonance imaging (MRI) are more likely to find aggressive tumors than those that rely on ultrasound, – See more at: http://www.siteman.wustl.edu/ContentPage.aspx?id=8115#sthash.ExKA8YfO.dpuf

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New 17-Gene Test Enhances Ability to Predict Prostate Cancer Aggressiveness.

bjgabrielsen : June 22, 2014 4:08 am : 2014, Diagnostics, Genetics, Imaging

Genomic Health Inc., a cancer diagnostics company, recently announced they are now marketing a genomic test for men diagnosed with prostate cancer that will provide better information on how likely it is that their prostate cancer is an aggressive form of the disease needing immediate treatment, or a slow-growing, low-risk form of prostate cancer that can safely be monitored over time for signs of progression. The new assay, Oncotype DX Prostate Cancer Test, will potentially give tens of thousands of men increased confidence that they can safely forego aggressive treatment and instead enter a program of active surveillance, where their tumor is monitored over time, deferring surgery or radiation and potentially avoiding the sexual and/or bowel and bladder dysfunction side-effects that can result from those treatments. The new test—a 17-gene predictive “signature”, measures the amount of ribonucleic acid (RNA) expressed by these various genes, with some genes making large amounts of RNA and others making little. Seven separate studies by Genomic Health Inc., involving over 1,000 men diagnosed at biopsy with prostate cancer have shown that in men whose tumors turned out to be high-risk, those men tended to test positive for this 17-gene “signature.” The Oncotype DX Prostate Cancer Test currently costs about $3,800 and is not covered by insurances at this time. For further information, please see the following link.


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All You Need to Know About the Gleason Score and Its Diagnostic Use.

bjgabrielsen : June 19, 2014 6:26 pm : 2014, Diagnostics, Genetics, Imaging, General Patient Information

The Johns Hopkins Health Alerts are extremely informative about various health issues including prostate cancer. The latest alert (June 14th)  discussed the Gleason Score, the most important factor in predicting the current state of a prostate cancer. The Gleason Score is based on tumor grade, which is an indication of the tumor’s aggressiveness. The tumor grade reflects how far the cancer cells deviate from normal healthy cells. See the link for the full article.


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Exercise and Prostate Cancer; Enzalutamide Extends Survival; and, Synergy in Cancer Risk Assessment.

bjgabrielsen : June 19, 2014 5:54 pm : 2014, Diagnostics, Genetics, Imaging, General Patient Information, Treatment Information

Several articles of interest were recently published in the February-March, 2014 NewsPulse from the Prostate Cancer Foundation (PCF). This information had been presented at the American Association for Cancer Research (AACR) meeting. The first article described the benefits of exercise in men prior to their prostate cancer diagnosis as well as during therapy for their condition.  A second article cited a new study involving 1700 men who received a new, oral hormone therapy drug, enzalutamide. The treatment increased survival by 29% and delayed disease progression by 81% in men with advanced prostate cancer who had become resistant to standard hormonal therapies and who had not received previous chemotherapy. In 2012, the U.S. Food and Drug Administration had approved enzalutamide for use in prostate cancer patients who had received prior chemotherapy. Enzalutamide is a type of hormonal therapy that blocks the androgen (male hormone) receptor on cells. In addition, treatment with enzalutamide delayed the need for chemotherapy by 17 months.  A third article described  how combining clinical information from the CAPRA score with the genetic information expressed in either of the Oncotype DX or Prolaris assays yielded improved prostate cancer risk assessment and reduced overtreatment. These results were better than results achieved with either clinical or genetic information alone. A CAPRA score is a means to predict whether a patient has low, intermediate, or high risk prostate cancer; the scores generated are used to guide treatment decisions. CAPRA scores integrate PSA levels, Gleason score, clinical T stage, patient age, and the percentage of prostate biopsy tissue containing malignant cells. This methodology is 80% accurate in predicting the likelihood of progression to fatal disease.


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More News on Genetic Screening for Prostate Cancer Involving BRCA1 and BRCA2 Genes Among Others.

bjgabrielsen : June 3, 2014 5:04 am : 2014, Diagnostics, Genetics, Imaging

It is widely accepted that selected genetic screening is the future of prostate cancer detection. Two interesting articles were recently published describing such screening involving the aggressive breast cancer genes, BRCA1 and BRCA2 among others (CHEK2, PALB2 and ATM). For details, see the following link. In addition, researchers in the United Kingdom have determined that advanced prostate cancer can been linked to mutations in eight genes.


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Selenium and Vitamin E Supplements Can Increase Prostate Cancer Risk.

bjgabrielsen : June 3, 2014 4:47 am : 2014, General Patient Information

A multi-center study from the Fred Hutchinson Cancer Center in Seattle and published in the Journal of the National Cancer Institute have shown that vitamin E can heighten the risk in men with low baseline selenium levels. In addition, selenium supplements can raise the prostate cancer risk in men with high baseline levels of the trace element. The researchers concluded that their study showed no benefits to any man from either selenium or vitamin E supplements and for a significant number of men, these supplements were actually harmful. For more details, see the following link.


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Prostate Cancer Diagnosis Using PSA Velocity and PSA Density

bjgabrielsen : June 3, 2014 4:24 am : 2014, Diagnostics, Genetics, Imaging

To improve the accuracy of PSA values in the diagnosis of prostate cancer, PSA density and PSA velocity are useful concepts. PSA density takes into account the size of a man’s prostate gland when evaluating his PSA level. It is calculated by dividing the PSA value by the size of the prostate as determined by ultrasound. The numerical range of values is useful in differentiating prostate cancer from an enlarged benign prostate. Studies conclude that a PSA density value of greater than 0.15  indicates a higher cancer risk. In my own case, this value was useful in my cancer diagnosis since my prostate was not enlarged yet my PSA was in the high normal range. On the other hand, PSA velocity takes into account changes in a man’s PSA values over time which rise more rapidly in men with prostate cancer than in those without the disease.  For more information and a summary of numerical values for PSA density and PSA velocity see the May 28th, 2014 article in Prostate Disorders from the Johns Hopkins Health Alerts.


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