The Prostate Cancer Blog for Wives and Partners lets you know when new information has been added to our site. Anytime a new page is created — or we feel there is something worth noting — it will be posted here.
Of men with early-stage prostate cancer who choose active surveillance (sometimes called watchful waiting), only about 15% follow up with suggested monitoring, according to early results of a study (Chen et al) reported by University of North Carolina Lineberger Comprehensive Cancer Center. The study—which was presented at the American Society of Clinical Oncology Annual Meeting—included 346 men who were diagnosed with prostate cancer between 2011 and 2013. Guidelines recommend PSA testing at least every 6 months, a yearly digital rectal exam (DRE), and a biopsy within 18 months of diagnosis. In the study, 67 percent of men had a PSA test and 70 percent had a DRE in the first 6 months. But only 35 percent underwent a biopsy within 18 months of diagnosis. The reasons for not following the guidelines were not provided, so it is unclear if the men did not follow their physician’s instructions, or their physicians did not recommend proper monitoring tests. Either way, it is a serious concern.
Blocking a protein known as BRD4 may be a new way to help prevent the spread (metastasis) of prostate cancer that is resistant to hormone therapy (castration-resistant prostate cancer or CRPC). This is an important discovery by Boston University School of Medicine researchers (Shafran et al) because CRPC is a highly aggressive form of the disease that often stops responding to hormone treatment after a few years. While this was a laboratory study in prostate cancer cell lines, the results are promising.
We already know from previous studies that coffee consumption may inhibit progression of prostate cancer (but the “how coffee does it” has not been made clear). Now Japanese researchers (Iwamoto et al, in The Prostate) have targeted 2 compounds in Arabica coffee (kahweol acetate and cafestol) that were shown to inhibit grow of prostate cancer cells in mice in a pilot study, including cells that were resistant to chemotherapy. While interesting, we are still at the early “petri-dish” phase of this science, and the researchers tested the compounds in mice, not men. Further testing is needed to determine if the same effect is even possible in men with prostate cancer. In materials released by the European Association of Urology, an increase in coffee consumption is not advised, especially in men with other medical conditions (always check with your doctor).
Men with metastatic hormone-sensitive prostate cancer who added enzalutamide (brand name XTANDI) to their androgen deprivation therapy (ADT) had a significantly reduced risk (by 61%, P < 0.0001) of radiographic disease progression or death compared to ADT alone, according to results from a Phase 3 trial (the ARCHES Trial) that were presented at the 2019 Genitourinary Cancers Symposium in San Francisco, CA. This Phase 3, randomized, double-blind, placebo-controlled, multi-national trial enrolled 1,150 men with metastatic hormone-sensitive prostate cancer. The primary endpoint of the trial was radiographic disease progression as assessed by central view, or death within 24 weeks of treatment discontinuation. While XTANDI is approved for men who have castration-resistant prostate cancer, researchers still needed to determine if it could benefit men with hormone-sensitive prostate cancer. Now we must wait to see if enzalutamide will be approved for men who have prostate cancer that has spread (metastasized), but is not yet hormone resistant.
Men 66 years or older who treat their (nonmetastatic) prostate cancer with surgery or radiation are more likely to take antidepressant medications than men who do not undergo treatment, according to a new study (Matta et al) that was published online in European Urology. Researchers looked at data from over 12,000 men with prostate cancer (4,952 had surgery, 4,994 had radiation, and 2,136 had surveillance). One year prior to starting treatment, 7.7% of men were prescribed an antidepressant, which increased to 10.5% a year after their treatment. Men also had an increased risk of using antidepressants 5 years after surgery vs men who had no treatment (surveillance). Bear in mind, however, that this was a retrospective study. Retrospective studies look backwards at existing data vs a prospective study that looks for specific outcomes during the course of a study period. Prospective studies typically have fewer potential sources of bias (ie, systematic errors that encourage one outcome over others, which can result in incorrect conclusions).
Two drugs used together may be more effective for erectile dysfunction (ED) following the failure of either drug alone, according to an article (Moncada et al, 2018) published in the International Journal of Impotence Research. The clinicians looked at various published articles about two drugs for ED: first-line phosphodiesterease-5 inhibitors (PDE5Is) and alprostadil, which is often a second-line choice by physicians. They suggest that combination therapy may be a treatment option for men to consider following prostatectomy, if they have had a poor response to either drug alone.
To those of us who have been watching, it comes as no surprise that a recent study has found that prostate cancer screenings are down, which has led to fewer American men being diagnosed and treated. Part of the decline is no doubt a direct result of the 2012 US Preventive Services Task Force (USPSTF) recommendation against prostate cancer screening. But the numbers started to fall in 2009, according to a new study of 6 million men published in the online edition of CANCER. Specifically, the prostate cancer biopsy rate per 100 men following a PSA test decreased from 1.95 to 1.52 (over the study period, which was from 2008-2014). The incidence of prostate cancer, however, increased from 0.36 to 0.39. The proportion of men with newly diagnosed prostate cancer that underwent local treatment decreased from 69% to 54%. After 2011, both PSA testing and prostate cancer incidence decreased significantly (P < .001).
Wives of men with advanced prostate cancer believe that their lives are being undermined by their husband’s illness—and more than half said their own health had suffered—according to a new (but small) study by Danish researchers from Herlev and Gentofte University Hospital. The study included 56 wives of men with metastatic prostate cancer who were undergoing hormone therapy. The researchers selected 8 women (randomly) to conduct focus-group type interviews, which allowed them to express their feelings. Some of the women said they felt isolated and fearful and worried about how their role in life would change as prostate cancer advanced. We have often written that prostate cancer can be as stressful for wives and partners as it is for men and this study supports this belief. But this study does raise some unanswered questions (such as, how old were the women and did the couples have any marriage problems prior to a prostate cancer diagnosis?). The results of the study were presented at the European Association of Urology conference in Copenhagen.
There was an interesting onclive.com article this week by Danielle Bucco discussing the results of the 10-year PROTECT study that was published last year (Hamdy et al). In this study, the survival rate of men with localized prostate cancer was not significantly different between 3 groups, including men on active monitoring, men who had external beam radiation therapy, and men who had radical prostatectomy. The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Only 1% mortality was reported in each group. What’s interesting about this study is that the researchers recruited 82,429 healthy men aged 50-69 for PSA screening who were counseled about the uncertainties of early prostate cancer treatment before they were even diagnosed. Of that number, 2,664 were eventually diagnosed and 1,643 of those men agreed to be randomized into 1 of the 3 groups. There were 17 prostate-cancer-specific deaths overall (5 in the surgery group, 4 in the radiation group, and 8 in the active monitoring group). Do these results mean that men can safely defer treatment? It is important to note that metastases developed in more men in the active monitoring group (that would be our biggest fear) and higher rates of disease progression were also noted in the same group. When you look at prostate cancer statistics, a lot of men with localized prostate cancer are still alive 10 years after their diagnosis. What we would like to see is what those numbers are like at 20 or 25 years. What remains is the $100,000 question: how long can a man who will ultimately need treatment defer his treatment to preserve his quality of life without fear of cancer progression? In our opinion, we don’t have the right assessment tools to answer that question yet.
Recently, there was a very interesting Washington Post article about immunotherapy and the host of strange side effects that some cancer patients are starting to experience, such as myocarditis, type 1 diabetes, and rashes. My husband and I had a potential PSA-on-the-rise scare recently and his urologist mentioned the hope he has for immunotherapy for prostate cancer. This article certainly gave us some pause about whether he would opt for immunotherapy versus traditional hormone depravation therapy. According to the consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group, when it comes to immunotherapy for cancer, “Skin, gut, endocrine, lung and musculoskeletal immune-related adverse events [irAEs] are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently." Of course, all therapies have potential side effects. That is why it is wise to always do your own research on possible side effects that are related to a prostate cancer treatment.
Always consult a medical professional.