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Health & Medicine for Senior Citizens

New Strategies for Prostate Cancer Care Demanded by Longer Life Expectancy, Aging Population

As boomers pass age 65 – the most common time of prostate cancer diagnosis – researchers have a handful of new barriers to put in the path of the disease

By Garth Sundem, University of Colorado Cancer Center

Dec. 4, 2012 - The population of the United States is getting older, due not only to aging boomers but also to a four-year increase in life expectancy from 1990 to 2010. An aging population means increased diagnosis of prostate cancer. Statistically, the older the patient at time of diagnosis, the more aggressive the disease – and also the less well the patient is likely to tolerate traditional chemotherapies. In sum, we have more, aggressive prostate cancer that can’t be targeted by traditional treatments.

Members of the University of Colorado Cancer Center recently published a review in the journal Drugs and Aging describing the modern state of prostate cancer care – examining not only new drugs but entirely new classes of drugs that may be effective and well-tolerated in these aging patients.

 

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Interpretation of PSA Tests May Be More Meaningful with DNA Study

May reduce risk of men being treated for prostate cancer unnecessarily

Oct. 30, 2012

Pricey New Prostate Cancer Proton Therapy Raises Questions About Safety, Cost

Proton therapy targets more precisely, should minimize damage to nerves and tissue; hope is it translates into fewer side effects, but has become center of intense debate

Oct. 29, 2012

Contrast-Enhanced Ultrasound Detects High-Grade Prostate Cancer Using Less Biopsies

Older men in ‘active surveillance’ for prostate cancer would benefit from using micro-bubble technique to watch progression

Oct. 1, 2012

Prostate Cancer Survival Rates Improved After Introduction of PSA Screening

Growing evidence that questions U.S. Preventative Services Task Force recommendation against PSA screening in all men - Aug. 23, 2012

No PSA Testing May Triple Cases of Advanced Prostate Cancer, Spread

Data very clear: not doing PSA will result in many men with far more advanced prostate cancer spread to other parts of the body

July 30, 2012

More links to prostate cancer reports below story


 
 

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“For patients with advanced prostate cancer, there are more options than ever before. But with more options comes a more complex decision tree in choosing appropriate therapies,” says Elizabeth Kessler, MD, oncology fellow at the University of Colorado Cancer Center and the review’s lead author.

First among these options are targeted therapies. Modern targeted therapies are able to selectively kill cancer cells as opposed to accepting high collateral damage in healthy tissue and so frequently have fewer side effects than traditional chemotherapies. (And, are thus better tolerated by elderly patients.)

“These are drugs like abiraterone and enzalutamide that have been approved for use in late stage prostate cancer and are now being evaluated for earlier use,” Kessler says. Prostate cancer generally depends on androgen hormones like testosterone to survive and grow – even after traditional hormone blockade, the body continues to produce minute amounts of testosterone and even this little bit is enough to drive prostate cancer.

By completely removing the body’s ability to produce testosterone or the cancer’s ability to use it, these drugs break the messaging chain that tells prostate cancer to grow. CU Cancer Center researchers have played an important role in the clinical development of both of these drugs.

Researchers are also looking for additional, molecular drivers of prostate cancer, perhaps for example insulin growth factor.

“We’re also exploring the use of targeted kinase inhibitors,” Kessler says. For example, the drug known as XL184 by Exelixis is currently in clinical trials to target MET and VEGF, “and appears to show effect against bone lesions, the most common location of prostate cancer metastasis,” Kessler says.

“Another promising strategy to treat metastatic prostate cancer is immunotherapy,” Kessler says. In immunotherapy, drugs, devices or treatments are used to sensitize the body’s immune system to attack cancer cells – boosting the body’s ability to clear itself of cancer.

For example, the drug Sipuleucel-T was approved by the FDA in 2010 for treatment of metastatic prostate cancer – “but it requires blood to be removed, treated, and reinfused,” Kessler says – a procedure that can only be accomplished by shipping the patient’s blood to facilities in other cities before reinfusing it here. Second generation prostate cancer immunotherapies including Prostvac are in development or clinical trials, including an open trial at the CU Cancer Center.

Finally, researchers are exploring ultra-precise targeting of radiation that rides along with drugs that attach to bone metastases and affects only the tumor cells in the immediate areas of attachment. “One of these drugs is Alpharadin,” Kessler says, “which goes only shallowly into bone and so targets lesions without stopping the production of bone marrow.”

“There has been a major shift in the acceptance of these drugs,” Kessler says. “We’re learning to reach for them sooner and more frequently in place of traditional chemotherapies.”

This shift means that just as boomers pass age 65 – the most common time of prostate cancer diagnosis – researchers have a handful of new barriers to put in the path of the disease.

About the author: Garth Sundem

In addition to writing for the University of Colorado Cancer Center, Garth is the author of the books The Geeks' Guide to World Domination, Brain Candy, and Geek Logik.


Links to More on Prostate Cancer in SeniorJournal.com

Debate About Recommendation Against PSA Test for Prostate Cancer to Continue

The recommendation by U.S. Preventive Services Task Force against PSA screening for men of any age for prostate cancer stirs swirl of controversy: says special report in NCI Cancer Bulletin

By Carmen Phillips, National Cancer Institute - June 5, 2012

Four New Drugs Will Change Prostate Cancer Care, Colorado Expert Says

Hope this will lead to making prostate cancer a disease a patient is more likely to die with than from

By Garth Sundem - Feb. 16, 2012

Researchers Find Possibility of Heart Disease Causing Prostate Cancer

Duke researchers find evidence linking prostate cancer and coronary artery disease - Feb. 8, 2012

Why Observing Prostate Cancer Gaining Ground On Surgery: NIH Panel Says Not Cancer

‘Some think these tumors should be rebranded as something else, such as idle tumors’

By Richard Knox, NPR’s Shots blog - Dec. 9, 2011

Delay of Treatment for Low-Risk Prostate Cancer Gets Nod from NIH Panel

Recommends active monitoring but details of strategies not determined, Dec. 8, 2011

Cardiovascular Deaths Not Linked with ADT for Prostate Cancer but Lower All- Death Risk May Be

Study should be 'generally reassuring' to most men with unfavorable-risk prostate cancer considering ADT, because it was associated with improved survival  - Dec. 7, 2011

Prostate Cancer Patients Considering Suicide May Find Help in New Concept

Patients who have these negative thoughts before surgery are more likely to have a lower perceived quality of life 3 months afterwards

Oct. 31, 2011

Influential Panel Giving Thumbs Down To Routine PSA Test for Prostate Cancer

See links to other comments and reports on this recommendation

By Scott Hensley, NPR News, Oct. 10, 2011

New Models Predict Likelihood of Erectile Function Return After Prostate Cancer Treatment

Problem still there but it helps men make better informed decisions with realistic expectations - watch video report

Sept. 20, 2011

New Surgery-Free Treatment for Enlarged Prostate Avoids Sexual Dysfunction

Prostatic artery embolization as effective as popular TURP surgical method; more than half of senior men have enlarged prostate; also silodosin a new treatment for prostatitis

May 18, 2011

Ten Ways to Improve Communications, Make Better Decisions About Your Cancer Care

Michigan researchers outline how to improve communication about the risk

Sept. 20, 2011

Concern Is Growing That the Elderly Get Too Many Medical Tests; Little Benefit

Growing skepticism about widespread, routine screening for cancer and other ailments of people in their 70s, 80s and 90s

By Sandra G. Boodman, Kaiser Health News

Sept. 13, 2011

Prostate Cancer Patients Live Much Longer with Hormone Therapy Added to Radiation

Larger graphs of prostate cancer cases and deaths 1987-2007 below story

ADT therapy works well with intermediate grade cancer, not so well with low grade; only two grades tested in this trial

July 15, 2011

Medicare Bites Bullet to Cover Expensive Provenge, Prostate Cancer Drug for Bad Cases

CMS also to continue expensive breast cancer drug, Avastin; Sipuleucel-T activates immune system to defend against prostate cancer; first approved autologus cellular immunotherapy

July 1, 2011

Cancer Death Rates Continue Decline That Began in Early 1930s Says Cancer Society

Cancer Statistics 2011 shows among men the reduction in lung, prostate, and colorectal cancers is nearly 80% of decline; among women, almost 60% of decrease in breast and colorectal - see chances of seniors getting cancer - June 17, 2011

Drug Approved to Treat Nail Fungus Found to Delay Chemo in Advanced Prostate Cancer

Itraconzole slows prostate cancer progression but has potential of serious side effects - June 3, 2011

Rising PSA Levels May Sometimes Lead to Negative Biopsies But Usually Means Cancer

News study shows nearly 70 percent with rising PSA eventually get prostate cancer - May 18, 2011

 

 

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