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Proton Therapy for Prostate Cancer: Assessing Long-Term Results

Proton Therapy for Prostate Cancer: Assessing Long-Term Results

The American Cancer Society estimates that there will be 233,000 new cases and more than 29,000 deaths from prostate cancer in 2014. Although the disease can be serious, most men will not die from it. More than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today. The disease can be managed with a variety of treatments, including watchful waiting, chemotherapy, surgery, brachytherapy, and external beam radiation therapy (EBRT) that is delivered with x-rays or protons. “Treatment selection for prostate cancer is dependent on the extent of the disease, the patient’s overall medical condition, and patient preferences,” says Nancy P. Mendenhall, MD. “Ideally, the goal is to find a treatment that will be highly effective and avoid toxicities.” The Role of Protons Radiation therapy is used in two-thirds of cancer patients and is most often delivered with EBRT, a radiation therapy that is produced from a source external to the body. The most common source of radiation in EBRT is x-rays (photons). Most x-ray-based EBRT procedures use sophisticated techniques, such as intensity modulated radiation therapy (IMRT), but there is growing interest in protons as a radiation source. “With proton therapy, a lower radiation dose is deposited in normal non-targeted tissues than with x-rays,” explains Dr. Mendenhall. “This has the potential to reduce toxicity, improve quality of life, and decrease risks for second malignancies. Reducing radiation doses to normal tissues may also permit shorter, less expensive treatment schedules, making proton therapy more convenient for patients.” Recent studies have shown that men with prostate cancer who are treated with proton...

PSA Screening: More Harm Than Good

A new analysis presented at the European Cancer Conference 2013 adds fuel to the ongoing debate over whether routine prostate cancer screening reduces prostate cancer mortality. Overall, lead author Mathieu Boniol, MD, and colleagues found that the harms outweigh the benefits on a population level—which should further discourage the use of routine PSA testing for prostate cancer in the general population. High-risk groups, including those with a family history of aggressive disease, however, can benefit from PSA testing. A recent statement by the United States Preventive Service Task Force (USPSTF) recommending against the routine screening of PSA for men who are symptomatic caused controversy and disagreement among the medical community. Dr. Boniol explains that in this era of high testing, particularly in countries like France, incidence of prostate cancer is now up 14%—but the risk of dying remains at 2%. In a virtual population of 1000 individuals aged 55 to 69 years of aged—under the best scenario—Dr. Boniol and his colleagues estimated that for 1 cancer death to be prevented, an additional 154 biopsies would have to be performed, of which 9 would require hospitalization for severe adverse events; another 0.2 deaths would result from biopsy complications. The breakdown would be as follows: Based on data from a variety of sources, Dr. Boniol and colleagues made two sets of estimates. In a group of 1,000 men aged between 55 and 69 years of age who were not exposed to PSA screening for risk of prostate cancer, there would be 116 biopsies performed 60 cases of prostate cancer identified 119 deaths overall 5.17 deaths would be as a consequence of...
Examining an Innovative Treatment for BPH

Examining an Innovative Treatment for BPH

Globally, more than 110 million men suffer from benign prostatic hyperplasia (BPH), a condition associated with frequent urination during the day and night, trouble urinating, and/or urinary retention. According to the American Urological Association (AUA), the prevalence of BPH by the time a man reaches age 60 is higher than 50%. By the time they reach age 85, the prevalence jumps to as high as 90%. If left untreated, BPH can lead to bladder stones, urinary tract infections, and kidney failure. Medications effectively treat symptoms for most men with BPH, but surgery can be used as a last resort for severe cases. Several surgical procedures are available for BPH, the most common being transurethral resection of the prostate (TURP). Although TURP has been shown to be safe and effective, there are surgical risks and patient preferences to consider. TURP has been associated with long hospitalizations, catheterizations, and recovery times. Advancing Science on Laser Therapy At the 2013 AUA annual meeting, data were presented on the GOLIATH study, a head-to-head study involving TURP and laser therapy. The prospective, multicenter, randomized trial compared TURP and photoselective vaporization of the prostate (PVP) using the 180W GreenLight XPS system (American Medical Systems, Inc.). According to the results, PVP provided several advantages to TURP for addressing lower urinary tract symptoms associated with BPH.             The GOLIATH study demonstrated that PVP was equivalent to TURP with regard to safety and efficacy, as evidenced by the number and rate of adverse events and by the International Prostate Symptom Score and Qmax score (which reflects peak urinary flow rate). PVP was superior to TURP with...

Discontinuing PSA Screening: Perspectives From PCPs

Age and life expectancy appear to be considered often by primary care providers (PCPs) when considering the discontinuation of PSA screening. Nearly 60% of PCPs considered both age and life expectancy in their decision, while 12.2% did not consider either factor. Patient expectations and time constraints were reported by 74.4% and 66.4% of PCPs, respectively, as barriers to discontinuing PSA screening. Abstract: Cancer, November 15,...

Prostate Cancer: Comorbidities, Treatment, & Survival

In 2008, the United States Preventive Services Task Force released recommendations on screening for prostate cancer that indicated men aged 75 or older should not undergo PSA screening. Using that as a proxy, physicians will often not treat men with the disease who fall in this age range. It’s often believed that men won’t realize the benefits of surgery or radiation therapy for prostate cancer until 10 to 15 years after treatment. In addition, few men who reach the age of 75 are expected to reach age 90. New Data on Comorbidities in Prostate Cancer In prostate cancer, age has long been viewed in the context of outcomes, but new research is showing that comorbidities are another important consideration. My colleagues and I had a study published in the Journal of General Internal Medicine in which we sought to determine the 10-year life expectancy of men with prostate cancer who had one or no comorbid conditions. We found that 84% of all men with no comorbid conditions lived at least 10 years. For men aged 75 or older, 58% lived beyond 10 years. Ten-year survival rates were: 65% for those with comorbid diabetes with no associated organ damage. 51% for those with comorbid peripheral vascular disease. 50% for diabetics with organ damage. 35% for men with moderate to severe COPD. These rates were for non-prostate cancer-related survival. Surprisingly, men with some severe comorbid conditions— moderate-to-severe COPD, diabetes with organ damage, congestive heart failure, stroke, heart attack, liver disease, and peripheral vascular disease—were treated at the same rate as men with no comorbidities. It appears that when patients tell physicians...
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