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LDR Brachytherapy: Study Demonstrates Viable Option for Men with High-Grade Prostate Cancer

 

Men with high-grade prostate cancer may be particularly interested in important new research findings that demonstrate the benefits of LDR brachytherapy–also known as seed implant— when used in combination with external beam radiation therapy (EBRT).

Published in the Journal of the American Medical Association, the large study reflects findings of research underway at Prostate Cancer Foundation of Chicago (PCFC).

LDR Brachytherapy ‘Boost’ Improves Outcomes for Patients with High-Grade Prostate Cancer

Researchers at 12 specialty centers were led by Amar U. Kishan, M.D., University of California Los Angeles.  They analyzed prostate cancer treatment outcomes for over 1,809 patients with Gleason scores of 9 and 10—men more likely to have their cancer spread to other organs. The study showed that men who received low dose rate (LDR) brachytherapy as a boost to external beam radiation therapy (EBRT), had better clinical outcomes than men undergoing either radical prostatectomy surgery (removal of the entire prostate gland) or EBRT alone.

Men in both external beam radiation groups also received androgen deprivation hormone therapy, which is prescribed commonly to slow the growth of cancerous tissue and/or reduce the size of the prostate gland pre-treatment..

Mortality Rate Reductions

According to the study, adding LDR brachytherapy to EBRT resulted in less prostate cancer deaths and less spread of cancer beyond the prostate. More exactly, EBRT with seed implant resulted in lower 5-year prostate cancer-specific mortality; lower 5-year rate of distant metastasis and lower all-cause mortality within 7.5 years of follow-up, when compared to both prostate removal surgery and to EBRT alone.

Research by Prostate Cancer Foundation of Chicago

Prostate Cancer Foundation of Chicago (PCFC) strives to educate men about their range of prostate cancer treatment options. Working hand-in-hand with Chicago Prostate Cancer Center, PCFC is currently tracking outcomes for men treated with combination therapy—men receiving LDR brachytherapy after prescribed sessions of external beam radiation.  PCFC’s findings, along with those reported by UCLA, will educate physicians treating patients with high-grade prostate cancer, while informing men seeking treatment options.

Learn more

Contact Michelle Braccioforte, Director of Research and Education, at 630-654-2515, to learn more about Prostate Cancer Foundation of Chicago and our mission to improve quality of care and quality of life through clinical research, patient support programs and professional and public education. Details about PCFC Informational Support Group meetings, Free Prostate Cancer Screening and educational outreach for your organization or corporate wellness program are also available at www.chicagoprostatefoundation.org.

 

 

 

 

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New analysis demonstrates prostate cancer screening really does save lives

Screening linked to approximately 32% decrease in prostate cancer deaths

“Men trying to follow the advice on whether they should get screened for prostate cancer have long been confused, since guidelines and recommendations keep changing. Now, in the latest analysis of data published in the Annals of Internal Medicine, researchers conclude that testing does help save lives from the disease and is linked to as much as a 32% decrease in prostate cancer deaths, compared to men who aren’t screened.” according to TIME Health’s Alice Parks in “Getting Tested for Prostate Cancer May Be Worth It After All”.

New research led by Ruth Etzioni, PhD, of the Fred Hutchinson Cancer Research Center, Seattle, Washington, re-analyzed two major prostate cancer studies that had conflicting results. Parks, contrasting the original findings, “The U.S. study, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), did not find any difference in deaths from prostate cancer among men 55 to 74 years who were screened with PSA and men who were not screened. The European Randomized Study of Screening for Prostate Cancer (ERSPC) which included men 55 to 69 years, however, found that PSA screening led to a 21% lower risk of dying from prostate cancer during the study follow-up compared to men who didn’t get screened.”

Upon re-analysis, both major studies showed reduction in death among screened men

“The new analysis concludes that both studies do, in fact, show a reduction in the risk for death from prostate cancer among men who were screened. The new analysis of data used a mathematical model to account for differences in the two studies. Adjusting for implementation compliance and practice settings, it found that both the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality,” according to Roxanne Nelson for Medscape.

Adjustments allowed comparing ‘apples to oranges’

One adjustment accounts for the European practice of recommending prostate biopsies for men with lower prostate specific antigen (PSA) scores than common for U.S. patients. This could have lead to earlier prostate cancer diagnosis and treatment for ERSPC trial subjects compared to U.S. patients.

Re-analysis also corrected for the fact that in the U.S. study (PLCO), some men in the ‘non screened’ group actually had PSA screening at some point and may have received treatment before the study.

“The new analysis showed a 25% to 31% lower risk in the ERSPC and a 27% to 32% lower risk in the PLCO for dying from prostate cancer among men who were screened compared to men who were not screened,” writes Nelson.

“Nail in the coffin to the argument that screening does not prevent prostate cancer mortality” — Dr. Jonathan Shoag

Jonathan E. Shoag, MD, New York-Presbyterian Hospital, New York City had himself re-analyzed only the U.S. PLCO trial last year. “Up until recently, there was the widespread belief in the medical community that PSA screening did not save lives.” Shoag commented on the latest re-analysis of both studies, emphasizing its importance, “as it shows that when accounting for control-group contamination and other study differences, both trials actually show a comparable mortality benefit to screening. This should serve as the nail in the coffin to the argument that screening does not prevent prostate cancer mortality.”

Will re-analysis shift US Task Force prostate cancer screening recommendations?

“This is a big turnabout. The PLCO was originally reported as not showing any effect on prostate cancer mortality, a finding that was a big factor on the US Preventative Services Task Force’s (USPSTF’s) decision to recommend against routine PSA screening in 2012,” says Roxanne Nelson.

Historical significance of the PSA blood test for prostate cancer screening

Giving the historical importance of the new study, Parks explains, “For decades since the 1980s, doctors have recommended that men start to get an annual blood test that can detect possible signs of growing tumors: one for the prostate specific antigen (PSA). But PSA testing has always been tricky, since prostate cancers (unlike breast cancer tumors) tend to grow more slowly—so slowly, in fact, that most men are more likely to die of something else other than prostate cancer. That made treating prostate cancer detected by the blood test less black and white. It also led many men to get biopsies—a relatively safe procedure, but one that still carries potential complications like infections—and even treatment with surgery, radiation or other therapies to remove the tumors, despite the fact that they were slow-growing.

In the U.S., that led to a surge in what some doctors view as unnecessary medical treatments that put men at risk without providing them much benefit. (For most men, prostate cancer isn’t fatal.) So in 2012, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation that most men ages 55 to 69—except for those who have a family history of the disease or are at high risk of developing the cancer—should not get PSA testing at all.”

Conflicting results affected screening recommendations

The 2012 USPSTF recommendations were largely centered on the two original studies—the U.S. PLCO and the European ERSPC—which showed seemingly conflicting results. “Given the uncertainty, and the risks of treating cancers that weren’t aggressive, the USPSTF decided there wasn’t convincing enough evidence to recommend PSA screening.”

But, in April 2017, based on early evidence that less screening was resulting in more cases of advanced prostate cancer, the Task Force modified its recommendation against general PSA testing.  They currently suggest men age 55 to 69 resume individual discussions of screening related to their risk of prostate cancer with their doctors. “The current study will likely play a role in any revised guidelines on prostate cancer screening,” states Nelson.

Screening recommendations of Prostate Cancer Foundation of Chicago

Prostate Cancer Foundation of Chicago commends the efforts of author Alex Tsodikov and colleagues to extend the utility of the two major original studies through re-analysis. Both PLCO and ERSPC are important randomized controlled trials, which top the hierarchy of clinical study designs.

Prostate Cancer Foundation of Chicago (PCFC) also applauds USPSTF’s decision to modify their 2012 recommendations, now calling for patient-physician discussions on whether and when to screen. PCFC supports screening starting at age 50, even if just to establish a baseline PSA score. Annual screening is recommended earlier — at age 40 — for African Americans and men with a family history of prostate cancer. Screening and discussion is especially important since prostate cancer can be considered as a spectrum disease, with varied manifestations and a wide range of aggressiveness, according to Brian J. Moran, M.D., PCFC Medical Advisor and Chicago Prostate Cancer Center (CPCC) Medical Director.

About Prostate Cancer Foundation of Chicago

PCFC shares prostate cancer treatment advancements, working hand-in-hand with CPCC to measure patient outcomes for research studies. Click Prostate Cancer Foundation of Chicago for ways to stay informed about prostate cancer and screening recommendations, through Informational Support Groups, current clinical research and recent publications.

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Five Leading Prostate Cancer Research Papers

“AUA 2017: Best Prostate Cancer Papers from Past Years”

Prostate Cancer Foundation of Chicago (PCFC) comments on an overview of  five impactful papers in prostate cancer research from 2016.  

Two important papers in the prostate cancer screening arena included the New England Journal of Medicine letter revaluating PSA testing rates in the PLCO trial, and the GWAS PSA SNPs manuscript. The PLCO 2009 PSA screening trial noted no improvement in survival with PSA screening, however there was a reported 50% contamination rate (men in the control arm receiving PSA screening). This letter looked at rates of testing during the trial, which was administered as a questionnaire to a subgroup of control patients, demonstrating that in fact >80% of controls without baseline screening receiving a PSA test during the trial. This letter was important as it likely contributed to the revised Grade C recommendation among men 55-69 years of age. The GWAS trial identified 40 genome-wide significant SNPs, 19 being novel entities. These 40 SNPs explain 9.5% of PSA variation in non-Hispanic whites, since >50% are PSA associated independent of prostate cancer.

PCFC comments: A letter appearing in the New England Journal of Medicine helped convince  US Prevention Services Task Force to reverse its recommendation that men forego prostate cancer screening.  PCFC applauds the Task Force decision and early prostate cancer detection. 

 

The PROMIS study was highlighted as an important paper for prostate cancer diagnosis in 2016. This study assessed whether multiparametric MRI (mpMRI) used as a triage test may allow men to avoid an unnecessary TRUS-biopsy and improve diagnostic accuracy. In this multi-center study, 576 men with PSA < 15 ng/mL underwent an mpMRI followed by a transperineal mapping biopsy. The study found that for significant cancer, mpMRI was more sensitive (93%) compared to TRUS Bx (48%), but less specific (41% vs 96%). Using mpMRI to triage men may allow 27% of patients to avoid a primary biopsy and diagnose 5% fewer clinically insignificant prostate cancer.

PCFC comments: Stereotactic transperineal mapping biopsy is especially useful for diagnosing and planning treatment for men with low-grade cancer confined to the prostate gland. 

 

 The much acclaimed and highly publicized ProtecT trial was highlighted as an important paper in the category of initial treatment for prostate cancer. In this trial 1,643 men with newly diagnosed prostate cancer aggressed to undergo randomization to either active monitoring, surgery or radiotherapy. The primary outcome of PCa-mortality was not reached as only 17 (1%) of patients died of prostate cancer. The monitoring group was more likely to have progression or develop metastatic disease, and there was no significant difference between radiation and surgical treatment. The main emphasis of this trial is that the natural history of prostate cancer is very long and places importance on assessing each patient’s life expectancy. Also, the Australian RCT randomizing 326 men to open vs robotic radical prostatectomy was published in 2016. The major findings of this trial was that there was no difference in urinary or sexual function at three months follow up and no difference in positive margin rate (10% open, 15% robotic). As Dr. Preston mentioned, this shows that surgical RCTs are feasible and should be performed. The ASCENDE-RT was a randomized trial comparing two methods of dose escalation for intermediate and high risk prostate cancer, with all participants receiving 12 months of ADT. After 8 months of ADT, all men received 46 Gy of pelvic XRT followed by a 32 Gy XRT boost, followed by randomization to receive a brachytherapy boost 3 weeks after XRT. Compared to men receiving only XRT, men randomized to brachytherapy boost were twice as likely to be free of biochemical recurrence at 6.5 years of follow-up.

PCFC comments:  A combination of radiation therapies may provide the best cure rates for men with more advanced disease.  Compared to men receiving only external beam radiation treatment, men randomized to LDR brachytherapy boost (additional radiation supplied via a seed implant) were twice as likely to be free of biochemical recurrence at 6.5 years follow-up. 

 

Several trials in the setting of locally recurrent prostate cancer were highlighted. A double blind, placebo controlled trial among 760 men that underwent prostatectomy with a pT2 or pT3, N0 with a PSA of 0.2 to 4.0 ng/mL set to undergo radiation therapy were randomized to either 24 months of bicalutamide or placebo. The trial found that the addition of bicalutamide to salvage XRT resulted in significantly higher overall survival rates: 12 year – bicalutamide 76.3% vs placebo 71.3% (HR 0.77, p=0.04). A subsequent GETUG multi-center RCT aimed to establish the effect of adding short term ADT at the time of salvage XRT on biochemical outcome and overall survival among men with rising PSA. There were 743 men that were randomized to salvage XRT or salvage XRT plus short-term goserelin. The results showed that XRT + goserelin resulted in improved 5-year PFS (80% vs 62%, HR 0.50, p=<0.001).

PCFC comments:  Brachytherapy, or seed implant, is another effective salvage radiation option that can be part of treatment for patients with recurrent prostate cancer.

 

The final paper, in the metastatic setting, highlighted the frequency of inherited mutations in DNA-repair genes (ie. BRCA2) in patients with metastatic prostate cancer. Among 692 men, 20 DNA repair genes were assessed; 11.8% of men with metastatic disease had inherited DNA-repair gene mutations, significantly higher than men with localized prostate cancer. The implications of these findings are that this will allow us to identify men that may have sustained responses to PARP inhibitors and platinum-based chemotherapy.

PCFC comments:   Inherited mutations of the BRCA1 or BRCA2 genes can raise the risk of breast, ovarian and prostate cancer in some families.

Speaker: Mark A. Preston, Harvard Medical School, Boston, MA, USA

Original blog written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md  at the 2017 AUA Annual Meeting – May 12 – 16, 2017 – Boston, Massachusetts, USA

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Task force rethinks guidelines: recommends men age 55-69 resume prostate cancer screening, with physician input

 

A reversal of 2012 U.S. Preventative Services Task Force (USPSTF) recommendations— that had called for all men to forego prostate cancer screening— was released this week.

Two- tiered recommendations

USPSTF now suggests men age 55 to 69 should resume discussions of prostate cancer screening with their physician.  Screening would include men who do not have any signs or symptoms of prostate cancer.  USPSTF reversed its recommendations  based on new research that demonstrated a negative impact of their 2012 advice against routine PSA blood testing.

The task force furthermore advises men who have reached age 70 should discontinue screening for prostate cancer, rather than age 75 as previously recommended.  USPSTF cites “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

Risk groups

According to USPSTF, revised recommendations apply to men in each age group, whether they are at an average risk for prostate cancer, and even men at increased risk, such as African Americans and men with a family history of prostate cancer. USPSTF states there are not enough data to make a different recommendation, even though decision models strongly suggest that African American men have more to gain by screening and may also benefit by starting earlier than the age of 55.

PCFC recommendations

Prostate Cancer Foundation of Chicago (PCFC) champions early detection and concurs in large part with the direction of these recent recommendations.  Yet, we support that men generally begin receiving annual screening at age 50, which is 5 years earlier than recommended by USPSTF.   For men at increased risk for prostate cancer, we recommend screening beginning at age 40, or 15 years earlier than USPSTF advises.

Add DRE for greater detection power

Unlike USPSTF, PCFC also promotes prostate cancer screening that further includes digital rectal examination (DRE).   DRE fell out of favor when many physicians stopped offering their patients routine screening.  In combination with PSA, DRE can uncover abnormalities associated with prostate cancer, even with a normal PSA level.

New evidence of benefits for men age 55 to 69

The USPSTF had previously suggested that PSA testing could lead to unnecessary biopsies and treatment of insignificant cancers.  Task force member Alex H. Krist, MD, MPH, in an interview stated, “There is new evidence to suggest that there is slightly more benefit to screening than we thought before in 2012.  The important thing that we are trying to emphasize is that there is a real close balance between benefits and harms,” he said, but the balance has been tipped slightly toward benefit for the age group aged 55 to 69.”

Less screening led to higher grade tumors when detected

Several studies— and the outcry from many urologists and prostate cancer patients— lead USPSTF to reconsider discouraging men from receiving PSA screening.  Quoting K. Fleshner in Nature Reviews Urology , “Since the 2012 recommendation, rates of PSA screening decreased by 3–10% in all age groups and across most geographical regions of the USA.  Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a shift towards tumours being of higher grade and stage upon detection.”

Results of the European Randomized Study of Screening for Prostate Cancer, demonstrated that slightly more men who are screened would not die from prostate cancer than was the case previously (in 2012).  Also from the European trial, longer-term follow-up shows that three men out of 1000 will avoid advanced prostate cancer because of screening.

Genomic testing of tumors informs treatment decisions

A discussion of a possible limitation of prostate cancer screening points to the difficulty of knowing which cancers will be more likely to advance beyond the prostate.  If a man is found to have a prostate tumor, genomic testing is now available for physicians to understand more about the aggressiveness of a patient’s cancer cells and help men make better prostate cancer treatment decisions.

Education is key

Like the USPSTF, PCFC advocates patient education and shared decision making between doctor and patient.  Discussions of the pros and cons of screening, and available treatment options, will continue to be important for men to have with their family and their physician.

For more information on prostate cancer and screening, contact PCFC at 630-654-2515 or visit the PCFC website.    Prostate Cancer Foundation of Chicago advances patient education, by offering free prostate cancer screening and hosting an Informational Patient Support Group.

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Brachytherapy improves outcomes in men age 60 and younger with prostate cancer

Comparing 8-year survival with LDR brachtherapy (BRT) or with external beam radiation (EBRT)

Life saving advantages of low-dose rate brachytherapy, or seed implant, were demonstrated in a recent study that compared seed implant to external beam radiation treatment (EBRT) eight years after treatment.

Better survival with LDR Brachytherapy

Men who were treated with low-dose rate brachytherapy at ages 60 years and younger survived at twice the rate when compared to men treated with external beam radiation treatment (EBRT) alone.

Men in higher risk groups also benefit

Even for men in subgroups associated with greater mortality risk— high Gleason score, black race, higher Tumor (T) stage and grade— LDR brachytherapy still demonstrated significantly reduced death rate.  Conducted by researchers at New York-Presbyterian Brooklyn Methodist Hospital and Weill Cornell Medicine, the study emphasizes the importance of brachytherapy for men considering a treatment option that provides excellent outcomes.

Read the full article.

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African American men may benefit less from hormone therapy added to brachtherapy

Prostate Cancer Foundation of Chicago recently published a study in the journal Cancer in collaboration with Harvard Radiation Oncology Program and Dana-Farber Cancer Institute.  The study assessed the impact of race on the risk of death from all causes and from prostate cancer alone among men actively treated for favorable-risk prostate cancer.

To make prostate cancers shrink or grow more slowly, androgen-suppression hormone therapy (ADT) is often added to brachytherapy radiation therapy as the standard of care for men with intermediate- and high-risk prostate cancer.   Intermediate-risk prostate cancer can be further classified as favorable- or unfavorable-risk disease

African Americans are more likely to be affected by concurrent chronic diseases— diabetes, coronary artery disease, previous myocardial infarction or congestive heart failure—which may interact with hormone therapy and reduce its benefits.  This new research demonstrates that adding hormone therapy to treatment received by African American men for favorable intermediate risk prostate cancer is actually associated with shortened survival, when compared to non-African Americans with the same stage prostate cancer.

These findings will help physicians determine whether to add hormone therapy to radiation therapy for their African American patients, possibly reserving hormone therapy for cases of higher risk prostate cancers.  Read more about the study, Race and mortality risk after radiation therapy in men treated with or without androgen-suppression therapy for favorable-risk prostate cancer.  Further information on prostate cancer risk and detection includes special recommendations for African American men and is available at Prostate Cancer Foundation of Chicago’s educational infographic, The Importance of Prostate Cancer Screening.

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Power of Genomic Testing

Prostate cancer tumor growth rates vary

While men of the same age may have similar PSA (prostate specific antigen blood test results), Gleason score (grading of tumor cell irregularities), and T category (spread of the tumor), they may actually have prostate cancer tumor growth rates that vary widely.  By knowing how aggressively tumor cells are replicating,  physicians may be able to better personalize prostate cancer treatment.

Who benefits from genomic testing?

National Comprehensive Cancer Network (NCCN) Guidelines for Prostate Cancer address staging and risk assessment after an initial diagnosis of prostate cancer, as well as man­agement options for localized, regional, and metastatic disease.  NCCN is currently discussing newly available tests of genes identified in prostate cell function.  Prolaris and Oncotype DX are two molecular assays that NCCN deems may answer the need for a biomarker to predict disease progression.   Genomic testing is typically limited to patients with early-stage prostate cancer contained within the prostate, and is not currently required as the standard of care.  Cost of genomic testing is covered by some insurance plans and can typically be performed with biopsy tissue already submitted for routine pathology.

More information

The predictive power of genomic testing promises to help many men more confidently weigh their prostate cancer treatment options, aligning with the mission of the non-profit organization Prostate Cancer Foundation of Chicago to provide education, support and research on prostate cancer treatment.  For further patient information visit Chicago Prostate Cancer Center;  NCCN also provides a patient guide to prostate cancer.

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The Grainger Foundation Supports Prostate Cancer Foundation of Chicago

Market Manager Joe Schneider and Team Leader Jason Astudillo share The Grainger Foundation’s generous grant with Michelle Braccioforte, Director of Research and Education, Prostate Cancer Foundation of Chicago, and Jennifer McCartney, Administrative Director, Chicago Prostate Cancer Center.

Market Manager Joe Schneider and Team Leader Jason Astudillo share The Grainger Foundation’s generous grant with Michelle Braccioforte, Director of Research and Education, Prostate Cancer Foundation of Chicago and Jennifer McCartney, Administrative Director, Chicago Prostate Cancer Center.

 

Westmont, IL, December 2, 2015 – The Grainger Foundation, an independent, private foundation located in Lake Forest, Illinois, has donated $10,000 to the Prostate Cancer Foundation of Chicago.  This grant will go toward the support of programs that promote awareness, prevention, detection, and treatment options for patients, their families and medical professionals, and information for newly diagnosed patients to help make informed treatment decisions.

“These funds will be used to educate men about prostate cancer through the various PCFC programs, including our Patient Support Group, Community and Workplace Wellness Presentations, and free prostate cancer screening events, said Michelle Braccioforte, Director of Research and Education, Prostate Cancer Foundation of Chicago.  “Each year, approximately 250,000 men nationwide are diagnosed with prostate cancer, according to the American Cancer Society.  In fact, during the last 20 years, the U.S. has seen a six-fold increase in men under the age of 60 receiving a diagnosis of aggressive, life-threatening prostate cancer.  We are grateful to The Grainger Foundation for its generosity.”

This donation was recommended by Joe Schneider, Market Manager of W.W. Grainger, Inc.’s, Downers Grove location.  Grainger has been a part of the Downers Grove business community for more than 27 years as the leading broad line supplier of maintenance, repair, and operating products.  “We are proud to recommend the programs offered by the Prostate Cancer Foundation of Chicago,” said Schneider.  “We understand the need for greater awareness and detection of prostate cancer by men of all ages.”

The Grainger Foundation, an independent, private foundation based in Lake Forest, Illinois, was established in 1949 by William W. Grainger, founder of W.W. Grainger, Inc.

The Prostate Cancer Foundation of Chicago is a non-profit organization dedicated to improving quality of care and quality of life by funding patient support programs, clinical research, as well as professional and public education.  Its goal is to further promote public awareness, cancer prevention, detection, and treatment options to prostate cancer patients, their families, and medical professionals involved in the diagnosis and treatment of prostate cancer.  This philanthropic organization works hand-in-hand with the Chicago Prostate Cancer Center, which is the only freestanding, full-service medical facility in the world that is solely dedicated to minimally invasive prostate cancer treatments.

For further information about Grainger contact: Joe Micucci, Director of Media Relations at Joseph.Micucci@grainger.com

For further information about Prostate Cancer Foundation of Chicago contact: Jennifer McCartney, Administrative Director at jennifer@prostateimplant.com

 

 

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Men’s Health Supplements Useless in Prostate Cancer Patients

While a daily multi-vitamin may be advisable to fill in some general  nutrition gaps, there is currently no proof any of the supplements studied here improve prostate cancer health.

Pam Harrison

October 20, 2015

SAN ANTONIO ― Patients with prostate cancer who take any kind of men’s health supplement purporting to improve prostate health derive absolutely no benefit from supplementation, either in terms of improving their prognosis or reducing their risk for toxicity from radiation therapy, new research shows.

The study was presented here at the American Society for Radiation Oncology (ASTRO) 57th Annual Meeting.

“We’ve routinely told patients not to take any medication unless they have a diagnosis and they have a particular reason to take a drug,” Nicholas Zaorsky, MD, resident physician in radiation oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, told Medscape Medical News.

“And to our knowledge, there is no diagnosis that would have been a reason for men to take these supplements, but now we have a study to back us up on this.”

The study was done as a retrospective analysis and included patients treated at a National Cancer Institute–designated comprehensive cancer center.

From 2001 to 2012, 2207 men were treated with intensity-modulated radiation therapy (IMRT) for localized prostate cancer.

Men received a median dose of 78 Gy; the median follow-up was 46 months.

Using a very strict definition for men’s health supplements, only about 10% of the cohort were taking supplements marketed specifically for men’s health in general or prostate health in particular, but in the cohort overall, approximately half of all the patients were taking at least some sort of supplement.

Men’s health supplements contained a median of three identifiable ingredients, the most common being saw palmetto.

However, as Dr Zaorsky noted, there is no law saying that whatever is contained in a supplement must be shown on the label, and many of the ingredients listed on the label were simply “other,” “trade secret enzyme,” or “prostate complex.”

“None of the drug companies we know about have actually published a study in which these men’s health supplements were used, so we wanted to see, first of all, do these drug help men with the cancer they are most likely to get, which is prostate cancer, and do they affect the side effects from radiation therapy?” Dr Zaorsky explained.

The answer to both of these questions was clearly no.

Table. Outcomes and Toxicities, IMRT

Outcomes No Supplement Use Supplement Use sHR
5-year FFBF 9% 8% 0.75
5-year FFDM 3% 2% 0.75
5-year CSS 1% 1% 0.41
5-year OS 9% 5% 0.61
Acute toxicity GU grade 3-4 6% 5% 0.96
GI grade 3-4 1% 0% NA
Freedom from late toxicity GU grade 3-4 1% 1% NA
GI grade 3-4 2% 2% NA
FFBF, freedom from biochemical failure; FFDM, freedom from distal metastases; CSS, cancer-specific survival; OS, overall survival; sHR: adjustment for “healthy male bias”

 

Adding insult to injury, Dr Zaorsky noted that these supplements do not always come cheap.

“For a 1-month supply, some of these supplements cost upwards of $150, so it can range anywhere from $10 a month to well over $100 a month, which is very significant,” he said.

Dr Zaorsky has disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 57th Annual Meeting: Abstract 2492. Presented October 20, 2015.

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What is a Prostate Cancer Support Group?

Support groups connect people facing similar challenges. Members share experiences and advice with one another. Since 1998, ChicagoProstateCenter has hosted prostate cancer support group meetings once a month, where a physician and support staff are present to answer questions and discuss current research information, treatment options and what’s new in the treatment of prostate cancer.

CPC asked three patients who attend support group on a regular basis what this support group means to them and what their experience has been. Dick was diagnosed with prostate cancer fourteen years ago and has been attending CPC’s support group since 1998. Dick commented, “support groups keep me updated with prostate cancer and the different treatment options that are new.” Dick is also very grateful to have met amazing people throughout the years and loves helping men in need.  Eddie stated, “I was a basket case when I found out that I had prostate cancer. I didn’t know what to do, very nervous; it really helped having a hands-on physician to help answer my questions.” Eddie added, “it gives you piece of mind and it relaxes you knowing that there are different methods of treatment, and there are other men going through these same issues.” At the last support group meeting, Eddie brought a friend along and his friend was blown away that there was an actual physician there to answer any questions without having to make an appointment. Another regular attendee, Larry, who was diagnosed with prostate cancer seventeen years ago, said, “The urologist told me that I have only two years to live. I was nervous; looked into every type of option, saw specialists all around the world and even tried dieting (which did not work).” Four years of research later, he was treated with brachytherapy, which is radiation seed implants. The three patients all had the same outlook on the support group experience– that it is a wonderful place to meet new people, help men who have been newly diagnosed or were just treated with their questions.

If you have been diagnosed with prostate cancer and are looking to discuss treatment options, have had a recent seed implant or other treatment for prostate cancer and want to share your experience with others, if you want to listen, ask specific questions about treatment options or meet other patients, this support group is for you.  Spouses, partners, friends and family members are welcome to attend.

The staff and other guests are there to help answer questions and give the tools needed to make an informed treatment decision and maintain your current quality of life. We meet the first Wednesday of each month, at 7:00 pm at ChicagoProstateCenter in Westmont.  For details and dates for the upcoming support group meetings, please visit www.prostateimplant.com and click on the Upcoming Events page.

 

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