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Archive for June, 2009

JUNE 30:  SCIENCE CODEX.COM: The two recently reported large randomised studies in Europe and the US illustrate that the price to pay for 20% reduction in prostate cancer deaths is high – over-diagnosis and over-treatment are great problems. The answers lie in improving the PSA test or finding biomarkers that effectively separate aggressive cancers from slow-growing ones. READ MORE>

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JUNE 30: EUREKALERT.COM:  The recent release of two large randomised trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians. READ MORE>

In a separate but related editorial, Peter Boyle, Ph.D., D.Sc., of the International Prevention Research Institute, Lyon, France and report co-author Dr Brawley say “the real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease.”

They conclude that “men should discuss the now quantifiable risks and benefits of having a PSA test with their physician and then share in making an informed decision,” and that “the weight of the decision should not be thrown into the patient’s lap.” 

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JUNE 30: URO TODAY: In selected patients with prostate cancer metastases to the spine, aggressive surgical decompression and spinal reconstruction is a useful treatment option. The results show that on average, neurological outcome is improved and use of analgesics is reduced. Gleason score, metastatic burden, and degree of spinal canal compression may be associated with survival following surgery, and thus should be considered carefully prior to opting for surgical management. READ MORE>

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JUNE 29: PROSTABLOG NZ: Is NZ Herald columnist Deborah Coddington right when she warns of a prostate cancer risk from the mandatory addition of folic acid to bread?

In her column today, titled Spoonful of meddling helps the medicine go down, she writes:

The New Zealand Food Safety Authority warns we won’t know the effect of this for at least another generation, but studies are looking at links between excess folic acid and colon and prostate cancer.

A read of the authority’s website shows the risk appears to be insignificant, if a 274-page Food Standards Australia New Zealand report called FINAL ASSESSMENT REPORT, PROPOSAL P295, Consideration of Mandatory Fortification with Folic Acid, dated October, 2006, is anything to go by. It says, in part:

One trial and three cohort studies found no significant association between serum folate levels and incidence of prostate cancer.  A large Swedish study, however, did observe a significant association between higher serum folate levels and increased risk of prostate cancer but only among study participants with a particular genetic make-up.  In this study, ‘higher’ folate levels were below the pre-voluntary fortification mean in a Perth cohort.

Based on these findings, and the lack of intake studies, the evidence base is not sufficient to draw a conclusion about the relationship of folic acid and increased risk of prostate cancer.

The results of more recent studies on the incidence of all cancers and cancer of the prostate, breast and colorectum do not alter the conclusion reached in earlier reviews (SACN, 2004; SACN, 2005; Sanjoaquin et al., 2005e) that there is no apparent increase in risk associated with higher folic acid intakes for the population as a whole.  Many of the studies suggest that some reduction in cancer risk might occur, however, most of these are observational and so might be affected by uncontrolled confounding factors.

[Following analysis of a number of studies]…In summary, the only study with intakes that are relevant for consideration to mandatory fortification reported a non-significant 11% increase in risk; the serum studies all report a non-significant associations ranging from a 15% decrease to a 20% increase in risk with higher levels.  Given this, and lack of intake studies, the evidence base is not sufficient to allow a conclusion to be drawn regarding the relationship of folic acid to the incidence of prostate cancer.

But, the March 10, 2009, issue of the US Journal of the National Cancer Institute was widely reported for this publication:

Data regarding the association between folate status and risk of prostate cancer are sparse and conflicting.

We studied prostate cancer occurrence in the Aspirin/Folate Polyp Prevention Study, a placebo-controlled randomized trial of aspirin and folic acid supplementation for the chemoprevention of colorectal adenomas conducted between July 6, 1994, and December 31, 2006. Participants were followed for up to 10.8 (median = 7.0, interquartile range = 6.0–7.8) years and asked periodically to report all illnesses and hospitalizations.

Aspirin alone had no statistically significant effect on prostate cancer incidence, but there were marked differences according to folic acid treatment. Among the 643 men who were randomly assigned to placebo or supplementation with folic acid, the estimated probability of being diagnosed with prostate cancer over a 10-year period was 9.7% (95% confidence interval [CI] = 6.5% to 14.5%) in the folic acid group and 3.3% (95% CI = 1.7% to 6.4%) in the placebo group (age-adjusted hazard ratio = 2.63, 95% CI = 1.23 to 5.65, Wald test P = .01).

In contrast, baseline dietary folate intake and plasma folate in non-multivitamin users were inversely associated with risk of prostate cancer, although these associations did not attain statistical significance in adjusted analyses.

These findings highlight the potential complex role of folate in prostate cancer and the possibly different effects of folic acid–containing supplements vs natural sources of folate.

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JUNE 28: NEW PROSTATE CANCER INFOLINK: A study on the possibility that lifestyle modification will help cancer survivors to avoid the risks that they are at for second malignancies, other co-morbidities, and accelerated functional decline seems worthwhile. READ MORE>

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JUNE 28: NEW PROSTATE CANCER INFOLINK: Those who receive salvage brachytherapy report a worsening of bowel and urinary symptoms followed by some improvement at 2-3 years of follow-up, while sexual function steadily declines over time. READ MORE>

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JUNE 28: NEW PROSTATE CANCER INFOLINK: Researchers conclude that total serum PSA and free/total (f/t) serum PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values. However, the f/t PSA ratio rather than the total PSA level appears to be more helpful in suggesting risk for prostate cancer in such patients. READ MORE>

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JUNE 28: NEW PROSTATE CANCER INFOLINK: A new review shows vitamin D deficiency may increase risk of cancer – but the findings are based primarily on epidemiological and observational data, with no clinical trial ever done on prostate cancer. READ MORE>

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Prostablog apologises to regular followers for the silence yesterday: the blogger had a very nasty stomach virus. “Bankrupt at both ends,” was the scatalogical epithet used by my father on such occasions. Full blog service has resumed – although the blogger still can’t eat anything. For those outside NZ, “crook” means sick.

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JUNE 27: PROSTABLOG NZ: Hopes held by the NZ prostate cancer community that the Government might fund a marketing campaign urging men to get checked took a blow this week.

Hopes were lifted the week before with an announcement the Health Select Committee will inquire into screening, but last Friday this news item appeared in Fairfax media outlets:

THE slashing of millions of dollars from health-promotion programmes targeting cancer, heart disease, diabetes and other long-term conditions will affect frontline services, Government critics warn.

According to Budget documents released by Treasury yesterday, $37 million of ‘‘savings’’ have been docked from 18 health-promotion services, including $2.3m from cancer control, $4.8m from the ‘‘let’s get checked’’ diabetes programme and $3m from the heart disease budget.

Health Minister Tony Ryall said very few of the savings affected any existing services and even in tough economic times, health funding had increased $750m.

Millions of dollars have been spent on extensive TV campaigns aimed at groups in society most at risk of not getting early detection of breast and cervical cancer, heart diseases, diabetes and smoking-related diseases.

These campaigns have focused on Maori and Pacific people, whose poor health statistics justify the special attention

The prostate cancer community has been pushing for a similar effort aimed at men – especially Maori men – but so far the Ministry of Health has said there is no proven benefit from a population-based screening programme.

The Ministry has provided guidelines to GPs, but stepped back from recommending PSA and/or digital examination tests as a matter of course for men with no symptoms of prostate cancer.

The select committee inquiry has already drawn fire, the latest coming from Otago epidemiologist Brian Cox, whose paper in the New Zealand Medical Journal earlier this month rubbished the idea of prostate screening.

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