Posts Tagged ‘androgen-deprivation therapy’

URO TODAY: High levels of testosterone have until recently been regarded as dangerous for prostate cancer patients, but new evidence is emerging that suggests something different. READ MORE>

Provocative new evidence suggests that it is not high serum testosterone that is problematic for prostate cancer, but low serum testosterone that is associated with worrisome cancer features and outcomes, such as high Gleason score, advanced stage of presentation, and increased risk of biochemical recurrence after surgery.

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URO TODAY: Younger men with high-risk prostate cancer appear to have worse prognosis than older men with similar disease, according to a study of 4000 men receiving hormone treatment. READ MORE>

This, along with the other prognostic variables established in the current study, may help identify candidates for clinical trials evaluating secondary treatments for patients with castrate-resistant disease.

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URO TODAY: Enzymes in the prostate that promote aggressive cancer growth need to be suppressed and a study looks at the success of new drugs now available to do the job. READ MORE>

The objective of this review is to provide an understanding of the pharmacological properties and the potential clinical benefits of 5AR inhibition.

The efficacy of 5AR2 monotherapy with finasteride alone or in combination with an androgen receptor antagonist on more final outcome measures seems to be limited.

Combining an androgen receptor antagonist with a 5AR inhibitor in patients with asymptomatic, locally advanced or recurrent prostate cancer might be a reasonable first therapeutic hormonal approach.

5-alpha reductase is an enzyme that converts testosterone, the male sex hormone, into the more potent dihydrotestosterone:

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URO TODAY: Physical activity effectively attenuates many of the side effects of androgen deprivation therapy and should be recommended to prostate survivors as an alternate therapy. READ MORE>

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NEW ENGLAND JOURNAL OF MEDICINE: A new drug just approved by the FDA for high risk prostate cancer patients suffering bone loss has performed well in a trial.

Denosumab was associated with increased bone mineral density at all sites and a reduction in the incidence of new vertebral fractures among men receiving androgen-deprivation therapy for non-metastatic prostate cancer.

Background: Androgen-deprivation therapy is well-established for treating prostate cancer but is associated with bone loss and an increased risk of fracture.

We investigated the effects of denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor-{kappa}B ligand, on bone mineral density and fractures in men receiving androgen-deprivation therapy for nonmetastatic prostate cancer.

Methods: In this double-blind, multicenter study, we randomly assigned patients to receive denosumab at a dose of 60 mg subcutaneously every 6 months or placebo (734 patients in each group).

The primary end point was percent change in bone mineral density at the lumbar spine at 24 months. Key secondary end points included percent change in bone mineral densities at the femoral neck and total hip at 24 months and at all three sites at 36 months, as well as incidence of new vertebral fractures.

Results: At 24 months, bone mineral density of the lumbar spine had increased by 5.6% in the denosumab group as compared with a loss of 1.0% in the placebo group (P<0.001); significant differences between the two groups were seen at as early as 1 month and sustained through 36 months.

Denosumab therapy was also associated with significant increases in bone mineral density at the total hip, femoral neck, and distal third of the radius at all time points.

Patients who received denosumab had a decreased incidence of new vertebral fractures at 36 months (1.5%, vs. 3.9% with placebo) (relative risk, 0.38; 95% confidence interval, 0.19 to 0.78; P=0.006). Rates of adverse events were similar between the two groups.

Researchers: Matthew R. Smith, M.D., Ph.D., Blair Egerdie, M.D., Narciso Hernández Toriz, M.D., Robert Feldman, M.D., Teuvo L.J. Tammela, M.D., Fred Saad, M.D., Jiri Heracek, M.D., Ph.D., Maciej Szwedowski, M.D., Chunlei Ke, Ph.D., Amy Kupic, M.A., Benjamin Z. Leder, M.D., Carsten Goessl, M.D., for the Denosumab HALT Prostate Cancer Study Group.

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URO TODAY: The dual inhibition of both types 1 and 2 of the testosterone-reducing enzyme 5-AR with the new drug dutasteride may prove more useful than another commonly used drug, finasteride, in treating prostate cancer. READ MORE>

A review just published by the Department of Urologic Sciences, University of British Columbia Vancouver says:

Normal growth and function of the prostate are contingent on the reduction of testosterone to dihydro-testosterone (DHT) by 5-alpha reductase (5-AR) enzymes types 1 and 2.

It has been theorised that an over-abundance of DHT may be implicated in the pathogenesis of both benign prostatic hyperplasia (BPH) and prostate cancer.Dutasteride inhibits both types 1 and 2, whereas finasteride inhibits type 2 only.

Available data show that dutasteride, in contrast to finasteride, provides greater suppression of DHT than finasteride, is able to shrink tumour volume quicker and more dramatically than finasteride, and is more effective against genetic variants of 5-AR than is finasteride.

Thus, full clinical investigations of these and other approaches to the inhibition of 5-AR are ongoing and results are greatly anticipated.

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AUGUST 4: URO TODAY: Androgen deprivation therapy for prostate cancer has adverse side effects like reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass.

An Australian investigation has examined the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation. READ MORE>

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