The Cancer Society fears the effect on cancer sufferers if Dunedin loses neurosurgery.
Chief executive Mike Kernaghan and board member Dr Blair McLaren, a medical oncologist, outlined their concerns for cancer patients and their families if the South Island’s neurosurgeons are all based in Christchurch.
Dr McLaren, clinical leader of oncology for the Southern Blood and Cancer Service, warned the prospective change may also put at risk a long-standing national cancer contract for radiosurgery, which had neurosurgery input.
Dunedin Hospital was the only provider of radiosurgery in New Zealand.
Dr McLaren was concerned about the effect on sufferers – and their families – if they had to be transferred to Christchurch.
“It’s about disrupting a family at a critical phase of their life.”
He believed the situation was governed by “political” motivations, rather than clinical.
The focus must be on the patients.
When Southland and Otago oncology services were merged in 2008, delivering treatment close to patients’ homes was made a priority.
Centralising administration of a service did not mean centralising treatment, he said.
Some treatments, including radiotherapy, were only available in Dunedin. (more…)
Surgery for localized prostate cancer offers a significantly higher survival rate than either external-beam radiation or hormonal therapies, according to a new study led by researchers at UCSF.
The differences among therapies were more prominent at higher levels of cancer risk, and suggest, the researchers say, that in many cases surgery should play a greater role in treatment strategies for patients with prostate cancer that is likely to recur or spread.
The study is available online in the journal Cancer, the journal of the American Cancer Society.
Most previous reports comparing treatment outcomes among different treatment options have looked only at PSA responses to treatment, rather than at the more important long-term survival outcomes, according to the researchers. Measuring levels of PSA, or prostate-specific antigen, in the blood, is intended to help determine whether prostate cancer has recurred or spread, although in many cases a rising PSA level does not necessarily mean the cancer will progress.
Roughly one man in six will be diagnosed with prostate cancer, which is the second leading cause of cancer death in American men, according to the American Cancer Society. (more…)
Screening men for prostate cancer cut mortality rates by about half in a large study, researchers report.
The screening test under investigation is called a prostate-specific antigen (PSA) test, which measures blood levels of a protein produced by prostate gland cells and is a marker for prostate cancer. PSA is considered a controversial screening test because it can detect cancers that may not advance during a man’s natural life span, resulting in possible over-treatment and reduced quality of life.
These latest findings, published in the July 1 issue of Lancet Oncology, could shed new light on the potential benefits of PSA screening. Last year, the American Urological Association recommended that men begin undergoing prostate cancer screening at age 40 instead of age 50, the group’s previous recommendation. This revision was criticized by some prostate cancer experts because of concerns that extensive screening would lead to over-diagnosis of the disease and create unnecessary anxiety among patients.
PSA Test Cuts Prostate Cancer Deaths
In this study, Jonas Hugosson of the University of Gothenburg in Sweden and colleagues tried to determine whether the benefits of prostate cancer screening outweighed the risks. They randomly divided 20,000 men born between 1930 and 1944 into two groups; every two years, one group received the prostate-specific antigen test while the second group, known as the control group, did not undergo screening. If the PSA test result reached a predetermined abnormal level, the men underwent follow-up testing, such as digital rectal exams, prostate ultrasounds, and biopsies.
The researchers found that during 14 years of follow up:
Prostate cancer was diagnosed in 11.4% of the screening group vs. 7.2% of the control group.
Among men with detected prostate cancer in the screening group, 78.7% were diagnosed as a result of enrolling in the study.
Among this 78.7%, a total of 231 men had their cancer detected during the first round of screening and 665 men had their cancers detected during subsequent rounds of screening.
Cancers were detected on average earlier in the screening group; advanced prostate cancer was detected in 46 patients in the screening group vs. 87 in the control group.
The authors note that a great deal of screening needs to take place to avoid one death. Their statistical analysis showed that 293 men needed to be screened and 12 men needed to be diagnosed and treated to result in one less death from prostate cancer. The study is ongoing.
“The risk of over-diagnosis is less than previously reported, but still 12 men need to be diagnosed to save one life,” Hugosson and his colleagues said. “Among men participating in the study at or below age 60, the risk of prostate cancer death was notably low, with only a quarter of the expected rate of death from prostate cancer.”
The findings suggest the benefits of prostate cancer screening can outweigh the risks, they say.
“In this trial, prostate cancer screening was well accepted by the general population and can result in a relevant reduction in cancer mortality, greater than that reported in screening for breast or colorectal cancer,” the authors write. Nevertheless, “the benefit from PSA screening requires at least 10 years to take effect, it seems questionable to invite all men over the age of 70 years for PSA testing.”
PSA Test Not Perfect
This study follows another recent European study examining the pros and cons of prostate cancer screening. Known as the European Randomised Study of Screening for Prostate Cancer (ERSPC), it showed that during a shorter follow-up period of nine years a total of 1,410 men needed to be screened and 48 men had to be treated to save one life. That study also showed a 20% reduction in mortality over the course of a nine-year follow-up.
Prostate cancer is one of the leading causes of cancer death among men in the United States; every year, more than 28,000 men die from the disease and more than 203,000 men are diagnosed with the illness.
In an accompanying editorial, David E. Neal, at the University of Cambridge in England, says he’s cautiously optimistic about the results of this study. The findings, he writes, “show that in certain circumstances, PSA testing and early diagnosis reduces death from prostate cancer.” However, “it does not imply that PSA screening programs should now be introduced internationally.”
The next step, Neal writes, would be to do a better job at identifying men with intermediate and high-risk prostate cancers by looking at other markers that could improve the sensitivity and specificity of prostate cancer detection.
Jeffrey Karnes, MD, a urological surgeon at the Mayo Clinic in Rochester, Minn., tells WebMD that “PSA is not perfect,” but can still “potentially be a life-saving test.”
“This is a timely article,” writes in an email. “As the full ERSPC [study] matures, I also believe that it will show greater reduction and fewer men diagnosed to save one life. As everyone knows, there can be a long lead time with PSA screening [because it] detects cancers many years before detectable or symptomatic, and there is still a risk of over-diagnosis, perhaps cancer would not have caused problems or death. Nonetheless, this new study demonstrates that PSA screening in a population can be effective and reduce prostate cancer death.”
In this study, Jonas Hugosson of the University of Gothenburg in Sweden and colleagues tried to determine whether the benefits of prostate cancer screening outweighed the risks. They randomly divided 20,000 men born between 1930 and 1944 into two groups; every two years, one group received the prostate-specific antigen test while the second group, known as the control group, did not undergo screening.
If the PSA test result reached a predetermined abnormal level, the men underwent follow-up testing, such as digital rectal exams, prostate ultrasounds, and biopsies….. (more…)
Screening men for prostate cancer cut mortality rates by about half in a large study, researchers report. The screening test under investigation is called a prostate-specific antigen (PSA) test, which measures blood levels of a protein produced by prostate gland cells and is a marker for prostate cancer.
PSA is considered a controversial screening test because it can detect cancers that may not advance during a man’s natural life span, resulting in possible over-treatment and reduced quality of life. These latest findings, published in the July 1 issue of Lancet Oncology, could shed new light on the potential benefits of PSA screening….. (more…)
Several Northward Bay mortal patients instrument person to travelling to City for follow-up assessments after monthly clinics held here for decades were cut.
Sean Barrette, people relations serviceman for the City Regional Hospital, said the “skirting” clinics in cities such as Northwestern Bay and Timmins ended June 1 because there are not sufficiency medical oncologists – a person health-care write.
“Fundamentally, in arrangement for waiting nowadays to be restored and to avoid oncologist burnout, there had to be changes for follow-up want,” Barrette said.
“Volumes of cancer patients are always increasing,” he said, adding the regional centre has been functioning for a couple of years without a full complement of specialists. “It starts to eventually wear on those who are there.”
There were 285 patient visits at the clinics held twice a month in 2009, but Barrette said not all cancer outpatients will be forced to drive to Sudbury for their check ups every six or 12 months.
He said radiology oncologists will still hold clinics in North Bay when appropriate.
“Nobody likes to see any type of reduction in services, but this will ultimately benefit cancer patients. Acute treatment patients will be seen quicker,” he said.
Tiziana Silveri, vice president of surgery and maternal child at North Bay and District Hospital, said teleconferencing will also be an option for some outpatients, noting the quality of the technology has improved greatly.
And Silveri said the chemotherapy clinics providing active treatment are still being held in North Bay.
New research suggests that dogs can sniff out signs of prostate cancer in human urine, adding to the ongoing debate over the disease-detecting powers of man’s best friend.
Some scientists have questioned similar reports of dogs with such diagnostic powers in recent years, but the lead author of this latest study said the findings are promising and could lead to better cancer-sensing technology.
“The dogs are certainly recognizing the odor of a molecule that is produced by cancer cells,” said French researcher Jean-Nicolas Cornu, who works at Hospital Tenon in Paris.
The problem, he said, is that “we do not know what this molecule is, and the dog cannot tell us.”
Still, the report could represent a significant development since cancer often goes undetected until it is too late to treat.
The detection of prostate cancer has been particularly controversial. Some researchers think many patients are treated unnecessarily because existing tests of prostate-specific antigen (PSA) aren’t accurate enough and fail to distinguish between dangerous and harmless cancers.
Urine tests can turn up signs of prostate cancer, Cornu said, but miss some cases. Some types of molecules give a distinct odor to urine, “but today there is no means to screen odors from urine and separate them,” he said, and no way to link them to cancer.
Enter the dog, whose powers of smell are far greater than those of humans.
For this study, two researchers spent a year training a Belgian Malinois shepherd, a breed already used to detect drugs and bombs.
The dog was trained to differentiate between urine samples from men with prostate cancer and men without. Ultimately, researchers placed groups of five urine samples in front of the dog to see if it could identify the sole sample from a man with prostate cancer.
The dog correctly classified 63 out of 66 specimens.
If the findings hold up in other studies, they’ll be “pretty impressive,” said urologist Dr. Anthony Y. Smith, who was to moderate a discussion on the findings Tuesday at the American Urological Association annual meeting in San Francisco.
Skeptical researchers are concerned about factors that could throw off the results, said Smith, chief of urology at the University of New Mexico. Among other things, scientists wonder if the animals used in such studies pick up on subconscious signals from researchers.
Still, in this study, it’s hard to imagine anything “other than the dogs somehow being able to smell something that we don’t smell,” Smith said…. (more…)
TUESDAY, April 27 (HealthDay News) — The anticipated approval this week of a therapeutic prostate cancer vaccine by the U.S. Food and Drug Administration could be a milestone against the disease and cancer in general, experts say.
The vaccine, called Provenge, appears to extend survival in men with advanced prostate cancer, and it does so without the serious side effects associated with chemotherapy, radiation and hormone therapy.
“It is certainly exciting to see a drug that has made it this far and appears on the threshold of approval,” said Dr. J. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society.
The vaccine is not aimed at preventing prostate cancer in men who have not developed the disease, and it is far from a cure for those who have it, Lichtenfeld cautioned. “Provenge represents a modest advance in survival for patients with advanced prostate cancer, but the drug doesn’t delay the progression of the disease,” he said.
Still, it might prove possible to use Provenge in the earlier stages of prostate cancer, where it might be even more effective, Lichtenfeld said. “The hope is if a vaccine is effective in late-stage disease that it is going to be even more effective in the earlier treatment of that same disease,” he said.
But that benefit would have to be shown in clinical trials, Lichtenfeld said.
“If it does get approved it will be groundbreaking.” Lichtenfeld said. “It will represent a new treatment option. It will have a modest impact on prostate cancer survival, but it’s small changes in treatments over time that add up to a major improvement. So I wouldn’t be discouraged by what is a small increment in survival.”
Provenge is a therapeutic (not preventative) vaccine that is made from the patient’s own white blood cells. Once removed from the patient, the cells are treated with the drug and placed back into the patient. These treated cells then cause an immune response, which in turn kills cancer cells, while leaving normal cells unharmed.
Provenge was developed by Seattle-based Dendreon Corp., which conducted initial studies among men with advanced prostate cancer who had already failed standard hormone treatment. Among these men, the vaccine extended life by an average of 4.5 months, although some patients saw their lives extended by two to three years. The only side effects were mild flu-like symptoms, according to the study results.
In 2007, an FDA advisory panel recommended that the agency approve Provenge, but the FDA said more data was needed before it would approve the drug…. (more…)
Americans with Type-2 diabetes and inject insulin to control diabetes (with onset typically in adulthood) the associated risk of cancer is of increasing concern. Studies have demonstrated that obesity and excess insulin — whether naturally produced by the body or injected in synthetic form — are associated with an increased incidence of some common cancers.
With the release of the study in the Journal of Biological Chemistry, a team of researchers from Case Western Reserve University School of Medicine, led by Michael Weiss, MD, PhD, Cowan-Blum Professor of Cancer Research and Chair of the Department of Biochemistry, reveals their invention of a “smart” insulin protein molecule that binds considerably less to cancer receptors and self-assembles under the skin. To provide a slow-release form of insulin, t he analog self-assembles under the skin by means of “stapling” itself via bridging zinc ions. In light of its scientific and societal importance, the publication was highlighted as a “Paper of the Week” by the editors of the journal.
“It’s quite a novel mechanism. Our team has applied the perspective of biomedical engineering to the biochemistry of a therapeutic protein. We regard the injected insulin solution as forming a new biomaterial that can be engineered to optimize its nano-scale properties,” says Dr. Weiss. He adds, “The notion of engineered zinc staples may find application to improve diverse injectable protein drugs to address a variety of conditions from cancer to immune deficiency.”
While initially tested in diabetic rats by team member Faramarz Ismail-Beigi, PhD, professor of medicine at CWRU School of Medicine, the study of this new, self-assembling insulin will continue with approval by the National Institutes of Health toward the goal of human clinical trials…. (more…)
A new study of almost 700 patients from The Mount Sinai Medical Center shows that prostate cancer patients who had robotically assisted prostatectomy enjoyed significant benefits over patients who had a traditional open radical prostatectomy, including decreased surgical and recovery time, less blood loss during surgery and significantly shorter hospital stays. The study, by David B. Samadi, MD, Chief of the Division of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine, will be published later this month on the website of the Journal of the Society of Laparoendoscopic Surgeons (JSLS), and then in print following that.
Comparing 575 patients who had robotic prostatectomy with 106 patients who had open prostatectomy, the robotically assisted procedures were associated with 45 percent shorter median anesthesia time, 51 percent shorter surgical time, and 96 percent less estimated blood loss. Overall hospital stays were also 67 percent shorter in the robotically assisted cases.
In addition, none of the robotic prostatectomy patients required transfusions or intraoperative red cell salvaging. There were also no rectal perforations – a common complication of prostate surgery – or other intraoperative complications in the 575 robotically assisted prostatectomy patients….. (more…)
