What We've Learnt About Prostate Cancer in 2013
Urologists diagnose and treat more than around 20,000 new cases of prostate cancer in Australia and New Zealand each year. As one of the main causes of cancer deaths in men, doctors and patients alike are hungry for news of the latest research findings that shed light on the disease.
'Prostate cancer is a complex disease, and naturally there is considerable interest in new studies that unlock information about testing, treatment and prevention, that assist us in providing the best possible care to our patients," says the Urological Society of Australia and New Zealand's President, Dr David Winkle.
Below are some of the new things we learnt about prostate cancer in 2013.
1. A simple PSA blood test in your 40s can save your life and may reduce the number of tests you need in the future. A new study1 showed a PSA (prostate-specific antigen) test at age 45 can be used to predict a man's long-term risk of developing an aggressive prostate cancer. The study followed up more than 21,000 men after 27 years and showed almost half of prostate cancer deaths occurred in men who had recorded high PSA levels at age 45. The study suggests these men would benefit from regular testing for changes in PSA level until around age 70. However, for men with a lower PSA reading at around 45 (at least half of the men) it was suggested that just three lifetime PSA tests – mid to late 40s, early 50s and 60 - are probably sufficient. 'This study confirms the Urological Society's recommendation that men, after being fully informed of the benefits and risks, should not wait till 50 for a first prostate cancer test," says Dr Winkle.
2. Genetic testing may predict risk of prostate cancer outcome. In January, a 53 year old English man was the first to have a radical prostatectomy after discovering he carries the BRCA2 gene mutation. The BRCA gene mutations increase the risk for a number of cancers, including prostate and breast cancer (earlier this year Angelina Jolie underwent a double mastectomy to avoid breast cancer). The man who sought the surgery was participating in a clinical trial, (conducted by the Institute of Cancer Research) that involved more than 20,000 men, and has since showed that prostate cancer in men with the BRAC2 mutation is more aggressive and more likely to be fatal.2 Previous results from the trial have shown that a man with a BRAC2 mutation has an 8.6-fold risk of developing prostate cancer, and with a BRAC1 mutation has a 3.4-fold risk.
'While new research into the role of hereditary factors and genetic testing is unlocking new information which should prove useful in the future, the Urological Society would not recommend a prostatectomy in a man without any evidence of prostate cancer," says Dr Winkle.
3. Omega-3 fish oil supplements may be harmful. A study3 conducted by researchers at cancer centers across the US has found a link between Omega3 fatty acids and an increased risk of prostate cancer. The researchers expected to find a protective factor from the presence of omega-3 fatty acids in the blood. Instead, they found that those with the highest levels of omega-3 fatty acids had a 43% higher risk of developing prostate cancer,
1 Vickers et al. BMJ 2013
2 J Clin Oncol. 2013;31:1748-1757
3 Brasky et al. JCNI 2013 epub
and a 71% higher chance of developing high-grade prostate cancer, which is more likely to be fatal. 'This study should not be ignored. It is a well-designed study published in a highly-regarded journal. The Urological Society recommends men seek medical advice about taking Omega-3 supplements," says Dr Winkle.
4. Deep fried foods increase risk of prostate cancer. Regular consumption of deep-fried foods such as French fries, fried chicken and donuts is associated with an increased risk of prostate cancer and the effect appears to be slightly stronger with regard to more aggressive forms of the disease according to a study4 published this year. While previous studies have suggested that eating foods made with high-heat cooking methods, such as grilled meats, may increase the risk of prostate cancer, this American study is the first to examine the addition of deep frying to the equation. It showed eating these foods at least once a week put them at greater risk compared with men who ate such foods less than once a month.
6. A healthy lifestyle may guard against aggressive prostate cancer. A study, published in Nutrition and Cancer, which followed 2000 men with newly diagnosed prostate cancer suggests men may be able to lower their risk of being diagnosed with highly aggressive prostate cancer by following diet and exercise recommendations recommended by the World Cancer Research Fund (WCRF). In particular, the researchers found that limiting consumption of red meat and avoiding an energy-rich diet were significantly protective against aggressive tumours. Other WCRF recommendations include: maintain a normal body mass index; exercise daily; avoid sugary drinks; eat at least five servings of non-starchy vegetables and fruits daily; eat at least 25 grams of unprocessed grains/cereals and legumes daily; limit alcohol intake to two drinks per day and limit sodium intake to less than 2.4 grams per day.
7. New drug therapies are providing increased treatment options. New research this year demonstrated the benefits of new drugs in prolonging life and reducing pain in men with advanced prostate cancer who had already undergone chemo- or hormone therapy. These include Zytgia (Abiraterone) for men with advanced prostate cancer who have previously been treated with chemotherapy. New research6 published this year also showed the benefit of Abiraterone in increasing survival rates and quality of life in men with metastatic cancer who have not previously been treated with chemotherapy or hormone treatments. 'The emergence of these new drugs is opening up new treatment pathways for men with advanced cancer, and new studies suggest they may be used in a variety of ways, including in conjunction with other treatments to improve outcomes for men with prostate cancer," says Dr Winkle.
The Urological Society of Australia and New Zealand is the peak professional body for urological surgeons in Australia and New Zealand. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.