Unnecessary prostate biopsies may be avoided by using MRI

Although the only way to fully conclude that prostate cancer is present, a new study has suggested that MRI (magnetic resonance imagining) can be an effective tool in identifying which patients truly need a prostate biopsy and which patients do not need one.

Published online February 22, 2018 by JAMA Oncology, the study included 651 men screened for prostate cancer with blood tests and digital rectal exams. Each participant in the study underwent three separate procedures. The first was an MRI scan, the second procedure was a biopsy guided by transrectal ultrasound (TRUS), and the third procedure was a biopsy that was guided by both MRI and TRUS.

After undergoing all three procedures, 289 of the male participants were identified as having significant prostate cancer, defined as a Gleason score of 7 or higher. Researchers concluded that using the MRI scans to determine the need for biopsy could have avoided 38% of biopsies and still identified 89% of clinically significant cancers. They also determined that having an MRI first may be a productive step in helping men decide whether they need a biopsy.

What is the Prostate?

The prostate gland is an important part of the male reproductive system.

The prostate is a gland situated between the bladder and penis, just in front of the rectum, or lower end of the bowel.

The urethra, a narrow tube that carries urine and semen out of the body through the penis, runs through the center of the prostate, which is about the size of a walnut and weighs 1 ounce (30 grams).

The word “prostate” comes from the Greek word “prostates,” which means “one who stands before,” aptly describing the position of the gland.

That is, when viewed from below, the prostate “stands before” the bladder.

The Function of the Prostate

The prostate gland isn’t essential for life, but it is vital for reproduction and is part of the male reproductive system.

The function of the prostate is to produce a slightly alkaline (high pH) fluid that makes up part of the seminal fluid, or semen.

The rest of semen is composed of sperm cells from the testicles, fluid from the seminal vesicles, and secretions from the pea-sized bulbourethral gland.

The prostatic fluid contains substances that are important to the functioning and survival of sperm cells, such as the enzyme prostate-specific antigen (PSA), which thins or loosens up semen, helping the tadpole-like sperm cells swim freely to reach the egg.

During an orgasm, prostate muscles squeeze the gland’s stored fluid into the urethra, where it mixes with the sperm cells and other semen components.

This expulsive process also helps propel the semen out of the body during ejaculation.

Prostatitis

Prostatitis, or prostate inflammation, is the most common prostate problem for men under age 50, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

There are several types of prostatitis.

Prostatitis caused by bacteria is known as bacterial prostatitis, and it can be acute (short-term) or chronic.

Non-bacteria microbes may cause chronic prostatitis, also known as chronic pelvic pain syndrome, which may develop as a result of chemicals in the urine, a urinary tract infection, or pelvic nerve damage.

Symptoms vary depending on the type of prostatitis, but can include urination problems, pain, fever, and body aches, among other things.

Some people develop asymptomatic inflammatory prostatitis, in which the prostate is inflamed but doesn’t produce any symptoms or require treatment.

Benign Prostatic Hyperplasia (BPH)

Prostate enlargement is the most common prostate problem for men over 50 years old, according to the NIDDK.

It’s not well understood what causes prostate enlargement, also known as benign prostatic hyperplasia (BPH), but research suggests age-related hormonal changes may be to blame.

In men with BPH, the prostate presses into and pinches the urethra.

This pressure can negatively affect the urine-holding bladder, which is connected to the urethra, by weakening it and preventing it from emptying completely.

Prostate enlargement can cause a number of related urination symptoms, including increased urinary frequency and urgency, weak or interrupted urine stream, and urine with an unusual color or smell.

Prostate Cancer

Aside from prostatitis and BPH, another common prostate issue is prostate cancer.

Excluding skin cancer, prostate cancer is the most common type of cancer affecting American men, and one of the leading causes of cancer deaths in American men, according to the American Cancer Society.

The risk of developing prostate cancer is higher for men who are over age 65, African American, and have a family history of the disease.

Most often, prostate cancer develops slowly, but some men develop an aggressive form of prostate cancer.

Symptoms generally develop as the disease progresses, and include urination issues, erectile dysfunction, bloody semen, and bone pain.

Research Finds That Low Vitamin D Levels May Signal More Aggressive Prostate Cancer

New research suggests that prostate cancer may be more aggressive in men who are deficient in vitamin D.

A study of nearly 200 men having their prostate removed found those with low vitamin D levels were more likely to have rapidly growing tumors than those with normal levels of the “sunshine” vitamin.

Some physicians think that if men with vitamin D deficiency are more likely to have more advanced disease at the time of prostate surgery, that it is possible men should be tested for this when they are diagnosed with prostate cancer. They have suggested that it might be a good idea to supplement the patients with vitamin D if they are deficient.

However, many other physicians believe that there is not enough evidence to recommend vitamin D supplements to either prevent prostate cancer or make it less aggressive.

The human body gets vitamin D from certain foods. These include fortified products (such as milk, orange juice and cereal), and certain fish (such as salmon), according to the U.S. National Institutes of Health. The body also makes the vitamin when the skin is exposed to sunlight. Dark-skinned people have more melanin, which prevents burning.

The study included 190 men having prostate surgery. The researchers found that nearly 46 percent of the men had aggressive cancer, and these men had vitamin D levels about 16 percent lower than men with slower-growing tumors.

After accounting for age, PSA levels and abnormal rectal exams, researchers found that vitamin D levels below 30 nanograms per milliliter (ng/mL) of blood were linked to higher odds of aggressive prostate cancer.

The report was published in the Journal of Clinical Oncology.

Prostate Cancer Survival May Be Boosted With Regular Exercise

Researchers find that men who exercised the most had the best outcomes.

A new study suggests that sticking to a moderate or intense exercise regimen may improve a man’s odds of surviving prostate cancer.

The study, conducted by the American Cancer Society, included more than 10,000 men, aged 50 to 93, who were diagnosed between 1992 and 2011 with localized prostate cancer, which means that it had not spread beyond the gland. The men in the study provided researchers with information about their physical activity before and after their diagnosis.

According to the team of researchers, men with the highest levels of exercise before their diagnosis were 30 percent less likely to die of their prostate cancer than those who exercised the least.

The men who had the highest level of exercise seemed to confer an even bigger benefit: these men had the highest levels of exercise after diagnosis were 34 percent less likely to die of prostate cancer than those who did the least exercise.

The study results support evidence that prostate cancer survivors should adhere to physical activity guidelines, and suggest that physicians should consider promoting a physically active lifestyle to their prostate cancer patients.

The researchers also examined the effects of walking as the only form of exercise. They found that walking for four to six hours a week before diagnosis was also associated with a one-third lower risk of death from prostate cancer. But timing was key, since walking after a diagnosis was not associated with a statistically significant lower risk of death.

The American Cancer Society recommends that adults engage in a minimum of 150 minutes of moderate or 75 minutes of vigorous physical activity per week. Physical activity has been found to help all aspects of health.

Certain Fatty Foods Could Be Linked to Aggressive Prostate Cancer

Study also suggests that cholesterol-lowering drugs may help counteract harmful effect.

A new study suggest that what men eat; particularly fatty meats and cheese, may affect how quickly their prostate cancer progresses.

A recent study showed that high dietary saturated fat content was associated with increased prostate cancer aggressiveness. It may suggest that limiting dietary saturated fat content may also have a role in prostate cancer.

However, the study did not prove that diet directly affects prostate cancer behavior, only that there is a link between those factors.

The researchers looked at more than 1,800 men from North Carolina and Louisiana. All had been diagnosed with prostate cancer between 2004 and 2009. They were asked about their eating habits and other factors at the time of their diagnosis.

Higher intake of saturated fat from foods such as fatty beef and cheese was linked with more aggressive prostate cancer, the researchers found.

A diet high in saturated fat contributes to higher cholesterol levels, researchers said. They noted that the link between saturated fat and aggressive prostate cancer was weaker in men who took cholesterol-lowering statin drugs.

The researchers said that suggests that statins reduce, but don’t completely reverse, the effect that high amounts of saturated fat may have on prostate cancer.

The study also found that higher levels of polyunsaturated fats, found in foods such as fish and nuts, were associated with less aggressive prostate cancer.

Further research is needed to learn more about why a diet high in saturated fat is linked with more aggressive prostate cancer.

The researchers presented their findings April 18 at the annual meeting of the American Association for Cancer Research in New Orleans. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

Studies Find That Smokeless Tobacco Product Tied to Higher Risk of Prostate Cancer Death

According to a new study, a smokeless tobacco called snus may increase a prostate cancer patient’s risk of death.

Many people believe that smokeless tobacco is a less harmful alternative to smoking just because it lacks the combustion products of smoking that are most associated with cancer risks. Researchers have found that men with prostate cancer who were smokeless tobacco users were at risk of premature death.

Snus is readily available in the United States. Usually sold in tea bag-like sachets, the powdered tobacco product is placed under the upper lip for extended periods.

Researchers analyzed health check-up data from thousands of men. The investigators found that, compared with men who never used tobacco, those who used snus but did not smoke, had a 24 percent higher risk of death from prostate cancer during the study period. They also had a 19 percent higher risk of death from any cause.

Among patients whose cancer had not spread, those who used snus but did not smoke, were three times more likely to die from prostate cancer than those who never used tobacco, the study found.

The study was published in the International Journal of Cancer.

Pathologic Features of Prostate Cancer Worse in Blacks

At the time of radical prostatectomy for prostate cancer, black men are more likely to have adverse pathologic features. Independent of socioeconomic and clinical factors, investigators came to this conclusion in a study presented at a Cancer Symposium.

According to researchers, these adverse pathologic features increase their risk of biochemical recurrence and more frequently lead to an indication for adjuvant radiation therapy.

Using the National Cancer Database, the investigators identified 313,013 men diagnosed with PCa from 2004 to 2014 and who underwent RP. The group included 256,315 whites (85%), 33,725 blacks (11%), and 12,973 patients of other races.

Significantly higher proportions of blacks than whites had Gleason grade group 2 cancer (46% vs 37.7%), PSA levels of 10 ng/mL or higher (18.5% vs 15.9%), and clinical stage T2b disease (17.8% vs 13.8%).

On multivariable analysis, the odds of having indications for adjuvant radiotherapy (pT3 disease or higher or positive surgical margins) were 21% greater among blacks than whites. Blacks had 26% greater odds of having positive surgical margins, but 23% lower odds of having pT3 or higher disease.

As for what might explain the findings, it was noted that black men may be more likely to harbor certain genetic polymorphorisms that give rise to more aggressive PCa. An autopsy study revealed that black men are more likely to have cancer in the anterior of their prostate, which could be a cause of pathologic upstaging. Another possibility is the low vitamin D, which has been linked to an increased risk of aggressive cancer. Black people in general have low vitamin D levels, possibly as a result of their darker skin.

Researchers Find That Statin Use May Improve Survival in Advanced Prostate Cancer

According to the finding of three studies presented at the Genitourinary Cancer Symposiom, statins may improve overall survival among men with metastatic castration-resistant prostate cancer (mCRPC) and improve cancer-specific survival among those with high-risk prostate cancer (PCa).

In a post-hoc analysis of data from the randomized clinical trials COU-AA-301 and COU-AA-302, in which men with mCRPC were treated with prednisone plus placebo or abiraterone, researchers found that statin users had significantly better overall survival than non-users.

The reference group for both studies included patients in the placebo arm who did not use statins. Among statin users in the COU-AA-301 study, patients treated with prednisone plus abiraterone had a significant 29% decreased risk of death compared with the reference group. The investigators observed no significant decrease in death risk among statin users in the placebo arm.

In the COU-AA-302 study, statin users in the abiraterone and placebo groups had a significant 28% and 19% decreased risk of death, respectively, compared with the reference group.

In a completely separate study, researchers examined the effect of statin use on outcomes among patients with mCRPC receiving abiraterone, an anti-androgen that inhibits CYP17A1. Their analysis included 301 patients. Of these, 84 (28%) were statin users. The median overall survival for statin users and non-users was 16.2 and 11.3 months, a borderline significant difference in adjusted analyses.

The study authors concluded: “Although limited by sample size, our data showed a trend that statins may mildly enhance the anti-tumor effects of [abiraterone] in CRPC patients.”

The findings suggest that depletion of de novo cholesterol production may further limit androgen synthesis in concert with CYP17A1 inhibition.

In a population-based study of 12,700 men with high-risk PCa identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, researchers found that post-diagnostic use of statins is associated with a 47% lower risk of PCa mortality compared with patients with no documented statin use. Among obese patients, statin use was associated with a 62% decreased risk of PCa mortality. The investigators observed a synergistic effect of statins and metformin among patients with metastatic disease.

Yoga Can Be Helpful For Prostate Cancer Patients

Study suggests that the side effects of therapy might be eased in patients who practice yoga.

A new research study suggests that yoga may be helpful in easing the side effects of prostate cancer therapy.

The study found that men who were novice yoga practitioners had more energy and fewer side effects such as sexual and urinary symptoms that are normally associated with radiation treatment, compared with men who didn’t practice yoga.

The typical levels of patient-reported fatigue that are normally expected to increase by around the fourth or fifth week within a typical treatment course were not evident in the study group that was practicing yoga.

Researchers reported that as many 85 percent of men who undergo radiation therapy for prostate cancer experience erectile dysfunction, often because they are also taking testosterone-depleting treatments. Many men undergoing radiation also report great fatigue after the therapy.

The patients involved in the study underwent six to nine weeks of external beam radiation therapy. Patients who were previously yoga practitioners, those with advanced stages of cancer, and those who’d previously undergone radiation therapy were not included in the study.

Of the patients in the study, 22 attended a structured yoga class two times a week while undergoing radiation therapy, while 28 others did not do yoga. This group served as a comparison group.

The findings, based on self-reported questionnaires, suggest that men who attended yoga classes had less fatigue and better sexual and urinary function than those in the other group. Furthermore, fatigue levels for men taking yoga fell as the classes went on, while they rose for men not in the classes. There was not a drop in sexual functioning scores for the men in the yoga group but these same scores dropped for the men in the non-yoga group.

One of the many theories that may explain these positive results is that yoga is known to strengthen pelvic floor muscles.

The study on yoga and men with prostate cancer was funded by grants from the American Cancer Society and the Prostate Cancer Foundation, and was published recently in the International Journal of Radiation Oncology, Biology, and Physics.

New Study Suggests There May Be a Link Between Sleep Deprivation and Fatal Prostate Cancer

Not just a luxury any more. An adequate number of hours of sleep is not a luxury, it’s essential. A preliminary study suggests that for some men, the amount of sleep they get each night might even mean the difference between life and death.

A new preliminary study found that men younger than 65 who slept just three to five hours a night were 55 percent more likely to develop fatal prostate cancer than those who got the recommended seven hours of shuteye nightly.

Moreover, researchers in this study found that men who got six hours of sleep a night had a 29 percent higher risk of prostate cancer death compared to men who got seven hours of sleep.

The findings need to be confirmed by additional studies, but if confirmed in other studies, these findings would contribute to evidence suggesting the importance of obtaining adequate sleep for better health.

Much more research is needed to better understand the biologic mechanisms, but many experts consider the study “interesting” but not substantive enough to cause sleep-deprived males any alarm.
However, the findings from this study do contribute to evidence that the body’s natural sleep/wake cycle — circadian rhythms — might play a role in prostate cancer development.

The study results were concluded using an analysis of long-term data on more than 823,000 men in the United States. The findings were presented at the annual meeting of the American Association for Cancer Research.

It has long been known that lack of sleep can inhibit production of melatonin, a hormone that affects sleep cycles. When melatonin production is low, many experts believe that it can lead to an increase in genetic mutations, greater oxidative damage, reduced DNA repair and a weakened immune system. Some specialists believe that lack of sleep may also contribute to the disruption of genes involved in tumor suppression.

The National Sleep Foundation recommends adults get at least seven hours of sleep a night.

NOTE: Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.