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.

New Study Suggests That Black Men Should Start Prostate Cancer Screening Earlier

New findings suggest that the disease progresses faster in this demographic.

Some researchers now believe that black men may merit their own race-specific screening guidelines due to studies that have shown that they have a higher risk of developing — and dying from — prostate cancer.

Compared to white men, the incidence of prostate cancer is 60 percent higher among black men in the U.S. Also the death rate from prostate cancer is more than twice as high for black men than white men in this country, and the prostate cancers in black men tend to progress faster.

Based on these statistics/facts, some researchers believe that black men merit their own race-based screening guidelines. Other experts disagree with the idea of race-based screening guidelines.

Some experts strongly believe that black men should start talking to their physicians about prostate cancer screening at an earlier age; in their 40’s vs. their 50’s. Most standard guidelines suggest that these talks begin when a man is in their 50’s. Black men may also benefit from more frequent screening.

In the U.S. prostate cancer is the leading cancer diagnosis for men. It is also the second leading cause of cancer death for males in this country.

Because screening can sometimes lead to unnecessary treatment, it can be a source of controversy among medical experts. Many experts feel that there should be specific clinical guidelines written that are specific to black men.


When it comes to prostate cancer, screening usually consists of a blood test to measure the level of prostate-specific antigen (PSA) and a digital rectal exam to check the prostate gland for enlargement or other abnormalities.

If a PSA level is above 4.0 nanograms per milliliter (ng/mL) of blood it is considered high, according to the U.S. National Cancer Institute.

The U.S. Preventive Services Task Force has recently proposed new recommendations for prostate cancer screening. It now suggests that men in their 50s should start a discussion with their doctor about the risks and benefits of screening. According to this task force, whether a man gets screened or not should be an individual, informed decision.

Study Finds That Taller And Heavier Men Are More Likely To Get Prostate Cancer And Die From It.

BMI, which is body-mass index together with waist circumference were recently studied as how they relate to prostate cancer. The results show that both factors can directly predict risk of developing high-grade prostate cancer.

A new study suggests that the larger a man is, the greater his risk of getting and dying from aggressive prostate cancer.

Each additional segment of 4 inches of height increased a man’s chances of being diagnosed with high-risk prostate cancer by 21 percent. Researchers found that this also increased their odds of dying from prostate cancer by 17 percent.

The size of a man’s waist yielded similar results in the study. With every 4-inch increase in waist circumference, the odds of developing aggressive prostate cancer were increased by 13 percent.The risk of dying from prostate cancer using this waist measuring criteria, increased by 18 percent.

The study researchers came to their conclusions based on data from nearly 142,000 men in eight European countries who participated in a large-scale study of cancer and nutrition.

There have been previous studies done that have suggested a potential link between prostate cancer and a man’s height or weight, but this study is the first to assess whether those factors influence the risk of being diagnosed with either a slow-growing or aggressive cancer.

As a statistic measured on its own, height by itself was not linked to a man’s overall risk of developing prostate cancer, nor was it associated with risk of being diagnosed with low- or intermediate-grade prostate cancer.

The results of the study did show that height did indeed influence a man’s risk of being diagnosed with aggressive prostate cancer and of dying from prostate cancer.

Along the same lines, body-mass index and waist circumference were both shown to directly predict risk of developing high-grade prostate cancer.

This particular study only found an association between height, weight and aggressive prostate cancer risk; it couldn’t prove a cause-and-effect link.

The association between height and prostate cancer risk isn’t a new finding. Researchers have long suspected that the increased risk from height could possibly be related to early childhood nutrition that promoted fast growth.

There are some theories in regards to the possible link between obesity and prostate cancer. One is that obesity influences hormones in the body in a way that promotes prostate cancer. The second is that it may simply be more difficult to catch prostate cancer early in men who are obese partly because the digital rectal exam is more difficult to do. If the men have a large prostate it’s easier for a doctor to miss something during an exam.

Another contributing factor could be that PSA blood tests for prostate cancer are less reliable in obese men, because they tend to have a higher volume of blood that dilutes and masks elevated levels of prostate-specific antigen.

The 15-year survival rate of men diagnosed with prostate cancer is 96 percent, according to the American Cancer Society.

The study was published July 12, 2017 in the journal BMC Medicine.

A High PSA Level Can Indicate Less Serious Conditions Than Prostate Cancer

The first sign of prostate cancer can certainly be a high PSA level, but it can also be a sign of a less-serious condition.

Here are some reasons you may have an abnormal PSA reading:

1. PSA Levels Are Affected By Age

Your PSA level can increase gradually as you age even without any prostate problems. At age 40, a PSA of 2.5 is the normal limit but by age 70, a PSA of 6.5 could be considered normal.

2. Many Men Under 50 Suffer From Prostatitis

Prostatitis is the most common prostate problem for men younger than 50. Common causes of inflammation in the prostate gland, called prostatitis, can cause high PSA levels.

3. PSA Can Be Elevated Due To Medical Procedures

Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up such as placing a catheter into the bladder. A bladder exam that involves passing a scope or taking a biopsy can also affect PSA levels.

4. BPH May Be the Cause of High PSA In Men Over 50

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. BPH means more cells, so that means more cells making PSA. BPH is the most common prostate problem in men over age 50. It may not need to be treated unless it’s causing frequent or difficult urination.

5. Urinary Tract Infections Can Create High PSA Levels

Any infection near the prostate gland such as a urinary tract infection, can irritate and inflame prostate cells and cause PSA to rise. If you’ve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test.

6. Ejaculation Can Be a Potential Cause of Mildly Elevated PSA

Ejaculation can cause a mild elevation of your PSA level. This type of PSA elevation is usually not enough to make a significant difference unless your PSA is borderline.

Arnold Palmer And Other Famous People Diagnosed With Prostate Cancer

The American Cancer Society estimates that 161,360 new cases of prostate cancer will be detected in 2017. Many famous men including actors, politicians and sports figures have been diagnosed with prostate cancer, and their diagnoses can help to build awareness for the disease.

The following is a list of only some of the celebrities who have coped with prostate cancer:

• Arnold Palmer: Golfer (see below for Arnold Palmer’s story)
• Harry Belafonte: Singer and actor
• Bob Dole: Former Republican senator from Kansas
• Robert De Niro: Actor and director
• Rudy Giuliani: Former New York City mayor
• Charlton Heston: Actor
• John Kerry: United States Secretary of State since 2013
• Nelson Mandela: Former president of South Africa and anti-apartheid activist
• Francois Mitterand: Former president of France
• Roger Moore: Actor
• Colin Powell: Retired Secretary of State
• Frank Zappa: Musician

Arnold Palmer’s Prostate Cancer Story

Following his own diagnosis, Arnold Palmer became a champion for prostate cancer. His cancer was originally detected based on a rising PSA test, and confirmed with a prostate biopsy. He chose a radical prostatectomy for treatment and remained cancer free until the end of his life in September 2016.

Known for being a world-renowned professional golfer, Arnold Palmer had won dozens of PGA Tour events. He also is recognized for his involvement in politics, such as his personal relationship with President Dwight D. Eisenhower, and his charity work and community outreach, including working with foundations such as the Eisenhower Medical Center Foundation and the March of Dimes.

Arnold Palmer became known as a champion off the greens as well, for his work raising awareness about prostate cancer.

Palmer’s Prostate Cancer Diagnosis

In 1997 Palmer was diagnosed with prostate cancer. He had been getting routine physicals that included a PSA test. Because his PSA result rose steadily with each passing year, his physician ultimately recommended performing biopsies. Initially, these tests showed no evidence of cancer, though the PSA continued to rise in subsequent exams. However in 1997 one biopsy in came back showing the early stages of cancer. The biopsy was confirmed at the Mayo Clinic and he received a diagnosis of prostate cancer.

Palmer chose to undergo a radical prostatectomy to remove his prostate entirely. This was followed by radiation therapy treatments that lasted for seven weeks.

Within two months post-treatment, Palmer was back on the golf course and getting back in tour shape. Palmer did say that he noticed that post-surgery and radiation that he was weaker than he had previously been and that he required a longer time to recover after his practices.

Spokesman for Prostate Cancer Awareness

After his treatment in 1997, Arnold Palmer was at the forefront of prostate cancer awareness and was very public and vocal about his support of PSA testing.

Palmer strongly recommended that men not wait until their 50s to get screened for prostate cancer, and often reiterated that choosing to get this simple blood test can help save a life. He was a true example of someone for whom early detection of the disease proved life-saving.

As part of his prostate cancer advocacy, Palmer founded the Arnold Palmer Prostate Center at the Eisenhower Lucy Curci Cancer Center within the Eisenhower Medical Center near Palm Springs, Calif. This is a non-profit center that offers state-of-the-art prostate cancer treatment options.

In 2002 his dream of opening a cancer research facility in his hometown of Latrobe, Pennsylvania was realized when the University of Pittsburgh Medical Center and Latrobe Area Hospital unveiled the Arnold Palmer Pavilion. This cancer treatment center, a 30,000 square-foot addition to Latrobe Hospital features outpatient oncology and diagnostic testing.

Though Arnold Palmer died on September 25, 2016 of complications from heart problems, his name continues to be linked to prostate cancer awareness.

A High PSA Level Can Indicate Other Things Besides Prostate Cancer

An abnormally high PSA level can be a sign of prostate cancer, but it can also be a sign of a less-serious condition.

There Are Many Reasons For An Abnormal PSA Reading.

When a man has a PSA test it measures a protein in his blood called prostate specific antigen. Prostate cancer makes PSA levels go higher, but a high PSA test result doesn’t always mean a man has prostate cancer.

Sometimes PSA readings are elevated because of something benign and that has nothing to do with cancer. For instance, two reasons could be: ejaculating within 24 hours of the test, or a problem that needs treatment like a urinary tract infection.

Because the test can’t distinguish between serious causes of elevated PSA and other causes, the United States Preventive Services Task Force (USPSTF) has historically recommended against prostate specific antigen (PSA) testing in healthy men/men who have no family history, known risk factors, or symptoms of prostate cancer.

However in 2017, the USPSTF released new draft guidelines that encourage doctors to discuss the potential benefits and harms of using the PSA test to screen for cancer in men ages 55 to 69. The final recommendation statement is now being developed.

Here are five reasons, besides prostate cancer, your PSA level could be above normal.

1. Aging Affects PSA Levels

PSA levels can rise gradually as you age even without any prostate problems. At age 40 the normal limit for PSA is 2.5, and by age 60 the limit rises to 4.5 and even higher at age 70 where 6.5 could be considered normal.

2. A Common Problem in Men Under 50; Prostatitis

Common causes of inflammation in the prostate gland, called prostatitis, can cause high PSA levels, and prostatitis is the most common problem for men under the age of 50, so it is very prevalent. Prostatitis is caused by bacteria and can be treated with antibiotics. However, another type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.

3. PSA Can Rise Due to Medical Procedures

A catheter in the bladder or any type of procedure that traumatically interferes with the architecture around the prostate gland can make PSA go up. Another factor that could make the PSA rise is a prostate or bladder exam that involves passing a scope or taking a biopsy.

4. BPH May Be the Cause of High PSA In Men Over 50

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, but it’s not prostate cancer and it is the most common prostate problem in men over age 50.

In some cases a primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but usually this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.

5. Urinary Tract Infections Can Cause High PSA Levels

A man suffering from any infection near the prostate gland, including a urinary tract infection, can have a higher PSA because the infection can irritate and inflame prostate cells.

Men who have been diagnosed with a urinary tract infection should wait until after the infection has cleared up before they get a PSA test. Having BPH increases your risk for a urinary tract infection.

Despite Not Being Perfect, PSA is Still a Really Important Screening Test for Prostate Cancer.

According to the American Cancer Society, prostate cancer is the third leading cause of cancer death in American men, behind lung and colon cancer.

Four Questions to Ask Your Doctor About Prostate Cancer Surgery

Despite the fact that some media reports have recently been published claiming that prostate cancer has been over-treated, there are many men each year who still need aggressive therapy. Different treatment options each have their own pros and cons.

Men who are considering undergoing a radical prostatectomy will appreciate getting answers to the following questions in order to make an informed decision.

Ask Your Doctor

1. How many of these operations have you performed in the last year?

Research has shown that doctors performing more than 20 prostatectomies per year have a lower complication rate on average than doctors doing less than that number. Some urologists like Dr. Robert Gaertner and Dr. Christopher Knoedler specialize in prostate cancer surgery. Studies have shown that the best results come from very experienced surgeons.

2. What is the likelihood surgery will cure the cancer?

Statistically the best candidates for surgery are patients where the cancer is completely inside the prostate; but even then it is sometimes possible that the cancer will recur. When the cancer is growing outside the gland some men will need radiation after surgery. Ask your doctor to provide you with the odds that the surgery will be enough or whether additional therapy will be needed. The answers to these questions might influence your decision to choose radiation instead.

3. What are the odds of developing side effects?

All types of treatments can have side effects, and they can happen regardless of the expertise of the surgeon. The odds of side effects occurring vary, in part due to the cancer and a patient’s health. It is not enough to know what complications can occur; to make an informed decision, men also should find out the odds of them occurring. Ask your doctor things like: how often do men of my age and health develop impotence, incontinence or a urethral stricture? Ask the doctor how those results were measured. The most reliable information comes from written surveys completed by patients treated by their doctor.

4. Ask what happens if you develop impotence or incontinence; ask how is it treated and what are the odds of success?

Good treatments are available for incontinence or impotence, but some men still find these problems unacceptable. Knowing what can be done may influence your decision for or against surgery. Remember, all treatments can cause complications, but the odds of them occurring vary.