Cancer de la prostate / Prostate cancer:

[Al-khiyal]

The first genetic test that allows young men to assess their risk of developing prostate cancer in later life could be available as early as next year, scientists said yesterday.

Several teams of researchers have identified a total of seven genetic risk factors that account for about half of prostate cancers in the general population.

The scientists believe the findings could form the basis of a DNA test that could be used to identify young men at higher-than-average risk who could then be screened more closely for early signs of prostate cancer as they reach middle age.

In Britain, prostate cancer is the most common form of cancer in men, accounting for nearly a quarter of all new cancer cases among males. About 32,000 men in the UK are diagnosed with prostate cancer each year.

Prostate cancer is strongly associated with increasing age, with 60 per cent of cases occurring in men over the age of 70. But there are also strong genetic factors, with the risk increasing in men whose fathers developed the disease.

Much of the research focus in recent years has been on a region of chromosome 8 - one of the 23 pairs of human chromosomes - which appears to be instrumental in conferring a high risk of inheriting a predisposition to prostate cancer.

"There is a fairly large genetic component to the risk. That means you don't inherit the disease, you inherit various dispositions to the disease," said Kari Stefansson, the head of the Icelandic company deCode Genetics which formed part of the research team.

"We have found two sets of genetic variants on chromosome 8 that have dramatic impacts on the risk of prostate cancer," Dr Stefansson said.

"When you can identify the risk, there is a theoretical possibility of developing it into a pre-diagnostic test to screen men. It would be a reasonable goal to turn it into a genetic test before the end of this year or the beginning of the next," he said.

Three teams of scientists, who published their findings in the journal Nature Genetics, have identified seven genetic risk factors in total on two regions of chromosome 8.

"The study has identified combinations of genetic variants that predict more than a five-fold range of risk for prostate cancer," said David Reich, an assistant professor of genetics at Harvard Medical School.

"I think the genetic variations are clearly predictive of prostate cancer risk, but it is not clear whether the medical community is ready because of the ethical issues," he said.

One issue concerns the accuracy of the non-genetic, antigen test for prostate cancer, and whether it is advisable to carry out surgery on what may turn out to be a relatively benign tumour.

The scientists found that both the high-risk and the low-risk variants of the genetic combinations are common within the general population but in some ethnic groups, notably Afro-American men, the high-risk combinations are far more common than the average, Dr Reich said.

One high-risk variant of the genetic factors for instance is found in only 2 to 4 per cent of men in the general population but in about 42 per cent of African-American males.

"The identification of these genetic variants is an important step in helping us to understand the higher risk for prostate cancer in African Americans compared with other US populations and, more importantly, why some men develop prostate cancer and others do not," said Christopher Haiman of the University of Southern California in San Diego.

The combined research effort involved studying the DNA of thousands of men with prostate cancer from various ethnic groups drawn from America, Japan and Europe.

The scientists said that the region of chromosome 8 that is implicated in prostate cancer does not contain any known genes, which may indicate an as-yet undiscovered genetic trigger for cancer.

Cause for concern

* Prostate cancer has now over taken bowel cancer as the most common cancer diagnosed in men. It is the second major cause of death in men in the UK.

* About 7 per cent of men, or 73 in 1000, will develop prostate cancer in their lifetime.

* 23 out of every 100 cancers diagnosed in men are prostate cancers.

* Nearly 31,900 men were diagnosed it in 2003.

* Age is the most significant risk factor with 63 per cent of diagnosis occurring in men aged 70 and over.

DNA test will detect prostate cancer risk

[piccolomondo]

The Anglo-Swedish pharmaceutical laboratory “ASTRAZENECA” has organized an international symposium this week in Algiers , during which, its brand-new treatment of the prostate cancer was highlighted in plenary session.

2 new pharmaceutical products were expounded during the session; they are Casodex 50 mg and Zoladex 10.8 mg.
The 2 products are said to most efficient in the anti-cancer treatment.

[Read more...]

Related:

AstraZeneca

Casodex.net provides information on prostate cancer treatment, disease management and Casodex (bicalutamide), a non-steroidal anti-androgen, ...


Zoladex information (goserelin acetate) in prostate and breast cancer treatment and management including key publications, congress reports and slide ...

[Al-khiyal]

Only $300 to learn risk of prostate cancer

January 17, 2008 -- A combination of common and minor variations in five regions of DNA can help predict a man's risk of getting prostate cancer, researchers reported Wednesday.

A company formed by researchers at Wake Forest University School of Medicine is expected to make the test available in a few months, said Karen Richardson, a Wake Forest spokeswoman. It should cost less than $300.

This is, some medical experts say, a first taste of what is expected to be a revolution in medical prognostication. The results, they agree, are clear. But the question is what happens next. And will patients be helped or harmed? Because the new test — which will analyze DNA in blood or saliva samples and is to be offered by ProActive Genetics — cannot predict which men will get aggressive cancers, it could lead to more screening and unnecessary surgery and complications. But, proponents say, it could also help men decide whether they want aggressive screening in the first place.

The researchers found that about 90 percent of the men in the study had one or more of the gene variants and more than half had two or more. The cancer risk increased as the number of variants rose and increased substantially when men had four or five of the variants.

Men with four or five variants made up only 2 percent of the study population but had a 4.5-fold increased risk of having prostate cancer compared with men who had none of the variants. If the men also had a family history of prostate cancer, their risk was nearly 10 times higher than that of men with none of those risk factors. Less than 1 percent of the population had all the variants and a family history.

The researchers report that nearly half of the cases of prostate cancer among the roughly 5,000 men in the study could be attributed to the five gene regions and a family history, with some men having one or two of the gene variants and others having all five and a family history.

Prostate cancer becomes more common as men age — autopsies of elderly men find that most had prostate cancer, whether they knew it or not. But the men in this study had an average age of about 65, when the disease is less common and more likely to kill.

William Isaacs, a professor of urology and oncology at Johns Hopkins University and an author of the new report, said that if research validates what has been found, men may want to get the new genetic test when they are young, 35, say. Those at high risk because of their genetics might then choose to start prostate-cancer screening earlier than the usual age of about 50, using a blood test that looks for proteins secreted by prostate tumors.

"I think that makes sense," said Dr. Howard Sandler, a professor of radiation oncology at the University of Michigan and a spokesman for the American Society of Clinical Oncology.

But others worry that more frequent testing could exacerbate what is already a major problem: most prostate cancers grow so slowly that they would have been harmless if left alone. But since doctors cannot tell which are dangerous, they treat nearly all that they find. And treatment has serious side effects, including, often, impotence and incontinence. Nonetheless, researchers say, the test is a harbinger of things to come.

"It's the boutique medicine of the future," said Dr. Peter Albertsen, a surgery professor and prostate cancer specialist at the University of Connecticut. "We can know what diseases we will have to face in the rest of our lives."

That worries him, as it does Dr. Edward Gelmann, deputy director of the Comprehensive Cancer Center at Columbia University. "Technology today enables us to find out a huge amount of information," Gelmann said. "But how does the public deal with this information? How does it help them make decisions? And if they make a decision, does that lead to a day, a week, a month, of life saved?"

The study, by scientists at Wake Forest University School of Medicine, the Karolinska Institute in Sweden, the Harvard School of Public Health, and Johns Hopkins Medical Institutions, will appear in the January 31 issue of The New England Journal of Medicine. It was released online on Wednesday, a journal spokeswoman said, because "it is a very active area of research with a lot of competition."

Researchers long knew that the disease often runs in families. Though scientists spent years looking for genes, they found none that were reproducibly associated with a marked effect.

With new technology to scan the entire length of a person's DNA, researchers tried a new approach. They began looking for small variations in tiny DNA regions that were associated with prostate cancer. That resulted in the discovery, by several groups of investigators in Iceland and the United States, of the gene variants, small alterations in gene sequences. Unlike traditional genetic links to disease, the variants are not mutations that destroy a gene's function. In fact, no one knows what their effect is.

The next step was to ask whether those variants really could predict who had prostate cancer. So Dr. Jianfeng Xu, a professor of epidemiology and cancer biology at Wake Forest University School of Medicine, and his colleagues studied a Swedish population of 2,893 men with prostate cancer and 1,781 men who did not have it. That led to their finding that each of the five variants independently predicted prostate cancer risk.

"Each confers a moderate risk," Xu said, adding that the effect of having just one of the variants — a 10 or 20 percent increase in a man's chance of having prostate cancer — was not enough to justify using a single variant for screening. But, he added, because each conferred an independent risk, the risks added up so that the more men had, the greater their risk. Then they found that family history of the cancer added an independent risk. "That was very, very surprising to us," Xu said.

The next step, Isaacs said, is to look in other populations. "We think that can happen almost instantaneously," he said, explaining how scientists have blood samples and family histories of thousands of men who were tested for prostate cancer.

But some said that if the test leads to more screening, it is not necessarily a good thing. There is already too much prostate-cancer screening, they say, resulting in too much treatment. "To me, it is a nightmare," Albertsen said. "We are just feeding off of this cancer phobia."

What is needed, and what the new test does not provide, is a way to decide which cancers are dangerous and which are not, Isaacs said. Still, he said the new test could help patients if it was used with caution. "We may be premature with this idea — everyone has a different way of thinking about this — but it should not take five years to know if we are on the right track. All this can happen very rapidly."

"We have worked with enough families that have a positive family history to know that people are anxious to know their risk of prostate cancer," he said.

[Al-khiyal]

Genetic test in three years to detect prostate cancer

[Bent_Bladi]

lovin' the progression... progress my scientists, PROGRESS!! i hope this saves lots of lives

[Al-khiyal]

Drug cuts risk of prostate cancer by 30%, study shows

June 15, 2008 -- For the first time, leading prostate cancer specialists say they have a drug that can significantly cut men's risk of developing the disease, dropping the incidence by 30 percent.

But the discovery, arising from a new analysis of a large federal study, comes with a debate: Should men take the drug?

Prostate cancer is unlike any other because it is relatively slow-growing, and while it can kill, it often is not lethal. In fact, most leading specialists say, a major problem is that men are getting screened, discovering they have cancers that may or may not be dangerous and opting for treatments that can leave them impotent or incontinent.

So should healthy men take a drug for the rest of their lives to avoid getting, and being treated, for a cancer that, in most instances, it would be better to leave undiscovered and untreated? Is it worth risking a chance that unanticipated side effects may emerge years later if millions of men with no prostate problems take the drug?

Some prostate cancer specialists say the answer is yes. Any man worried enough about prostate cancer to be screened might consider it, they say.

The drug, finasteride, is available as a generic for about $2 a day, and millions of men safely take it now to shrink their prostates, its approved use.

With finasteride, as many as 100,000 cases of prostate cancer a year could be prevented, said Dr. Eric Klein, director of the Center for Urologic Oncology at the Cleveland Clinic.

Dr. Howard Parnes, chief of the prostate cancer group at the National Cancer Institute's division of cancer prevention, also is convinced. "There is a tremendous public health benefit for the use of this agent," he said.

While it might seem convoluted to offer a drug to prevent the consequences of overtreatment, that is the situation in the country today, others say. Preventing the cancer can prevent treatments that can be debilitating, even if the cancers were never lethal to start with.

"That's the bind we're in right now," said Dr. Christopher Logothetis, professor and chairman of genitourinary medical oncology at M.D. Anderson Cancer Center in Houston. "Most of the time, treatment wouldn't help and may not be necessary. But the reality is that people are being operated on."

"We are trying to avoid a diagnosis to avoid a prevention whose value is disputed," he said. With finasteride, Logothetis added, "we're trying to overcome our other sins."

Other experts say, "Not so fast." Finasteride might not make much of a difference in the death rate, because so few men die from prostate cancer. What the drug's proponents are advocating is taking a drug to somehow compensate for what many believe is the nation's overzealous diagnosis and treatment of the disease.

Dr. Peter Albertsen, a prostate cancer specialist at the University of Connecticut, explains: While 10 percent of men 55 and older find out they have prostate cancer, the cancer is lethal in no more than 25 percent of them. So if finasteride reduced prostate cancer's incidence by 30 percent, about 7 percent of men would get a cancer diagnosis and approximately 1.8 percent instead of 2.5 percent would have a lethal cancer.

"Finasteride might make a difference, but only in a very small subset of men," Albertsen said.

And, he adds, the study did not look for a decline in death rates, and it is unlikely that any study ever will - it would take too long and be too expensive. Yet the ultimate goal of prevention is to save lives. It remains an assumption that finasteride would have much effect on the minority of prostate cancers that, despite early detection and treatment, still kill.

Finasteride blocks the conversion of testosterone to dihydrotestosterone, a hormone active mostly in the prostate and the scalp and that all prostate cancers need to grow. The drug is available from Merck, as Proscar, and from six companies as a generic to shrink the prostate in older men, whose prostates can enlarge, making urination difficult.

Researchers say it turns out that shrinking the prostate also may be good for cancer detection by making it easier to find all tumors, including the most aggressive.

"The data are compelling," said Dr. Peter Scardino, chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center in New York, a convert who originally thought the drug was dangerous. "Finasteride has to be recognized as the first clearly demonstrated way to prevent prostate cancer with any medication or any oral agent at all."

Finasteride

Finasteride has had its ups and downs. Its chronicle began in 1993, with the start of a study sponsored by the National Cancer Institute and involving 19,000 men. Half took finasteride pills; the rest a placebo. In March 2003, 15 months before the study's scheduled end, its directors halted it abruptly. The reason was that the results were overwhelmingly compelling - men taking the drug were not getting prostate cancer. Yet despite that note of triumph, a troubling finding emerged. The study was designed to look for a reduction in the overall prostate cancer rate. And that is what it found. But, as Scardino pointed out in an editorial five years ago in The New England Journal of Medicine that accompanied the study, it appeared that 6.4 percent of the men who took the drug got fast-growing, ominous-looking tumors. In contrast, such tumors were found in 5.1 percent of men who took the placebo. The concern was that the drug might be preventing cancers that never spread. At the same time, finasteride might actually be causing aggressive cancers that can kill. It would, of course, be the worst possible outcome. Scardino's editorial warned healthy men not to take finasteride.

That seemed to leave the drug dead. The study researchers, though, wondered if that conclusion was correct. Maybe, they thought, by shrinking the prostate, the drug was just making it easier to find aggressive tumors. When doctors do a biopsy for prostate cancer, they probe the gland with a needle, hoping to find cancer cells. But prostate cancer grows as little nests, and an aggressive cancer will appear as dangerous-looking cells in some clusters and less dangerous in others. A smaller prostate means a doctor is more likely to hit upon cancer nests and more likely to find aggressive-looking cells. The researchers had a way to learn if they were correct. Most of the men in the study who had cancer - aggressive or not - chose to be treated and many had their prostates removed. A pathologist could carefully examine every one of those 500 prostates and compare the kinds of cancers found at surgery to those initially diagnosed at biopsy. It took years, but the analysis showed the hypothesis was right. Now, two groups of independent researchers conclude, in papers in the current issue of Cancer Prevention Research, that finasteride decreases the risk of having any tumor at all - large or small, fast-growing or slow-growing, by the same amount - nearly 30 percent.

With this new analysis, many prostate cancer specialists, including Scardino, say their view of the drug has completely changed. The study actually found that finasteride protects against both lethal and less-dangerous tumors and could cut prostate cancer risk by nearly a third. Even the effect on smaller tumors has important implications, said Dr. Ian Thompson Jr., the study's principal researcher and a urologist at the University of Texas Health Science Center in San Antonio. "The cancers that were prevented were the ones men are having surgery and radiation for today," Thompson said. Now, though, prostate cancer specialists have a new problem: How can they change the drug's image? Drug companies are unlikely to be instrumental, Thompson and others say, because finasteride's patent has expired, giving companies little incentive to apply to the Food and Drug Administration to market it as a cancer preventative. Without FDA approval, finasteride cannot be advertised as preventing cancer, and insurers may not pay for it. But doctors can prescribe drugs for other purposes at their discretion, and Parnes said that men and their doctors may be persuaded to try it.

In the meantime, GlaxoSmithKline, which has a patented drug, Avodart, to reduce the size of men's prostates, has a study asking whether its drug can prevent prostate cancer. If it can, and the drug agency approves Avodart for cancer prevention, doctors and patients may have to decide between a generic drug used off-label or a more expensive brand-name drug that does much the same thing. Some leading prostate specialists, like Scardino, say they are recommending that men who worry about prostate cancer take finasteride. He also ponders taking it himself. "I regularly think, 'Why don't I take it? Why wouldn't every man take it?"' Scardino said. He hasn't done so yet, partly because those years of concern about the drug took a toll. "I think it's the difficulty of adjusting to something that originally had a bad reputation," Scardino explained. Thompson has no such fears. He is at no particular risk for prostate cancer, but, he reasons, taking finasteride is not that different from taking a statin for a slightly elevated cholesterol level. "Imagine the marathoner with no family history of heart disease, who's skinny, doesn't smoke and has normal blood pressure," Thompson said. "Should he take a statin? The amount of benefit he'll get is not much, but his risk reduction still is 25 or 30 percent." Thompson knows what he will do about finasteride. "I'm 54," he said. "The men in the study were 55 and older. So I'll start taking it next year."

[Al-khiyal]

Cancer de la prostate :
80% des cas arrivent à un stade avancé

Dimanche 15 Mars 2009 -- Chaque année, plus de 3 000 hommes sont touchés par le cancer de la prostate. Plus il est détecté tôt, mieux il est traité. Ainsi, un dépistage est recommandé après 50 ans. Détectées à un stade précoce, les spécialistes affirment que 95% des tumeurs de la prostate pourraient être guéries, c’est dire l’importance du dépistage. Le premier cancer masculin inquiète les praticiens en raison de son évolution rapide. Selon le Pr Bouzid, oncologue au CPMC, cette pathologie est en constante progression, passant de 10 nouveaux cas recensés en 1999 au CPMC à 450 nouveaux cas en 2008 lors d’une rencontre organisée jeudi dernier par l’association des urologues privés à Alger, pour l’adoption d’un consensus concernant la prise en charge des personnes qui sont atteintes du cancer de la prostate en Algérie. Selon lui, ce type de cancer progresse notamment chez les personnes âgées, en précisant que depuis 2000, le cancer de la prostate arrive en tête des cancers qui touchent les hommes de plus de 50 ans. Le cancer de la prostate est classé, selon les registres actuels, entre la 4e et la 7e position. Mais comparativement aux pays développés, ce type de cancer vient en première position en Algérie, a affirmé le Pr Bouzid. Sur le plan clinique, le Pr Bouzid a souligné que les symptômes du cancer de la prostate se manifestent par des troubles urinaires identiques à d’autres maladies bénignes chez les personnes âgées de 40 à 55 ans. Il a également estimé que le problème qui se pose actuellement en Algérie est le fait que 80% des cas arrivent à un stade avancé de la maladie, ce qui pousse les spécialistes à limiter le traitement aux soins palliatifs et non curatifs. Le spécialiste a en outre appelé à la nécessité d’un diagnostic précoce afin de dépister la maladie à temps, déplorant le manque de centres spécialisés (chirurgie et radiothérapie notamment). Il a également appelé à cibler la population et non pas à faire dans la prévention de masse qui est « très coûteuse et peu efficace ».

Concernant les cancéreux qui sont traités au niveau du CPMC, le Pr Bouzid a indiqué que la plupart des malades arrivent à un stade avancé de la maladie, ils suivent un traitement médical et une radiothérapie. De son côté, le Pr Adjali, chef de service d’urologie au CHU de Bab El Oued, a plaidé pour un consensus concernant le traitement à travers le pays qui permettra aux spécialistes de bien prendre en charge le malade à l’instar de ce qui se fait dans les pays développés. Il a estimé que « la mise en œuvre d’un consensus et de recommandations applicables par les spécialistes, notamment en urologie, oncologie et exploration, aidera à l’amélioration de la prise en charge de ce type de cancer ». Le Pr Adjali a ajouté que « la prise en charge du cancer de la prostate est très coûteuse et constitue un fardeau pour la santé publique », affirmant que « les chiffres actuels sont loin de refléter la réalité en l’absence d’un registre national sur ce type de cancer ». « Les moyens actuels de prise en charge du cancer de la prostate sont très limités, notamment dans les hôpitaux universitaires qui se contentent des interventions chirurgicales et de la radiothérapie qui demeure onéreuse. »

La mise en place d’un consensus sur la prise en charge de la maladie est à même de sensibiliser les pouvoirs publics et la Caisse d’assurance sociale à la mobilisation des moyens de traitement nécessaires, a-t-il encore souligné. Le Dr Belloucif, urologue, a indiqué que la prise en charge du cancer de la prostate nécessite une équipe médicale pluridisciplinaire (anatomo-pathologistes et oncologistes). Les données actuelles concernant cette maladie sont loin de la réalité algérienne, car elles se basent sur l’anatomie pathologique (anapat) et la biopsie, a-t-il ajouté, précisant que 40% de ces malades ne subissent pas de prélèvement. Il a, en outre, appelé à l’extension des cinq centres spécialisés dans le cancer de la prostate existant à travers le territoire national. Concernant le diagnostic précoce, le spécialiste a recommandé de cibler en premier lieu la population ayant des antécédents dans la famille, ensuite vient la catégorie âgée des 50 ans et plus. Déplorant le manque de moyens thérapeutiques (radiothérapie, chirurgie et exploration) au niveau national, le Dr Belloucif a appelé au développement de la formation en radiothérapie, urologie et exploration en vue d’une prise en charge précoce des malades. Cette journée scientifique sur l’adoption du consensus pour la prise en charge du cancer de la prostate a vu la participation des sociétés algériennes de chirurgie urologique et d’oncologie médicale et l’association des urologues privés.