Saturday, November 30, 2019

Men with prostate cancer can live longer on immunotherapy

In what could be a piece of great news for men with advanced prostate cancer, a new study has claimed that they can live two more years or even more on immunotherapy.

Yes, the study has found that those with advanced prostate cancer who have exhausted all other treatment options could benefit from immunotherapy.


Researchers also found that a small proportion of men were ' super responders' and were alive and well even after the trial had ended despite having had a very poor prognosis before treatment.


They found that one in 20 men with end-stage prostate cancer responded to the immunotherapy pembrolizumab-- but although the number who benefited was small, these patients sometimes gained years of extra life.


The most dramatic responses came in patients whose tumours had mutations in genes involved in repairing DNA, and the researchers are investigating whether this group might especially benefit from immunotherapy.


The phase ll clinical trial was led globally by a team at ' The Institute of Cancer Research,  London, and the Royal Marsden Foundation Trust, and involved 258 men with advanced prostate cancer who had previously been treated and become resistant to androgen deprivation therapy and docetaxel chemotherapy.


Overall, 5 % of men treated with pembrolizumab saw their tumours actually shrink or disappear, while a larger group of 19 % had some evidence of tumour response with a decrease in prostate-specific antigen (PSA) level.


Among a group of 166 patients with particularly advanced disease and high levels of PSA, the average length of survival was 8.1 months with pembrolizumab.


Nine of these patients saw their disease disappear or partly disappear on scans. And of these, 4 were super responders who remained on treatment at the end of study follow-up, with responses lasting for at least 22 months.


Meanwhile, a 2nd group of patients whose PSA levels were lower but whose disease had spread to the bone lived for an average of 14.1 months on pembrolizumab.


The study also compared the effectiveness of pembrolizumab in men whose tumours had a protein called PD-L1 on the surface of their cancer cells and those whose tumours did not.


Targeting PD-L1 activity with pembrolizumab takes the ' brakes ' off the immune system, setting free to attack cancer cells.


Commenting on the findings, Prof. Johann de Bono, Regius Prof. of Cancer Research at The Institute of Cancer Research, London, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said : 'Our study has shown that a small proportion of men with very advanced prostate cancer are super responders to immunotherapy and could live for at least 2 years and possibly considerably longer".


Adding to it, Prof. Paul Workman, Chief Executive of The Institute of Cancer Research, London, said : " Immunotherapy has had tremendous benefits for sine cancer patients and it's fantastic news that even in prostate cancer, where we don't see much immune activity, a proportion of men are responding well to treatment".

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Tuesday, March 19, 2019

Hormonal treatment may trigger depression in men with cancer

According to a recent study, men who receive anti-hormonal treatment after having their prostate removed are 80 % more likely to suffer from depression. The study suggests that patients receiving androgen deprivation therapy should be monitored for post-surgical depression.

Increasingly doctors are becoming aware that for many men, a cancer diagnosis and treatment leads to depression, with suicide rates seen rising disproportionately for those with urological cancers. The group of researchers has shown that men who receive anti-hormonal treatment after a radical prostatectomy have an increased tendency to depression.


" The anti-hormonal treatment is given to control the growth of tumour cells. Unfortunately, we've found that it is also associated with depression, said the lead author of the study.


The researchers examined medical records of 5,570 men. They found that 773 of these men were treated for depression after surgery. They found that men treated with anti-hormonal medicines were 1.8 times more likely to suffer from depression than men who did not receive the additional treatment. The researchers also checked whether radiotherapy after radical prostatectomy was associated with depression, but these results were inconclusive.


The treatment prevents the production of androgen hormones, like testosterone. We know from other studies that low testosterone can affect a man;s well-being, so it may be that limiting testosterone production might have the same effect m perhaps especially after a major stress such as cancer treatment. It is important to note that compared to men without prostate cancer the patients treated with prostatectomy as a whole has an increased risk of depression, the Dr. explained.


According to the Dr., after surgery, erectile dysfunction and urinary incontinence are frequent symptoms, in case of recurrence and hormonal treatment, these symptoms may worsen and in addition, altered body image and loss of libido are common. These treatment effects are likely to increase the risk of depression. Also, low testosterone levels may directly affect mood centres of the brain.


As many as 25 % of men undergoing radical prostatectomy will relapse and may be offered hormonal treatment. These men appear to be at a higher risk of developing depression once hormonal treatment is introduced. The reason could be either a consequence of failing surgery, directly caused by the hormonal manipulation or both.


 
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Sunday, May 10, 2015

Young prostate cancer patients suffer more hot flashes

Men who are younger or have a lower body mass index (BMI) are more prone to experience hot flashes during a common treatment for patients with advanced stage prostate cancer, a new research has found.

More than 25 percent of prostate cancer patients report that hot flashes are the most distressing side effect of androgen deprivation therapy (ADT).

"This study is a concrete step towards identifying which patients are more likely to experience these distressing symptoms," said Mayer Fishman from the Moffitt Cancer Center in Florida, US.
The researchers also reported that the presence of certain genes involved in processes such as immune function, nerve impulse transmission, blood vessel constriction and circadian rhythms were associated with an increased number of hot flashes.

They compared 60 prostate cancer patients on ADT to 83 prostate cancer patients who did not have ADT and 86 men without cancer.
They discovered that patients on ADT experienced significantly more hot flashes at six months and 12 months after therapy initiation than the other two control groups combined.

The severity of the hot flashes also increased over time in the group of men receiving ADT.

The patients reported that the hot flashes interfered with their daily lives by affecting leisure activities, sleep and general quality of life.
The researchers analysed patient characteristics and their DNA to determine which factors were associated with an increase of hot flashes.

The study appeared in The Journal of Urology. 


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