Actively monitoring prostate cancer can be safe alternative to surgery or radiation, study says

Good news has been released for men seeking to avoid prostate cancer treatment-related sexual and incontinence problems.

According to an Associated Press story by Carla K. Johnson a while back, it appears that most men can hold off on treatments because actively monitoring the disease is a safe alternative to surgery or radiation.

Dr. Stacy Loeb

Long-term evidence supporting that conclusion was confirmed, the piece notes, by Dr. Stacy Loeb, prostate cancer specialist at NYU Langone Health who was not involved in the research. 

It has long been known that most prostate cancer grows very slowly.

The story quotes Loeb as saying that a recent study's findings indicate that "there was no difference in prostate mortality at 15 years" between those who had surgery to remove tumors, those who had radiation treatment, and those who monitored.

The survival rate for all three groups was 97% — "also very good news," Loeb says.

Results of the study, funded by Britain's National Institute for Health and Care Research, were published in the New England Journal of Medicine.

The lead author of the study, Dr. Freddie Hamdy of the University of Oxford, was quoted to the effect that men diagnosed with localized prostate cancer should "consider carefully the possible benefits and harms caused by the treatment options" — and not rush their decisions or panic, despite the fact that a small number of men with high-risk or more advanced disease do need urgent treatments.

Dr. Freddie Hamdy

Researchers, Johnson's story says, "followed more than 1,600 U.K. men who agreed to be randomly assigned to get surgery, radiation, or active monitoring."

The study began on 1999, a time when monitoring practices were not as good as now (when MRI imaging and gene tests can be employed before informed decisions are made). 

"We have more ways now to help catch that the disease is progressing before it spreads," the AP story quoted Loeb as saying.

More information about the multiple facets of research can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Hereditary cancers are problem for males as well as for females, says head of genetic risk program

Breast cancer is not just a female problem. It strikes 2,500 men in the United States every year and kills about 500 of them.

Dr. Robert Sidlow

Those statistics come from Dr. Robert Sidlow, director of the Male BRCA Genetic Risk Program at New York's Memorial Sloan Kettering Cancer Center, in a recent Jewish Telegraphic Agency story by Larry Luxner.

Ashkenazi Jews, those of Eastern European descent, are particularly susceptible to the perils caused by a BRCA mutation that elevates the risk to men "not only of breast cancer, but also of melanoma and prostate, ovarian and pancreatic cancer," the article says.

Hundreds "of other mutations in the BRCA gene are just as dangerous, but they're not specific to Ashkenazim," Sidlow is quoted as saying.

The story notes that about "1 in 40 Ashkenazi Jews… carries the harmful mutation, compared to about 1 in 400 in the general population."

Roughly 1-2% of men "with the BRCA1 mutation and 6-7% of men with the BRCA2 mutation will develop cancer by age 80," Sidlow contends.

Luxner's piece also quotes Elana Silver, CEO of Sharsheret (Hebrew for "chain"), to the effect that "it's crucial that men with a family history of cancer undergo genetic counseling screening — via a standard blood or saliva sample — for BRCA and other hereditary cancer mutations."

Adds Silver, "This is not only a women's issue. Family history is so important. When a man shares his family history with his doctor, he may not realize that he should mention that his mother had breast cancer or his sister had ovarian cancer, as these are not general 'men's diseases.' They are not aware that these cancers could mean that they themselves are at increased risk for cancer and that they can pass on these mutations to the next generation."

Sidlow notes that "most men are pretty happy to enroll income kind of surveillance program once they get over the initial shock" of being a mutation carrier.

Luxner's story indicates that there are various precautions they can take for themselves and their children where the BRCA gene is concerned — as well as such mutations as ATM, TP53, CHEK2, and PALB2. They can "monitor their own health more closely, they can encourage their children to test to see if they are carriers and, for any future children, to take steps to prevent the mutated genes from being passed down. For example, couples can conceive via in vitro fertilization, or IVF, and then test the embryo before implantation to ensure that only those unaffected by the genetic mutation are implanted."

Much more information on BRCA1 an BRCA2 can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, its author, aimed at male caregivers.

Small study finds some patients can de-escalate, skip cancer surgery, do only chemo and radiation

Not doing surgery and relying only on chemo is possible for some women, a new study says.

Dr. Henry Kuerer

According to a story by Roni Caryn Rabin in The New York Times some time ago, the research, an early-stage clinical trial, found that "a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether."

About 60% of the test patients fit that category and went on to receive radiation treatment. They were still in remission, the article says, "after a median follow-up period of two years and two months," quoting Dr. Henry Kuerer, principal investigator of the study, which was published in Lancet Oncology.

"The elimination of surgery for invasive breast cancer is 'the ultimate form of breast-conserving therapy,'" the Times quotes him as saying.

Why skip an operation? It can lead to complications such as infections or lasting nerve pain.

Under any conditions, "there are always going to be people who would rather not have surgery," Rabin quotes Kuerer, professor of breast surgical oncology at the University of Texas Anderson Cancer Center in Houston.

The work, the story continues, "is part of an approach to cancer treatment called de-escalation — an effort to individualize treatment to a specific subtype of the disease, achieving the same results with less treatment and fewer interventions."

According to Karen Knudsen, chief executive officer of the American Cancer Society, "asking whether we can scale back surgery is a reasonable next consideration for the future of cancer care."

In a separate clinical trial, Kuerer is testing whether radiation is always necessary.

More information about choices when facing a life-threatening disease can be found in Rollercoaster: How a man can survive his partners breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.