Active Surveillance

Comment

Comment by Richard L. on June 24, 2009 at 9:05am

Wonder if there are stats on how many doctors urging men to get biopsy speak to them of the possibility of needle track seeding of a cancer that may have never spread otherwise

Let us know if you ever get your hands on a peer-reviewed paper on this idea; I'd be interested in seeing it.

Comment by Colby on June 24, 2009 at 8:57am

Things like noscapine and pomegranate juice may be a little off topic, you are right. Perhaps more on topic would be Dr Stamey's article in which he points out all men will get prostate cancer if they live long enough - but only 226 of 100,000 deaths over age 65 are related to it. Wonder if there are stats on how many doctors urging men to get biopsy speak to them of the possibility of needle track seeding of a cancer that may have never spread otherwise. Glad to see PSA tests not being urged on those over 75. Prevention with good health habits should be encouraged for all.

Comment by Richard L. on June 24, 2009 at 7:29am

Quite important, though, if you're a mouse.

Comment by E. Michael D. ("Mike") Scott on June 24, 2009 at 7:09am

What's noscapine got to do with active surveillance? And what clinical data are there indicating that noscapine has any effect on any cancer in man?

Comment by Colby on June 23, 2009 at 11:53pm

ScienceDaily (Dec. 21, 2008) — A study published December 18 in the December issue of the European medical journal Anticancer Research demonstrates that an ingredient used in a common cough suppressant may be useful in treating advanced prostate cancer. Researchers found that noscapine, which has been used in cough medication for nearly 50 years, reduced tumor growth in mice by 60% and limited the spread of tumors by 65% without causing harmful side effects.

The laboratory study was a joint effort by Dr. Israel Barken of the Prostate Cancer Research and Educational Foundation, Moshe Rogosnitzky of MedInsight Research Institute, and Dr. Jack Geller of The University of California San Diego. Noscapine has previously been studied as a treatment for breast, ovarian, colon, lung and brain cancer and for various lymphomas, chronic lymphocytic leukemia and melanoma. This study, however, is the first to demonstrate its effectiveness in treating prostate cancer.

Noscapine is a naturally-occurring substance, a non-addictive derivative of opium. As a natural substance, noscapine cannot be patented, which has limited the potential for clinical trials. Rogosnitzky notes that drug companies are generally unwilling to underwrite expensive clinical trials without being able to recoup their investment. A synthetic derivative of noscapine has been patented but has not yet reached the clinical testing phase.

Rogosnitzky, director of research at MedInsight Research Institute, points out the significant advantages that noscapine could present as a treatment for prostate cancer. “Noscapine is effective without the unpleasant side effects associated with other common prostate cancer treatments. Because noscapine has been used as a cough-suppressant for nearly half a century, it already has an extensive safety record. This pre-clinical study shows that the dose used to effectively treat prostate cancer in the animal model was also safe.”

Comment by David Friedlander on June 23, 2009 at 11:04pm

Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically

Mark Louie-Johnsun, Mischel Neill, Karien Treurnicht, Michael Jarmulowicz and Christopher Eden
Department of Laparoscopic Urology, Royal Surrey County Hospital, Guildford, Surrey and The Hampshire Clinic, Basingstoke, Hampshire, UK
Correspondence to Mark Louie-Johnsun, Department of Laparoscopic Urology, Royal Surrey County Hospital, Guildford, Surrey and The Hampshire Clinic, Basingstoke, Hampshire, UK.
e-mail: mlj88a@hotmail.com

Copyright © 2009 BJU International

ABSTRACT
To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series.

PATIENTS AND METHODS
From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level <10 ng/mL, clinical stage ≤T2a and biopsy Gleason score ≤6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed.

RESULTS
The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1–9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score ≥7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months.

CONCLUSION
In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.

Comment by Colby on May 29, 2009 at 11:47pm

The recently published US and European reports http://www.drweil.com/drw/u/QAA400572/Give-Up-on-PSA-Tests.html serve to confirm Dr Stamey's statements a few years ago: "The bad news is we all get prostate cancer - the good news is only 226 of 100,000 deaths over age 65 are related to it." Is there another disease treated by such invasive measures where 48 people have to be treated to show (possible) improvement in one? There seems to be something wrong with the 'medical profession' when they do things like this. Reminds me of the NNT (number needed to treat) using statin drugs (for cholesterol) - 50 have to take it for life to show (possible) benefit in one. Hopefully 'we the people' will start looking at 'Number Needed To Treat' when it comes to our personal health http://www.healthnewsreview.org/view_content/detail.php?type=Theme&id=17

Comment by E. Michael D. ("Mike") Scott on March 18, 2009 at 8:09am

The UK summary that Richard refers to is a very fair commentary on the Eggener et al. report. See also the comments on this study on the main site, also published on Tuesday.

Comment by Richard L. on March 18, 2009 at 6:09am

A UK response to the Eggener paper was published yesterday by the UK NHS, and makes interesting reading, though it's not very detailed. See here.

Notes: NHS is the UK National Health Service (free to all UK residents); Daily Mail is a popular newspaper not known for its rigorous appraisal of medical issues; NICE is the (UK) National Institute for Health and Clinical Excellence (advice and guidance on many prostate cancer issues, but heavily biased to cost-effectiveness in the NHS sector, and not necessarily private medical treatment). The NICE website is here.

Comment by Richard L. on March 16, 2009 at 4:25am

I believe this is the paper: A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer, Eggener et al, 2009.

Click here for the full text.

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