Tag: prostate cancer

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Metformin May Echo the Benefits of Exercise in Prostate Cancer Care

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Photo by Jonathan Borba on Unsplash

A new study has found that metformin may mimic one of exercise’s core biological effects in men with prostate cancer, raising levels of a molecule tied to energy balance and weight control even when patients are inactive. The findings suggest that metformin could help counter the metabolic strain of hormone therapy, when fatigue and other side effects often limit physical activity.

Led by physician-scientists at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, the study appears in the journal EMBO Molecular Medicine.

Exercise is one of the most reliable ways to support health during cancer treatment. It helps regulate weight, blood sugar, and cardiovascular health – factors that shape how patients feel during therapy and how well they recover afterward.

For many people with cancer, however, regular exercise isn’t always feasible. Fatigue, hormone therapy, pain, or advanced disease can limit physical activity precisely when metabolic health becomes most important.

That reality has led researchers to ask a practical question: If exercise confers its benefits through specific biological signals, could some of those signals be activated in other ways?

According to the research, the answer may be yes. Sylvester investigators report that metformin raises levels of a naturally occurring molecule involved in how the body manages energy and weight in prostate cancer patients.

The finding does not suggest that a pill can replace physical activity. Instead, it offers insight into the internal pathways that underlie exercise’s metabolic benefits – and how those pathways might still be engaged when movement is limited.

“This study reflects what’s possible when laboratory science, metabolic biology, and clinical investigation are intentionally brought together for transdisciplinary studies,” said Sylvester researcher and first author, Marijo Bilusic, MD, PhD, genitourinary medical oncologist and professor of medicine and medical oncology at the Miller School. “The result isn’t a new cancer biomarker, but a clearer understanding of how a widely used drug may support metabolic health during prostate cancer treatment – an outcome that matters to patients and clinicians alike.”

The molecule at the heart of the study

At the center of the collaborative, team-science study is a molecule called N-lactoyl-phenylalanine (Lac-Phe). While its name is technical, its role is relatively simple.

Lac‑Phe is produced when the body is under metabolic demand. It forms when lactate, which accumulates during exertion, combines with phenylalanine, a basic building block of protein. Scientists first took notice of Lac‑Phe because its levels spike after intense exercise, coinciding with shifts in energy use and appetite regulation.

In preclinical and early human studies, higher Lac‑Phe levels have been associated with reduced appetite and improved weight control – two effects commonly linked to regular physical activity.

Lac-Phe does not rise only with exercise. Scientists observed elevated Lac-Phe levels in people taking metformin, even in the absence of physical activity. That overlap raised an important question for cancer care: Could a pathway typically associated with exercise be activated pharmacologically in patients whose treatments limit movement?

Why prostate cancer patients are a focus

To explore that question, the Sylvester team focused on prostate cancer, where hormone-based therapies are known to disrupt metabolism, contributing to weight gain, insulin resistance, and cardiovascular risk.

Notably, Lac-Phe levels in patients treated with metformin approximated those previously reported after strenuous exercise. This occurred even though patients were not exercising at the time of blood collection, and the effect persisted after hormone therapy began.

“From a clinical standpoint, seeing a metabolic signal that mirrors what we associate with intense exercise was striking,” said Bilusic. “For patients whose treatments or symptoms limit physical activity, that kind of effect could be especially meaningful.”

Higher Lac-Phe levels were not associated with anti-tumour response to metformin. The metabolite did not correlate with changes in prostate-specific antigen (PSA), a standard marker used to monitor prostate cancer.

What Lac-Phe might mean for patients

That distinction is central to the study’s interpretation. While more expanded studies are needed to determine the utility of Lac-Phe as a marker of anticancer efficacy, it appears to reflect how the body manages energy, weight and metabolic strain during treatment. These results were confirmed to ensure the findings were not limited to one clinical setting. In fact, increases were also observed in patients receiving other metabolic therapies, suggesting Lac-Phe may reflect a broader metabolic response rather than a drug‑specific effect.

“Cancer therapy often affects the body in ways that go beyond the tumour,” said Sylvester researcher Priyamvada Rai, PhD, co-leader, Tumor Biology Program and professor of radiation oncology at the Miller School. “Supporting metabolic health can influence how patients tolerate treatment and how they feel over time, even if it doesn’t directly change tumour growth. This study was an opportunity to investigate molecular pathways that can be therapeutically activated for better outcomes to treatments that induce metabolic stress.”

Metformin raises a stress hormone called GDF‑15, but this study found that Lac‑Phe was more closely tied to weight changes. Because the two didn’t rise together, metformin likely affects weight through multiple pathways, with Lac‑Phe playing a bigger role.

Taken together, the findings offer a clearer picture of how a widely used diabetes medication may influence metabolic health during prostate cancer care.

“What’s encouraging about this work is that it reminds us cancer care isn’t only about targeting tumours – it’s also about supporting the whole patient,” said Rai. “By better understanding how treatments affect metabolism, we can begin to identify ways to help patients maintain strength, resilience, and quality of life throughout their care.”

Source: University of Miami

Categories : CancerTags :

New Trial Tests Lower Dose Treatments for Prostate Cancer

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Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

A major UK clinical trial co-led by researchers at UCL will test whether lower doses of common hormone therapies can treat advanced prostate cancer while reducing the severe side effects many patients experience.

The ENHANCE trial, jointly funded by Cancer Research UK and Prostate Cancer UK, will recruit 1,500 men with advanced prostate cancer from hospitals across the UK to compare standard and half-dose treatment using four commonly prescribed hormone drugs. UCL is sponsoring the trial and Professor Allan Hackshaw (Director of CRUK & UCL Cancer Trials Centre, UCL Cancer Institute) is joint-lead investigator, alongside Professors Ananya Choudhury and Peter Hoskin at the University of Manchester.

Men diagnosed with advanced prostate cancer, where the disease has spread beyond the prostate, are typically treated with powerful hormone therapies that slow tumour growth. While these drugs can extend life, they can also cause debilitating side effects such as extreme fatigue, hot flushes and high blood pressure, which can make it difficult for some patients to remain on treatment.

Researchers hope the £3.2 million ENHANCE trial will show that lower doses of these drugs can be just as effective while improving patients’ quality of life. The trial has not yet been launched and is awaiting the relevant regulatory and ethics approvals.

Professor Allan Hackshaw said: “Although focus is often on cancer trials to improve survival, we also need to find more tolerable ways of treating cancer without compromising survival. Side effects of cancer therapies matter a lot to patients, especially when they are frequent.

“We believe that several modern cancer drugs can be given at a much lower dose than what they were licensed for. Not only would this improve patient’s quality of life, but healthcare costs would be lower allowing more access especially in countries that cannot afford these drugs at their current high dose. The ENHANCE study can therefore influence clinical practice worldwide.

“Furthermore, Black men are more likely to get prostate cancer, and they too suffer from the same side effects of hormone treatment. They are often under-represented in clinical trials, so the ENHANCE study is a good opportunity to show that they get the same benefits from lowering the treatment dose as other ethnic groups.”

ENHANCE will compare full and half-dose treatment across four hormone therapies widely used for advanced prostate cancer: abiraterone, enzalutamide, darolutamide and apalutamide. If successful, the findings could influence prostate cancer treatment guidelines in the UK and internationally as early as 2030, improving care for thousands of men and reducing costs for the NHS.

Dr Ian Walker, Executive Director of Policy at Cancer Research UK, said: “Thanks to research, there’s been huge progress in prostate cancer treatments. Today, more than 8 in 10 men diagnosed with the disease in the UK will survive for 10 years or more. There’s more that can be done to save even more lives though, and in addition to finding more effective treatments, we need to find kinder ones too. The ENHANCE trial is looking to do just that and could mean that men affected by prostate cancer live not just longer lives but have a better quality of life.”

Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, said: “No man should be forced to compromise between survival and their day-to-day wellbeing. This is a crucial issue for men with prostate cancer. That’s why Prostate Cancer UK is thrilled to be working alongside Cancer Research UK, pooling our resources and expertise to deliver the impact men need by funding this bold new trial that puts men’s wellbeing at its centre.”

Prostate cancer is now the most common cancer in UK men. Around 55 900* men are diagnosed each year. While survival rates have tripled since the 1970s, many men still face difficult side effects from treatment.

Retired solicitor Jonathan Edwards, 80, from Cheshire, experienced severe side effects after starting the hormone-blocking drug enzalutamide following his prostate cancer diagnosis in 2024, but when his nurse reduced the dose, his cancer remained under control and his quality of life improved dramatically.

Jonathan said: “It was such a shock when I was diagnosed. I had several health issues and after many tests was eventually told that I was suffering from prostate cancer and that it had spread beyond the prostate wall to my bones. I was referred to The Christie Hospital for treatment and was prescribed hormone blockers. The side effects made me extremely tired; I was sleeping through the day on and off and I had frequent hot flushes and generally felt weak.

“When the nurse suggested lowering the dose I was not sure what to expect. The difference soon became apparent and I felt normal again. I know that I will stay on the medication for as long as it is effective but, in the meantime, I am able to live a pretty normal life. I now exercise more and do not usually need an afternoon sleep. Happily, my PSA level started to go down until, after a few months, it was undetectable and has so far remained undetectable.

“My life has been transformed by the medication, my energy levels are higher, and I can socialise as normal. Traveling was a problem but now I can plan trips as long as I work around the 12-week cycle of injections and consultations. I am delighted that this trial has the potential to help other men going through the same thing in the future by enabling them to be treated for prostate cancer with their quality of life still largely intact.”

At least 10 per cent of trial participants will be Black men. Historically under-represented in clinical trials, Black men are often treated based on data that may be less applicable to them. Although data shows Black men are more likely to develop prostate cancer, more evidence is needed to understand their risk of aggressive disease and the role of overdiagnosis.

Alongside testing lower doses, the trial will collect tissue, blood and urine samples to identify biomarkers that could help determine which men are most suitable for reduced-dose treatment, shaping more personalised care in the future.

*Based on the average annual number of new cases of prostate cancer (ICD10 C61) diagnosed in the UK in the years 2018-2019, 2021.

Source: University College London

Categories : Cancer UrogenitalTags :

Prostate Cancer Screening on Par with Breast Cancer Screening

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Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

Prostate cancer screening compares favourably to screening for breast cancer in identifying significant cancers, reducing mortality and avoiding unnecessary harms, according to new research. The findings are presented on Sunday 15 March 2026 at the European Association of Urology Congress (EAU26) in London. The research is also accepted for publication in European Urology.

The researchers maintain that the similarities between the two forms of screening mean it is no longer rational to reject prostate cancer screening on one hand while endorsing screening for breast cancer on the other. Nevertheless, they recommend some caution given their research compares a trial with a population-based screening programme and across two different cancers. 

Although breast and prostate cancer are the most commonly diagnosed cancers in Europe amongst men and women respectively, screening for the diseases is vastly different. Organised breast cancer screening programmes have been established across Europe for more than three decades. Prostate cancer screening has lagged behind, primarily due to concerns around the effectiveness of the PSA blood test and the risks of overdiagnosis and overtreatment. Nevertheless, many men undergo variable, ‘opportunistic’ screening for the disease, mostly based on self-referral.

Several prostate cancer screening trials in Europe have now reported long-term outcomes, showing a reduced risk of death from prostate cancer [1]. This risk reduction is similar to that seen in breast screening programmes.

The new analysis compares the two types of cancer screening in terms of the effectiveness of the diagnostic tests and levels of overdiagnosis. The researchers, from the German Cancer Research Centre in Heidelberg, Germany, drew on data from the PROBASE prostate cancer screening trial in Germany and the country’s breast cancer screening programme.

They used data from 39,392 men who underwent an initial PSA blood test as part of the PROBASE trial at age 45 or 50. They compared this with data from just over 2.8 million women, aged 50–69, who had a mammography as part of Germany’s organised breast cancer screening programme. They found:

  • PSA blood testing followed by an MRI scan leads to a higher number of false positives than mammography (37-42% vs 10%).
  • A similar proportion of men and women were referred for biopsy (0.8-2.4% for men and 1.1% for women) as men in the PROBASE trial were triaged before referral using various factors to determine the likelihood of significant cancer (known as risk stratification)
  • Biopsies were far more likely to identify significant cancer in prostate screening than in breast screening (50-68% vs 10%), indicating that fewer men were referred for biopsy unnecessarily.
  • The percentages of invasive cancers identified were similar across both prostate and breast cancer screening (60-74% vs 73%).
  • Prostate cancer screening was more likely to identify non-aggressive cancers than breast cancer screening (26-31% vs. 22%). However, in prostate cancer the option of active surveillance is well-established, and the researchers maintain this would limit the risk of overtreatment. Active surveillance involves monitoring lower grade cancers and only starting treatment (radiotherapy or surgery) if they progress.

Dr Sigrid Carlsson, who leads Clinical Epidemiology of Early Cancer Detection at the German Cancer Research Centre (DKFZ) in Heidelberg, is lead author of the research. She said: “Until we have a population-based screening programme for prostate cancer, we can’t make an exact like-for-like comparison with breast cancer. But we can make some informed assumptions based on the data from our trial, which shows that if prostate cancer screening were extended to the wider population, then the outcomes are likely to be very similar to breast cancer. Although our study used German data, the findings are applicable to other countries. The final question we now need to answer is: what will this cost compared to what we are already paying for opportunistic screening? And that work is already underway.”

Tobias Nordström is a clinical urologist and Associate Professor at the Karolinska Institute, Sweden and a member of the EAU Scientific Congress Office. He said: “There is much that prostate cancer screening can learn from breast cancer screening and that is why this analysis is an important addition to our knowledge base. As these kinds of comparisons are very challenging, the results do need to be taken with a level of caution. That said, the clear overall similarities between the outcomes for breast and prostate cancer screening show that we are moving in the right direction, ensuring prostate cancer screening offers more benefits than harm.”

[1] See the 23-year follow-up from the European Randomised Study of Screening for Prostate Cancer (ERSPC) in the New England Journal of Medicine: European Study of Prostate Cancer Screening — 23-Year Follow-up | New England Journal of Medicine

Source: European Association of Urology

Categories : CancerTags :

Hormone Therapy of Little Benefit with Radiotherapy after Prostate Surgery

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Findings could help patients avoid side significant effects and improve quality of life

Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

A new study led by UCLA Health investigators suggests that adding hormone therapy to post-operative radiotherapy may provide little survival benefit for most men with prostate cancer, especially for those with very low PSA levels before treatment. 

The researchers found that for men with low PSA levels prior to radiotherapy, adding hormone therapy, whether short-term or long-term, did not improve overall survival. Men with higher PSA levels before radiation may see modest improvements in survival and metastasis-free survival, suggesting hormone therapy may be beneficial primarily for this higher-risk group.

The results were published in The Lancet and presented by Dr Amar Kishan, professor and executive vice chair of radiation oncology at the David Geffen School of Medicine at UCLA, during the plenary session of the American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco. 

“Hormone therapy, which impacts the ability of testosterone to stimulate prostate cancer growth and repair, has been shown to improve outcomes when combined with radiotherapy in men whose prostates are still intact. However, whether it has a similar benefit for men receiving radiotherapy after prior surgery has remained unclear,” said Kishan, first author of the study and co-director of the cancer molecular imaging, nanotechnology and theranostics program at the UCLA Health Jonsson Comprehensive Cancer Center. “At the same time, hormone therapy carries significant side effects, including severe fatigue, hot flashes, sexual dysfunction, weight gain, bone loss and metabolic changes that can increase cardiovascular risk. Our findings show that for most men with detectable but low PSA levels (<0.5 ng/mL), after surgery to remove the prostate, post-operative radiotherapy is highly effective on its own. By safely omitting hormone therapy in these patients, we can potentially spare them months of treatment that may substantially affect their quality of life without extending survival.”

To better understand the impact of hormone therapy in this setting, the researchers conducted a large-scale, individual patient-level meta-analysis through the MARCAP Consortium, an international collaboration co-led by Kishan that is designed to evaluate long-term outcomes across randomized clinical trials.

The team analysed data from 6057 men enrolled in six randomised trials comparing post-operative radiotherapy alone to radiotherapy combined with either short-term (4-6 months) or long-term (24 months) hormone therapy. By pooling individual patient data rather than relying on summary trial results, investigators were able to examine outcomes in greater detail, including how pre-radiation PSA levels influenced treatment benefit.

Patients were followed for a median of nine years, allowing researchers to assess long-term overall survival, metastasis-free survival and recurrence outcomes. The analysis also enabled direct comparisons between short-term and long-term hormone therapy to determine whether extending treatment duration improved outcomes.

The researchers found that overall, 83.6% of men who received post-operative radiotherapy alone were alive after 10 years, compared with 84.3% for those who received post-operative radiotherapy plus hormone therapy.

Researchers found that pre-radiotherapy PSA levels, a measure of prostate-specific antigen in the blood after prostatectomy, played a crucial role. Men with low PSA levels before radiotherapy (≤0.5 ng/mL) saw no benefit from hormone therapy. In contrast, men with higher PSA levels showed modest improvements in survival, suggesting that hormone therapy may only be worthwhile for those with elevated PSA. 

The study also examined the duration of hormone therapy. Short-term therapy did not improve overall survival, though it slightly reduced the risk of cancer spreading. Long-term therapy showed a small survival benefit, particularly for men with higher PSA levels after prostatectomy. However, the team’s statistical analysis demonstrated that extending short-term therapy to long-term therapy did not further improve survival, although it did modestly lower the risk of metastasis.

“Our goal is always to treat the cancer while minimizing harm,” said Kishan. “This study helps us move toward more personalised care for men with prostate cancer. By better identifying who truly benefits from hormone therapy, we can make treatment smarter, reduce unnecessary interventions and focus on improving patients’ overall well-being.”

Building on those findings, ongoing research is working to further refine that approach. Trials such as the BALANCE Trial aim to pinpoint biomarkers that can identify which men are most likely to benefit from hormone therapy after surgery, helping tailor treatment decisions even more precisely.

Source: UCLA Health

Categories : Cancer IT in HealthcareTags :

Half of All Men Over 60 Have Prostate Cancer – an AI Tool Could Speed Diagnosis

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Photo by National Cancer Institute on Unsplash

Increasing use of blood tests to detect prostate cancer is leading to overworked doctors. NTNU has now created an AI diagnostic tool that can help lighten the burden.

Diagnostic tools based on artificial intelligence are now making their way into Norwegian hospitals. AI can independently read X-ray images and detect bone fractures, or assess cancer tumours in both the breast and prostate.

“AI tools can take over the detection of simple and clear-cut cases, allowing doctors to spend their time on more complex ones,” said Tone Frost Bathen. She is a professor at NTNU and the project manager of an AI-powered analysis tool for prostate cancer called PROVIZ.

Tests on patients at St Olavs Hospital indicate that the tool is very promising.

“AI can enable radiologists to determine more quickly and more accurately whether a patient needs a biopsy, and where in the prostate it should be taken from,” explained Bathen.

“The PROVIZ project started as early as 2018. It takes a long time to develop diagnostic tools in medicine because safety standards must be high. The application alone to be allowed to test the tool on patients was 500 pages. It is important to create a tool that clearly shows how the result was reached, and that fits into a busy hospital workday,” says Tone Frost Bathen, Professor at NTNU. Photo: Anne Sliper Midling / NTNU

A recent study shows that patients trust medical test results only if an experienced doctor confirms what has been detected.

“Trust in doctors and health professionals is key for artificial intelligence to gain a place in the diagnosis of prostate cancer. Technology alone is not enough. Human contact and professional assessment remain indispensable,” said Simon A. Berger, a PhD research fellow at NTNU.

Prostate cancer is a natural part of getting older

Prostate cancer is the most common form of cancer among men in Western countries.

Examinations have detected prostate cancer in 10% of 50-year-olds, 50% of 60-year-olds and approximately 70% of men over the age of 80.

This shows that the disease is naturally linked to ageing.

“Prostate cancer is something most men die with, not from,” added Berger.

A blood test called PSA can help detect prostate cancer. Since it has become more common for men to take this blood test, the number of new prostate cancer cases has risen sharply. There are now approximately 5000 new cases each year.

When more people are tested for something that many individuals naturally have as part of the ageing process, the next medical step after the blood test must also be carried out more often, so that doctors can obtain a broader clinical picture of its severity.

Most trust in doctors

Currently, this next step involves taking an MRI scan, which provides a detailed image of the prostate gland and the surrounding tissue. These images need to be interpreted manually by an experienced radiologist. As the number of images taken has increased sharply, this has created a need for new and more efficient ways of making diagnoses.

Through the PROVIZ project, NTNU researchers have developed an AI-powered tool that can help doctors interpret MRI images of the prostate. PROVIZ is currently available only for use as part of the ongoing research project, but efforts are underway to apply for a patent and make the tool commercially available.

High international competition for commercial AI tools

Several research groups around the world are now working on developing AI-based diagnostic tools for prostate cancer.

PROVIZ has completed its first clinical testing in collaboration with St. Olavs Hospital, and the results were good. The next step is a much larger clinical trial, as well as a regulatory approval process.

“Right now, we are seeking approximately 20 million NOK to finance this phase. Once funding is in place, the tool could be on the market in the US within a year, and in Europe in just over a year,” says Gabriel Addio Nketiah, a researcher at NTNU and responsible for the commercialisation of PROVIZ.

For a tool like this to be efficiency-enhancing in routine hospital practice, patients must also trust the findings detected through the use of AI.

“Patients have high expectations that AI can be used for faster diagnostics and to reduce healthcare waiting lists. Many see AI as a kind of safety valve – an additional resource that doctors can use alongside their professional judgment,” says Simon A. Berger, a PhD research fellow at NTNU.

Berger interviewed 18 men who had been diagnosed with prostate cancer through the use of PROVIZ. The study shows that trust in doctors and health professionals plays a decisive role in whether patients accept AI in the health services.

“Patients trust AI in lower-risk cases such as bone fractures, but not in cases where the perceived risk is higher, such as cancer. When the perceived risk is high, we place the greatest trust in specialized doctors who can confirm what AI has found,” explained Berger.

Doctors as guarantors

In his interviews, Berger identified three different dimensions of trust.

  1. Foundational trust in the healthcare system: many patients had positive experiences from previous encounters with the healthcare system. This laid a positive foundation.
  2. Inter-personal trust in health professionals: patients trusted the doctors and their assessments. This trust was crucial for accepting AI because the doctors explained and vouched for the technology.
  3. Possible trust in AI: even though patients recognized the potential of AI, they always wanted a human assessment as well in prostate cancer diagnostics. They were concerned about accountability, professional judgement and AI’s (in)ability to see the whole clinical picture.

“The relationship between patient and doctor is still key. For AI to be accepted in clinical practice, health professionals must be active communicators and guarantors of safety. In order for doctors to serve as guarantors, they must first understand how AI arrived at its conclusions so they can verify that it has made the correct assessment. Patients accept the use of AI within a framework they already trust,” concluded Berger.

NTNU owns an MRI scanner at St. Olavs Hospital that is currently undergoing a major upgrade. It helps researchers obtain the best possible images to be used in, among other things, PROVIZ. “Unfortunately, there are few investors in medical technology right now, but we hope that someone sees the societal value of our project,” says Professor Tone Frost Bathen at NTNU. Photo: Anne Sliper Midling / NTNU

By Anne Sliper Midling

Source:

Berger SA, Håland E, Solbjør M. Patient Perspectives on Trust in Artificial Intelligence-Powered Tools in Prostate Cancer Diagnostics. Qualitative Health Research. 2025;0(0). doi:10.1177/10497323251387545

Source: Norwegian Tech News

Categories : Cancer Surgeries & ProceduresTags :

Novel Laser Therapy Device Shows Promise in Prostate Cancer Clinical Trial

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Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

Because treatment of the whole prostate can lead to long-term side effects in patients with prostate cancer, interest in minimally invasive, focal treatment options has been growing for certain patients. A clinical trial published in BJU International generated promising results for a type of focal therapy, which directly targets the cancer and spares the remainder of the unaffected prostate gland.

The ProFocal Laser Therapy for Prostate Tissue Ablation (PFLT-PC) trial is the first pivotal trial of ProFocal®, a novel, cooled laser focal therapy device for prostate cancer treatment.

In the 100-participant trial, 84% of patients had no clinically significant prostate cancer on their 3-month post-treatment biopsy. The treatment provided similar cancer-related outcomes to those that have been reported for other focal therapy devices, but with an improved safety profile and low rates of incontinence.

“This new technology is very promising with excellent cancer control while preserving patients’ quality of life,” said corresponding author Jonathan Kam, MD, of Nepean Hospital, in Australia. “Traditional radical prostatectomy and radiotherapy for prostate cancer results in very high rates of incontinence and erectile dysfunction. With this new technology, patients can have their prostate cancer treated with very low risk of suffering the side effects associated with traditional prostate cancer treatments.”

Source: Wiley

Categories : CancerTags :

Strong Evidence for Effectiveness of Metastasis-directed Radiotherapy in Prostate Cancer

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Photo by Jo McNamara

Metastasis-directed therapy (MDT) significantly improved outcomes in patients with oligometastatic prostate cancer, according to a new study from researchers at The University of Texas MD Anderson Cancer Center published today in Lancet Oncology.

The study is a first-of-its-kind meta-analysis of individual patients across all available randomised clinical trials evaluating the addition of metastasis-directed radiation therapy to standard-of-care treatment.

According to corresponding author Chad Tang, MD, associate professor of Genitourinary Radiation Oncology, gathering level one evidence of the benefits of MDT in this cancer type has been a challenge due to several factors. Most significant among them are that only a small number of patients have oligometastatic cancer – meaning they have multiple metastases but not enough to be considered widely metastatic – and the relative indolence of oligometastatic disease.

“If we can identify and treat this disease in the narrow window before it spreads too far, we know that patient outcomes are significantly better. But gathering this data is difficult,” Tang said. “By bringing together all available patient data from randomized clinical trials, we have provided the best evidence to date that MDT improves patient outcomes.”

What is MDT and what is the significance of this study on oligometastatic prostate cancer?

Broadly, MDT can include multiple treatment approaches. In this setting, the most common form of MDT is radiation therapy, which targets metastases at a stage when cancer has begun to spread but hasn’t yet spread widely. This approach potentially brings several benefits to patients, such as delaying the time to progression and limiting the need for more aggressive therapies that will further impact quality of life.

The most common form of MDT is stereotactic body radiation therapy (SBRT), a type of very precise radiation therapy. In previous studies, like the Phase II EXTEND trial presented in 2024, MDT significantly improved progression-free survival (PFS). 

These and similar findings have led to widespread adoption of MDT in the oligometastatic setting, despite the lack of level one evidence.

To try and address that lack of data, researchers from several institutions created a global consortium, known as X-MET, to gather the data from all randomized trials for analysis at MD Anderson. Individual patient data from seven trials were ultimately included in this meta-analysis, known as WOLVERINE.

What were the results of the study?

This study, which included 574 men, showed a significant benefit for the patients receiving the MDT arm in PFS, radiographic PFS, and castration resistance-free survival.

Patients in the MDT arm gained a median of 7.6 months before disease progression, 4.9 months before radiographic disease progression, and 2.5 months before developing castration-resistance disease, compared to patients receiving standard of care alone. These findings were consistent across the individual trials and in the aggregated data.

Additionally, there were no significant differences in safety between the treatment arms. No grade five toxicities were observed in either arm, and any adverse effects above grade two were similar between the two arms.

“We hope that this dataset will lay the groundwork for future Phase III trials, which hopefully will show an overall survival benefit for these patients,” Tang said. “However, what this data does already show is the best evidence to date that MDT significantly benefits patients without adding any notable safety risks.”

Source: The University of Texas MD Anderson Cancer Center

Categories : CancerTags :

Many Men May Not Need Long-term Hormone Therapy for Prostate Cancer

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cancer 1
Wild type human prostate cells from an organoid. Credit: National Cancer Institute, National Institutes of Health

A study co-led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center found that most of the benefits of androgen deprivation therapy (ADT) for prostate cancer occur within the first 9 to 12 months. Extending therapy beyond that provides only a small additional protection and increases the risk of other health problems, such as heart or metabolic issues. Results show that the ideal length of ADT depends on cancer risk:

  • Low-risk patients may not need ADT.
  • Intermediate-risk patients benefit most from 6 to 12 months.
  • High-risk patients may benefit from up to 12 months, while very high-risk patients may require longer therapy.

The study was published in the journal JAMA Oncology. 

ADT is a type of hormone therapy that is commonly given alongside radiation to slow the growth of prostate cancer by lowering testosterone. While effective at controlling the disease, long-term ADT can cause side effects, including bone loss, muscle loss and cardiovascular problems. Current treatment guidelines generally recommend 4 to 6 months of ADT for intermediate-risk patients and 18 to 36 months for high-risk patients, but the optimal duration has been unclear.

Researchers conducted a Meta-Analysis of Randomized Trials in Cancer of the Prostate (MARCAP) Consortium using data from 10 266 men across 13 international clinical trials. They assessed outcomes including overall survival, cancer-specific survival and deaths from other causes, comparing different ADT durations. 

The findings highlight the importance of personalised treatment plans for men with prostate cancer. Shorter courses of hormone therapy may be sufficient for many patients, reducing side effects while maintaining effectiveness. Physicians can now use patient-specific factors, including cancer risk, overall health, age and preferences, to make more informed decisions about ADT duration, improving both safety and quality of life.

Source: University of California – Los Angeles

Categories : CancerTags :

Drug Combo Cuts Risk of Death in Advanced Prostate Cancer by 40%

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Cedars-Sinai Led Clinical trial showed combo treatment reduced deaths in patients with an aggressive form of the disease

Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

Men whose prostate cancer returns after surgery or radiation therapy may now benefit from a new drug combination shown in clinical trials to cut the risk of death by more than 40%.

The combination therapy, which adds the drug enzalutamide to commonly prescribed hormone therapy, reduced deaths in patients with recurrent prostate cancer after surgery or radiation for whom other treatments are no longer an option. The trial results were published in The New England Journal of Medicine (NEJM) with simultaneous presentation during the European Society for Medical Oncology Congress (ESMO) Oct. 19 in Berlin.

“After initial treatment, some patients see their prostate cancer come back in an aggressive way and are at risk for their disease to spread quickly,” said Stephen Freedland, MD, director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Cancer and co-principal investigator of the study. “Hormone therapy, which is what we’ve been offering patients for 30 years, has not improved survival and neither has anything else. That makes these findings a real game changer.”

The trial included more than 1000 patients from 244 sites in 17 countries. All the patients were diagnosed with what is known as high-risk biochemically recurrent prostate cancer. Following the patients’ surgery or radiation therapy, the levels of prostate specific antigen, or PSA, in their blood had risen rapidly. PSA is a protein used to detect prostate cancer, and a rapid rise in PSA levels after treatment indicates a patient’s cancer is likely to return and metastasise, often to the bones or spine.

“We know these patients are at high risk of developing metastatic disease and dying of their cancer unless we offer a meaningful treatment option,” said Freedland, professor of Urology and the Warschaw, Robertson, Law Families Chair in Prostate Cancer.

Patients were randomly selected to receive standard hormone therapy alone, enzalutamide alone, or a combination of the two. After eight years, the risk of death was 40.3% lower in the combination group than in the other two groups, Freedland said.

“This clinical trial, one of many that Cedars-Sinai Cancer has offered to its patients, is an example of the translational work being done by our physician-scientists,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “The result will be improved treatment and better outcomes for patients everywhere.”

Freedland noted that, based on previous results published by the team, enzalutamide is approved by the Food and Drug Administration and listed in National Comprehensive Cancer Network treatment guidelines. These latest results, he said, are likely to strengthen the network’s recommendation and solidify this drug combination as the standard of care for patients with high-risk biochemically recurrent prostate cancer.

“These important findings identify a treatment that prolongs survival in men with aggressive prostate cancer,” said Hyung Kim, MD, a urologic oncologist and chair of the Department of Urology at Cedars-Sinai.  “The latest analysis complements previous studies that found enzalutamide significantly improved survival in other prostate cancer settings, and will change how we take care of our patients.”

Source: Cedars-Sinai Medical Center

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Good Prognosis for Men with Prostate Cancer Treated According to Guidelines

On By ModernMedia
Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

Most men who are treated for prostate cancer according to modern guidelines have good survival rates and the majority of these men will die of causes other than prostate cancer. This is revealed in a new study from Uppsala University published in the Journal of the National Comprehensive Cancer Network.

“We were surprised by how much life expectancy affected the prognosis. This shows the importance of a thorough assessment of the general health of a man with newly diagnosed prostate cancer. The patient’s life expectancy has a substantial impact on the choice of appropriate treatment strategy,” says Marcus Westerberg, researcher at the Department of Surgical Sciences at Uppsala University, who led the study.

In prostate cancer, the disease progression often takes decades and the risk of dying from prostate cancer therefore depends on both the characteristics of the cancer and life expectancy based on the man’s age and other diseases at the time of diagnosis. Recommendations in guidelines and care programmes are therefore also based on both cancer characteristics and life expectancy. This means that the recommended initial treatment can range from active monitoring for low-risk cancer to combinations of local and systemic treatment for high-risk cancer.

High average age at disease onset

As the average age at diagnosis of prostate cancer is often high and the cancer often progresses very slowly, it is particularly important to know the long-term risk of death from prostate cancer in order to choose the best treatment for patients. Previously, not much has been known about this.

“We wanted to fill that knowledge gap, so we looked at outcomes up to 30 years after the men were diagnosed. In all cases, we had information about the characteristics of the cancer, treatment and the patient’s life expectancy based on age and comorbidity,” says Westerberg.

The researchers used data from the Prostate Cancer Database Sweden (PCBase), which contains information from the National Prostate Cancer Register (NPCR) and other health data registers. They focused on men who had received the recommended treatment for prostate cancer that had not spread in the body. Using statistical modelling, the researchers estimated the lifetime risk of dying from prostate cancer and other causes.

11 per cent risk of dying of cancer

For men with low-risk cancer and short life expectancy (less than 10 years), the risk of dying from prostate cancer was 11% and the risk of dying from other causes was 89% within 30 years of diagnosis.

For men with high-risk cancer (eg stage T3, PSA 30ng/mL and Gleason score 8) and long life expectancy (over 15 years), the risk of dying from prostate cancer was 34% and the risk of dying from other causes was 55% within 30 years of diagnosis.

“We hope that our results will be used to provide a realistic picture of the prognosis for men with prostate cancer. Our study shows that most men who receive the recommended treatment have a good prognosis,” Westerberg concludes.

Life expectancy was based on age and comorbidity. Examples of low-risk cancers are stage T1, PSA 5ng/mL and Gleason score 6. Examples of high-risk cancers are stage T3, PSA 30ng/mL and Gleason score 8.

Source: Uppsala University