Cancer cachexia as a multiorgan failure: Reconstruction of the crime scene

Researchers Question The Use Of "cancer" For Certain Prostate Conditions

A new paper in the Journal of the National Cancer Institute, published by Oxford University Press, indicates that patients may benefit if doctors stop calling certain early-stage changes to the prostate "cancer" at all.

Prostate cancer is the second leading cause of cancer death worldwide in men, but far more patients are diagnosed than die of the disease. In 2022, there were nearly 1.5 million cases of prostate cancer, but only 400,000 deaths. Low-grade prostate cancer, commonly known as GG1 among physicians, virtually never metastasizes or causes symptoms. Some medical researchers have wondered recently if it would be a benefit to public health to call GG1 something other than cancer.

To further this discussion, researchers convened an international symposium with participants from multiple fields, including patient advocacy. Key considerations included the very high rate of GG1 detectable on autopsy studies, the focus of contemporary diagnostic tests on detecting higher grade cancers, the benefits of relegating GG1 to something more like "incidentaloma" status, the adverse health effects of overtreatment, and the psychological burden of a cancer diagnosis for patients.

Those who convened at the meeting emphasized that while GG1is common among older men, it should not be considered normal. Patients with this condition should continue to monitor it with their physicians, according to investigators.

One concern is that patients may not bother to monitor the progression of the condition if their doctor doesn't use the word "cancer" to explain what's going on. Ultimately, those involved in the discussion emphasized, the goal of prostate cancer screening, diagnosis, and treatment is to bring down mortality rates while also reducing the harms of overdiagnosis and overtreatment. Matthew Cooperberg, the principal investigator involved with the symposium, believes that a reconsideration of nomenclature may be a good way to help bring this about.

The word 'cancer' has resonated with patients for millennia as a condition associated with metastasis and mortality."

Matthew Cooperberg, Oxford University Press

"We are now finding exceptionally common cellular changes in the prostate that in some cases presage development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill."

Source:

Journal reference:

Cooperberg, M. R., et al. (2024) When is prostate cancer really cancer? Journal of the National Cancer Institute. doi.Org/10.1093/jnci/djae200.

Maybe We Shouldn't Even Call Low-grade Prostate Cancer "cancer"

A new paper in the Journal of the National Cancer Institute, published by Oxford University Press, indicates that patients may benefit if doctors stop calling certain early-stage changes to the prostate "cancer" at all.

Prostate cancer is the second leading cause of cancer death worldwide in men, but far more patients are diagnosed than die of the disease. In 2022, there were nearly 1.5 million cases of prostate cancer, but only 400,000 deaths. Low-grade prostate cancer, commonly known as GG1 among physicians, virtually never metastasizes or causes symptoms. Some medical researchers have wondered recently if it would be a benefit to public health to call GG1 something other than cancer.

To further this discussion, researchers convened an international symposium with participants from multiple fields, including patient advocacy. Key considerations included the very high rate of GG1 detectable on autopsy studies, the focus of contemporary diagnostic tests on detecting higher grade cancers, the benefits of relegating GG1 to something more like "incidentaloma" status, the adverse health effects of overtreatment, and the psychological burden of a cancer diagnosis for patients.

Those who convened at the meeting emphasized that while GG1is common among older men, it should not be considered normal. Patients with this condition should continue to monitor it with their physicians, according to investigators.

One concern is that patients may not bother to monitor the progression of the condition if their doctor doesn't use the word "cancer" to explain what's going on. Ultimately, those involved in the discussion emphasized, the goal of prostate cancer screening, diagnosis, and treatment is to bring down mortality rates while also reducing the harms of overdiagnosis and overtreatment. Matthew Cooperberg, the principal investigator involved with the symposium, believes that a reconsideration of nomenclature may be a good way to help bring this about.

"The word 'cancer' has resonated with patients for millennia as a condition associated with metastasis and mortality," explained Cooperberg. "We are now finding exceptionally common cellular changes in the prostate that in some cases presage development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill."

The paper, "When is prostate cancer really cancer?" is available (at midnight on October 1st) at https://academic.Oup.Com/jnci/article-lookup/doi/10.1093/jnci/djae200."

Direct correspondence to: Matthew CooperbergDepartments of Urology and Epidemiology & BiostatisticsUniversity of California, San Francisco550 16th St., Box 1695San Francisco, CA 94143matthew.Cooperberg@ucsf.Edu

To request a copy of the paper, please contact:Daniel Luzer daniel.Luzer@oup.Com

Journal

JNCI Journal of the National Cancer Institute

Method of Research

Content analysis

Subject of Research

People

Article Title

When is prostate cancer really cancer?

Article Publication Date

1-Oct-2024

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Why Black Men Are 70% More Likely To Get Prostate Cancer

Prostate cancer is one of the most common cancers affecting men globally. However, when it comes to racial disparities, Black men are disproportionately affected in terms of both diagnosis and mortality. Research shows that Black men are 70 percent more likely to develop prostate cancer compared to other racial groups and are twice as likely to die from it. Understanding the reasons behind this disparity involves looking at both socioeconomic factors and genetic predispositions. Here's what you need to know.

Why Prostate Cancer Disproportionately Affects Black Men Socioeconomic Factors

One of the primary reasons why Black men are more susceptible to prostate cancer is linked to healthcare disparities. Black men often have less access to early screening and timely treatment.

"There are socioeconomic factors. For instance, a recent article showed that Black men typically don't have access to or are not getting screened early enough. And if they do get screened, they may not receive treatment in time," Dr. John Oertle, Chief Medical Officer at Envita Medical Centers, says.

Access to medical care, including regular screenings like PSA (prostate-specific antigen) tests, plays a crucial role in detecting prostate cancer early. Early detection is vital because prostate cancer, when caught in its early stages, is highly treatable. 

Genetic Predisposition

In addition to socio-economic barriers, genetics play a significant role in the disproportionate rates of prostate cancer among Black men. 

"Even if screenings were available earlier, prostate cancer in Black men is often more aggressive. It's been found that certain genetic markers, like the BRCA1 gene mutation, increase the risk of prostate cancer, and not just prostate cancer but also other cancers like pancreatic cancer, breast cancer, and ovarian cancer in women," Dr.Oertle adds.

Studies have shown that Black men are more likely to carry mutations in genes related to testosterone receptors.

"Some genes related to androgen receptors (testosterone receptors) make Black men more susceptible to aggressive prostate cancer. These androgen receptors can enhance cancer growth when overactive," Dr. Oertle notes.

Black men also tend to have higher levels of growth factor receptors and genes associated with inflammation.

"There are also genes associated with inflammatory signaling that have been linked to an increased risk of prostate cancer. All of these genetic factors combined create a heightened risk for more aggressive forms of prostate cancer in Black men," Dr. Oertle shares.

RELATED: Black Men Need Better Prostate Health: This Checklist Can Help

The Importance of Early Screening

The Prostate Cancer Foundation has recently updated its screening guidelines to recommend that Black men begin screening as early as age 40, given their heightened risk. Prostate cancer screening is relatively simple, often involving a PSA blood test and a digital rectal exam. While some men may be hesitant to undergo these exams, early detection is crucial in catching the disease before it becomes life-threatening.

"Early detection provides the best opportunity for a cure. Often, prostate cancer doesn't present symptoms until it's more advanced, which is why screening is so vital. Men sometimes think, 'I won't go to the doctor until something's wrong,' but that's the wrong approach. Symptoms like blood in the urine or pain in the prostate area may appear later, and you don't want to wait for those signs before getting screened," Dr. Oertle notes.

Advancements in Precision Oncology for Prostate Cancer

Precision oncology offers new hope for prostate cancer patients, particularly Black men who are at higher risk for aggressive forms of the disease. Unlike standard cancer treatments, which often follow a one-size-fits-all approach, precision oncology tailors treatment based on an individual's genetic makeup. This personalized approach allows doctors to target the specific genetic mutations driving a patient's cancer, leading to more effective treatments with fewer side effects.

"At Envita, we offer advanced screening methodologies like precision MRI imaging and DNA testing in blood and urine to detect cancer mutations. These methods provide more information before deciding whether a biopsy is necessary. For instance, you might not want to jump straight to a biopsy if your PSA is elevated but not high enough to cause immediate concern. These additional tests offer clarity in those situations," Dr. Oertle shares.

As Dr. Oertle notes, this approach is comforting to men who want to avoid unnecessary biopsies.

RELATED: Not Ready For A Biopsy? Talk To Your Doctor About These 3 Alternatives

"Our goal is to catch cancer early and develop personalized treatment plans based on genetic information. We use various methods, including chemotherapy, immunotherapy, and even off-label medications, to target the cancer's specific genetic profile," Dr. Oertle adds. "When delivering chemotherapy, for example, only about six to seven percent typically reaches the tumor, with the rest circulating through the body and causing side effects. We use interventional radiology to deliver treatments directly to the tumors, using imaging and small catheters to precisely target the cancer."

Environmental Factors and Prostate Cancer Risk

In addition to genetic and healthcare-related factors, environmental factors also play a role in the increased rates of prostate cancer among Black men. Black communities are often located in areas with higher levels of carcinogenic exposure, which can contribute to the development of prostate cancer.

For instance, exposure to certain chemicals in the environment, such as those found in air pollution or contaminated water, can increase the likelihood of gene mutations that lead to cancer. Addressing these environmental factors is a crucial part of reducing the overall risk of prostate cancer in Black men.

Tips for the Newly Diagnosed and Preventative Measures for Prostate Cancer

If you have been newly diagnosed with prostate cancer or are looking for ways to reduce your risk, Dr. Oertle suggests the following.

For Newly Diagnosed Patients:

Seek Comprehensive Evaluations: "For those newly diagnosed with prostate cancer, I recommend contacting specialists who focus on education and comprehensive evaluations, including genetic and immunotherapy assessments. It's crucial to get a full genetic analysis to understand the origins of the prostate cancer," Dr. Oertle says.

Consider Alternatives to Surgery: "Additionally, a common treatment recommendation is the surgical removal of the prostate, often using the Da Vinci robotic procedure to help reduce complications. However, I believe there are better methods than surgery for prostate cancer, even in early stages. Surgery can lead to severe side effects like erectile dysfunction and urinary issues. Instead, I advocate for precision-based treatments such as direct injections of genetically targeted chemotherapies or precision-based radiation treatments," Dr. Oertle says.

Explore Targeted Radiation Therapy: "Radiation can still be very effective for prostate cancer. The key is to minimize collateral damage. It's important to have a doctor who specializes in targeted radiation therapies, such as proton therapy or tomotherapy, which are more precise and limit damage to surrounding tissues. This, combined with a comprehensive program that addresses genetics and underlying causes, is a more favorable approach than simply removing the prostate and dealing with the long-term side effects," Dr. Oertle says.

Comprehensive Treatment Plan: Work with a medical team that can create a treatment plan addressing not only the cancer but also its genetic roots. This approach offers a more holistic and favorable option compared to surgery alone, potentially avoiding long-term complications.

Preventative Measures:

Reduce Exposure to Carcinogens: "Reducing exposure to carcinogens, such as herbicides and pesticides, is essential because they are hormonal disruptors," Dr. Oertle says.

Maintain a Healthy Weight: "Maintaining a healthy weight is also critical—having a BMI over 30 (obesity) is correlated with an increased risk of prostate cancer, as well as other diseases like cardiovascular disease, dementia, and diabetes," Dr. Oertle says.

Exercise Regularly: "Controlling weight through exercise is one of the best preventative measures. If exercise were a drug, it would be the best-selling one on the market because of its numerous health benefits. Regular, low-impact exercises like walking 10,000 steps a day can increase blood flow, reduce inflammation, and help maintain a healthy weight," Dr. Oertle says.

Follow a Healthy Diet: "Additionally, a diet rich in proteins and low in sugars and processed foods supports overall health and reduces cancer risk," Dr. Oertle says.

Control Calorie Intake: "There's also evidence that reducing calorie intake can help lower the risk of cancer development. Overeating and consuming empty calories contribute to weight gain and increased cancer risk. Maintaining a normal BMI through diet and exercise not only benefits prostate health but also improves cardiovascular health, brain function, and overall well-being. A diet with adequate protein supports muscle mass and bone density, which are important for recovery and maintaining energy levels," Dr. Oertle says.

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