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Treatment Side Effects, Quality Of Life Factors In Prostate Cancer
It's crucial for patients with prostate cancer to know that all treatments come with side effects, which may affect their quality of life.
Dr. Tyler M. Seibert spoke to patients with prostate cancer to discuss quality of life factors, such as sexual functioning during treatment.
Treatment options for patients with localized prostate cancer depend on how aggressive the cancer is, which opens conversations about quality of life.
At the CURE® Educated Patient® Prostate Cancer Summit, Dr. Tyler M. Seibert spoke to patients with prostate cancer about quality-of-life factors, such as sexual functioning, as they pertain to treatment options.
GlossaryLocalized prostate cancer: cancer only in the prostate; has not spread.
Prostatectomy: a surgical procedure to partially or fully remove the prostate.
Urinary incontinence: involuntary leakage of urine.
Seibert is an associate professor in the Division of Radiation Oncology at the University of California San Diego.
"When I was trained to treat prostate cancer, we said a lot of things that turned out to be somewhat inaccurate, and it was because we didn't really have the data to answer the right questions," Seibert explained. "So we used to say, for example, that sexual function was much worse after radiation. I'm not saying that there's no impact, but what we were looking at was really large studies."
However, he emphasized that focusing on this kind of data wasn't necessarily accurate for patients in the real world. Seibert noted that there were some problems with this approach. For example, surgery would be the go-to treatment option for men who were younger, had lower-risk prostate cancer and did not smoke. Men who had heart disease and were at risk for surgery tended to receive radiation, Seibert explained.
Treatment Approaches for Patients With Prostate CancerA common treatment option for patients with localized prostate cancer is active surveillance, said Seibert. This treatment approach is when doctors closely monitor the prostate cancer without providing treatments during this time, according to the Mayo Clinic.
"The first question is, is active surveillance safe? If there's one thing I want everybody to understand is that it is very safe for the right patients," he explained. "But it must be active, so you can't just ignore the cancer and go away. You have to be monitored because most of these patients eventually need treatment, but they had years of no treatment."
READ MORE: Next-Generation Imaging a 'Gold Standard' in Metastatic Prostate Cancer
Other treatment approaches, including prostatectomy and radiation therapy, may also be considered. Both approaches are "highly effective" at "getting rid of the prostate cancer," Seibert clarified.
"They're equivalent — it doesn't really matter [which approach is used]," he explained. "I know this is a stressful decision, but you can't really go too wrong because they're both going to be effective."
Nonetheless, some patients with higher-risk prostate cancer may require both surgery and then radiation, Seibert said, but "it's important to assess that risk." He emphasized that patients who may require this should talk to their doctors about their chance of needing radiation because the "side effects are worse if you need both."
When considering the side effects associated with prostate cancer treatment, it's important to note that some treatments may cause fewer side effects. However, "no therapy has no side effects," Seibert explained.
Of note, Seibert described some of the common side effects that affect quality of life after surgery, radiation or both for patients with prostate cancer. These included urinary incontinence, waking up at night to urinate more than twice and changes in sexual functioning.
Urinary incontinence is a side effect that may occur after surgery or radiation, but more patients with prostate cancer who undergo surgery may need to wear a pad than those who underwent radiation, Seibert said.
Waking up at night to urinate two or more times is a side effect more patients may experience after undergoing radiation versus surgery in the long term. In a study published in The New England Journal of Medicine, patients with prostate cancer were more likely to experience this side effect during the first year since receiving treatment. At around six months, the side effect peaked, but became better after one year, the study showed.
Changes in sexual functioning were another common side effect experienced by patients who underwent prostate cancer treatment. Seibert noted that sexual functioning is better one year after treatment versus after six years in patients who received radiation versus surgery.
"I [want to] remind you that 12 years out, a lot of these patients are in their 80s. Even [patients who received] active monitoring eventually got treatment," Seibert said. "But they're declining in terms of sexual function over time."
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Could A Pro-oxidant Supplement Help Slow Down Prostate Cancer Progression?
A pro-oxidant supplement may offer a uniquely effective means of targeting and killing prostate cancer cells, according to a new study in mice conducted at Cold Springs Harbor Laboratory (CSHL) in Cold Spring, NY.
The authors of the study — which appears in Science — found that the supplement, menadione, a precursor of vitamin K, significantly suppressed cancer growth in mice and in more than 100 human cells and mouse cancer cells in the laboratory.
It appears menadione inhibits a lipid, phosphatidylinositol 3-phosphate (PI(3)P), that allows cells to identify, sort, and correctly process incoming materials. Unable to do so, the cancer cells become overwhelmed, causing them to explode and die.
"It's like a transport hub, like JFK [airport]," study author Lloyd Trotman, PhD, professor and Cancer Center Deputy Director of Education at CSHL, noted in a press release. "If everything that goes in is immediately de-identified, nobody knows where the airplanes should go next. New stuff keeps coming in, and the hub starts to swell. This ultimately leads to the cell bursting."
This prostate cancer cell death provides a more definitive resolution of the disease than current treatments, such as radiation, that force prostate cancer into dormancy, from which it may at some point develop resistance.
The researchers also discovered that a relative excess of PI(3)P is a cause of a fatal genetic muscle disease, X-linked myotubular myopathy.
Menadione administration in mice bred with X-linked myotubular myopathy suggested menadione should be further investigated as a treatment for this disease.
Molecules that cause oxidation in the body are called oxidants. Oxidation reactions in the body can lead to free radicals, which are made during many processes, including inflammation, stress, and aging.
Oxidants serve valuable roles such as disposing of no longer needed cells and germs, and can help fight pathogens. Oxidants are kept in check by antioxidants the body produces.
When there are too many oxidants relative to antioxidants, oxidative stress occurs, and damage to healthy cells may result, leading to cancers and various chronic diseases.
During aging, the body makes fewer antioxidants. Fortunately, antioxidants are available in many foods and in supplements.
The trial was halted three years into the planned 12-year study period when it was observed that antioxidant intake was associated with an increase in prostate cancer rather than a reduction, and participants were instructed to cease taking the antioxidants.
"Despite the initial failure of selenium and vitamin E, oxidation remains an active area of investigation," oncologist and hematologist Daniel Landau, MD, medical director of virtual hematology at the Medical University of South Carolina in Charleston, who was not involved in the recent study, told Medical News Today.
The authors of the new study decided to explore the other side of the oxidation coin: What about pro-oxidants? They devised the new trials using menadione in which the vitamin K precursor would provide a pro-oxidant effect.
"One of the concerns with therapies that affect oxidation is that some cells do better with antioxidation and some with pro-oxidation," Landau pointed out. "Therefore, selective targeting of cancer cells is important."
"This is not yet something that we are able to do with most systemic therapies. However, antibody drug conjugates do exist, which can control which cells are targeted. Perhaps that is why earlier oxidation studies failed," he suggested. "We couldn't selectively target the cells of interest."
With menadione, this problem may be solved due to the nature of prostate cancer cells' natural deficiency of PI(3)P.
While healthy cells have enough of this lipid to overcome the inhibitory effect of menadione, prostate cancer cells do not, and thus are more grievously impacted by its reduction.
Furthermore, Trotman told MNT that when prostate cancer cells burst, there is no risk of cancer spreading "since any bursting of a cell is a terminal death event; there is no expectation of metastasis."
"Metastasis requires very fit cells that migrate out of tissues intact," he explained.
Side effects of menadione are not a concern, according to Trotman, who noted that:
"It was developed as a trigger for vitamin K production since it is the immediate precursor of that vitamin. Vitamin K is essential for blood clotting."
"Side effects are hardly seen when administered orally. It is often used in animal feed as a source for vitamin K," he also added.
As for "side effects of tissue damage", these only occur "upon high dose injections into animals," Trotman noted. "Our study only uses oral menadione delivery."
"While it is true that most prostate cancers are slow-growing cancers, we often fall short on options for patients with advanced disease who are expected to live for a long period of time," Landau admitted.
Explaining who might benefit the most from supplementation with menadione, Trotman said that: "We would see this primarily for patients who are under surveillance for progression of prostate cancer.
"Patient surveillance is either watchful waiting (minimal invasive testing) or active surveillance (repeated diagnostic testing)," he noted.
"In prostate cancer this would be a diagnosis of Gleason Grade 7, which is a grey zone between indolent (Gleason 6- left alone) and aggressive (Gleason 8-10, intervention needed)," Trotman explained.
"[W]hile at this time, oxidation is not a practical approach to care, we do require newer and novel therapies. Especially ones with low side effect profiles," Landau said. "There is hope from studies like this one that a new option may be on the horizon."
Highly Targeted Prostate Cancer Treatment Causes Fewer Side Effects, Study Finds
There's fresh information for prostate cancer patients and their doctors to consider when making treatment decisions.
A UK study has found those treated with a highly targeted type of radiotherapy appear to have fewer problems with two major side effects, compared with those who have surgery.
Auckland Radiation Oncologist Associate Professor Giuseppe Sasso says the treatment is also more convenient compared to conventional radiation.
He says it's able to take care of their disease with five appointments, rather than a four week, Monday to Friday course of radiation.
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