Improving the Diagnosis of Prostate Cancer

Improving the Diagnosis of Prostate Cancer | The University of York Centre for Health Economics

In diagnosing prostate cancer, the objective is to find the men with clinically significant prostate cancer, who are at high risk of metastases and who benefit the most from immediate treatment.

This economic evaluation examines a model which simulates the long-term costs and health consequences of immediate diagnosis and treatment compared with monitoring. By linking the diagnosis outcomes with the long-term costs and consequences, the model evaluates the costs and health consequences of the different diagnosis strategies over the patients’ expected lifetime.

Full document: Improving the diagnosis of prostate cancer

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Protocol: mHealth innovation for early detection of patient-reported symptom distress

Cancer patients are predominantly treated as out-patients and as they often experience difficult symptoms and side effects it is important to facilitate and improve patient-clinician communication to support symptom management and self-care | BMC Cancer

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Background: Although the number of projects within supportive cancer care evaluating mobile health is increasing, few evidence-based interventions are described in the literature and thus there is a need for good quality clinical studies with a randomised design and sufficient power to guide future implementations. An interactive information and communications technology platform, including a smartphone/computer tablet app for reporting symptoms during cancer treatment was created in collaboration with a company specialising in health care management. The aim of this paper is to evaluate the effects of using the platform for patients with breast cancer during neo adjuvant chemotherapy treatment and patients with locally advanced prostate cancer during curative radiotherapy treatment. The main hypothesis is that the use of the platform will improve clinical management, reduce costs, and promote safe and participatory care.

Method: The study is a prospective, randomised, controlled trial for each patient group and it is based on repeated measurements. Patients are consecutively included and randomised. The intervention groups report symptoms via the app daily, during treatment and up to three weeks after end of treatment, as a complement to standard care. Patients in the control groups receive standard care alone. Outcomes targeted are symptom burden, quality of life, health literacy (capacity to understand and communicate health needs and promote healthy behaviours), disease progress and health care costs. Data will be collected before and after treatment by questionnaires, registers, medical records and biomarkers. Lastly, participants will be interviewed about participatory and meaningful care.

Discussion: Results will generate knowledge to enhance understanding about how to develop person-centred care using mobile technology. Supporting patients’ involvement in their care to identify problems early, promotes more timely initiation of necessary treatment. This can benefit patients treated outside the hospital setting in regard to maintaining their safety.

Full reference: Langius-Eklöf, A. et al. (2017) Effects of an interactive mHealth innovation for early detection of patient-reported symptom distress with focus on participatory care: protocol for a study based on prospective, randomised, controlled trials in patients with prostate and breast cancer. BMC Cancer. 17:466

The Diagnosis and Treatment of Prostate Cancer

This review details recent advances in the diagnosis and treatment of prostate cancer which have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference.

Abstract

Prostate cancer is the most common cancer diagnosis made in men with more than 160 000 new cases each year in the United States. Although it often has an indolent course, prostate cancer remains the third-leading cause of cancer death in men.

When prostate cancer is suspected, tissue biopsy remains the standard of care for diagnosis. However, the identification and characterization of the disease have become increasingly precise through improved risk stratification and advances in magnetic resonance and functional imaging, as well as from the emergence of biomarkers. Multiple management options now exist for men diagnosed with prostate cancer. Active surveillance (the serial monitoring for disease progression with the intent to cure) appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer, particularly those with a prostate-specific antigen level of less than 10 ng/mL and Gleason score 3 + 3 tumors. Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life. For metastatic disease, chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone. New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference. Initial treatment with chemotherapy can improve survival compared with androgen deprivation therapy. Abiraterone, enzalutamide, and other agents can improve outcomes in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Full reference: The Diagnosis and Treatment of Prostate Cancer  | Mark S. Litwin, & Hung-Jui Tan | JAMA. 2017;317(24):2532-2542

Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer

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Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Men dangerously unaware of family link to prostate cancer

Two-thirds of men with a family history of prostate cancer are dangerously unaware of their increased risk of the disease and half of all UK men don’t know that a family link makes you two-and-a-half times more likely to get it, according to new research by Prostate Cancer UK.

It’s prompted urgent calls from the charity for men and their families to have a potentially life-saving talk about the disease with their relatives and doctor. Especially since an accompanying study  showed that only 1-in-10 GPs are likely to always ask a man whether any close relatives have had the disease. Although where men did take the lead and initiate a discussion with their doctor, it found their experiences were overwhelmingly positive.

Interactive prostate cancer guides

Prostate Cancer UK has launched interactive online guides relating to prostate cancer.  The guides are intended to support men who have symptoms or side effects from prostate cancer, prostatitis or their treatments.  Topics range from dealing with fatigue or urinary problems, to managing sex and relationships. The guides are interactive so tools and information can be tailored to the individual.

Starving prostate cancer with what you eat: Apple peels, red grapes, turmeric

New research from The University of Texas at Austin identifies several natural compounds found in food, including turmeric, apple peels and red grapes, as key ingredients that could thwart the growth of prostate cancer | ScienceDaily

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The new paper uses a novel analytical approach to screen numerous plant-based chemicals instead of testing a single agent as many studies do, discovering specific combinations that shrink prostate cancer tumors.

The researchers first tested 142 natural compounds on mouse and human cell lines to see which inhibited prostate cancer cell growth when administered alone or in combination with another nutrient. The most promising active ingredients were then tested on model animals: ursolic acid, a waxy natural chemical found in apple peels and rosemary; curcumin, the bright yellow plant compound in turmeric; and resveratrol, a natural compound common to red grapes or berries.