prostate cancer

Prostate Cancer Diagnosis? Eat Less Omega-6 fats and More Omega-3 fats

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To determine whether diet or supplements can play a role in managing prostate cancer, the UCLA-led team conducted a prospective clinical trial, called CAPFISH-3, that included 100 men with low risk or favorable intermediate risk prostate cancer who chose active surveillance. Participants were randomly assigned to either continue their normal diet or follow a low omega-6, high omega-3 diet, supplemented with fish oil, for one year.

The findings, published in the Journal of Clinical Oncology, show that a diet low in omega-6 and high in omega-3 fatty acids, combined with fish oil supplements, significantly reduced the growth rate of prostate cancer cells in men with early-stage disease.

University of California – Los Angeles Health Sciences. “A low omega-6, omega-3 rich diet and fish oil may slow prostate cancer growth.” ScienceDaily. http://www.sciencedaily.com/releases/2024/12/241213211326.htm (accessed December 13, 2024)

Another reminder I should get my PSA level checked.

Prostate Cancer Diagnosis? Eat More Veggies

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In this cohort study of 2062 men with prostate cancer, higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression. These findings suggest nutritional assessment and counseling may be recommended to patients with prostate cancer to help establish healthy dietary practices and support well-being and overall health. Plant-Based Diets and Disease Progression in Men With Prostate Cancer – https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818122

This reminds me I should get my PSA level checked at my next annual visit.

Last reading was 0.64 back in 2022.

Multifocal Positive Margins After Prostate Cancer Surgery

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In Cox multivariable analyses, compared with negative surgical margins, positive surgical margins were significantly associated with a 1.7- and 2.2-fold increased risk of cancer-specific and all-cause mortality, respectively, in patients with intermediate-risk and high-risk disease, respectively, Ugo Giovanni Falagario, MD, of Karolinska Institute in Stockholm, Sweden, and colleagues reported in European Urology Oncology. Positive surgical margins were also significantly associated with a 1.8-fold increased risk of adverse pathologic characteristics, including Grade group 4 or higher, pT3 or higher, pN1, or PSA persistence. Multifocal Positive Margins After Prostate Cancer Surgery Up Mortality Risks – https://www.renalandurologynews.com/news/multifocal-positive-margins-after-prostate-cancer-surgery-up-mortality-risks/

Reference:

Pellegrino F, Falagario UG, Knipper S, et al; ERUS Scientific Working Group on Prostate Cancer of the European Association of Urology. Assessing the impact of positive surgical margins on mortality in patients who underwent robotic radical prostatectomy: 20 Years’ report from the EAU Robotic Urology Section Scientific Working Group. Eur Urol Oncol. 2024 Aug;7(4):888-896. doi:10.1016/j.euo.2023.11.021

New Blood Test Improves Prostate Cancer Screening – the Stockholm3 test

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On July 9 2021, results from the STHLM3MRI study were presented in The New England Journal of Medicine, indicating that over-diagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in The Lancet Oncology, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyze a combination of protein markers, genetic markers and clinical data.

Karolinska Institutet. “New blood test improves prostate cancer screening.” ScienceDaily. http://www.sciencedaily.com/releases/2021/08/210813100313.htm (accessed August 14, 2021).

NCI Study: MRI of the Prostate Misses Cancers

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About 16% of lesions were missed, and approximately 5% of clinically important prostate cancers (>5 mm, Gleason score > 3+3) were underestimated on MP MRI, according to Baris Turkbey, MD, of the Molecular Imaging Program at the National Cancer Institute in Bethesda, Maryland, and colleagues. Overall, prostate cancer size was underestimated by at least 30% in eight (8%) of 100 patients. Their study was published online October 20 in Radiology.

Source: NCI Study: MRI of the Prostate Misses Cancers

Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement – ASCO Institute For Quality

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Published online before print February 16, 2016, DOI: 10.1200/JCO.2015.65.7759 Ronald C. Chen, R. Bryan Rumble, D. Andrew Loblaw, Antonio Finelli, Behfar Ehdaie, Matthew R. Cooperberg, Scott C. Morgan, Scott Tyldesley, John J. Haluschak, Winston Tan, Stewart Justman, and Suneil Jain

Source: Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement | ASCO Institute For Quality

Fish oil and prostate cancer: Go beyond the headlines

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The new study shows an association between higher blood levels of omega-3 and prostate cancer incidence, nothing more. Despite the inclination to burn them in effigy, the authors themselves claimed nothing more than that. Specific assertions about fish oil supplements are products of media distortion, a problem that routinely bedevils the delivery of medical news — and an issue my next column will show to be a life-and-death concern for us all.

via Fish oil and prostate cancer: Go beyond the headlines.

Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM

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These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA’s limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.

via Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM.

Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening — NEJM.

I realize today is the day after Thanksgiving and I’m working.  But medicine never stops and a life underwriter has to do what a life underwriter does on her day off.  Read medical journals!  Check out these articles from NEJM.  Time to change our PSA underwriting guidelines?  I think so.  Call me if you need help with this.  I have a mortgage, one undergraduate, and one medical student to support.

Speaking of the medical student I was trapped this Thanksgiving in the car and listened to over five hours of lectures on neurology and hematology during the ride.  To tell the truth, I enjoyed the lectures.

Medicine never takes a day off nor do expert life underwriters.