Study links cholesterol to prostate cancer

Scientists have discovered the first direct evidence suggesting that high cholesterol levels could be a cause of prostate cancer.

Earlier studies showed that cholesterol-lowering drugs, prescribed to reduce the risk of heart disease, also cut rates of prostate cancer.

But the mechanism of the effect was not clear and study findings had been inconclusive. It was thought that statins might interfere with the growth of the tumour once it was established rather than preventing it from developing.

Now a new study of almost 1300 men with prostate cancer conducted by Italian researchers has found they were 50 per cent more likely to have had high cholesterol levels than a similar number of men without the cancer. Both groups were matched for age and state of health.

No relationship was observed between the cancer and 10 other medical conditions, suggesting the link with cholesterol is a real one.

Cancer charities welcomed the finding, published online in Annals of Oncology, and said it emphasised the importance of eating a healthy diet.

Chris Hiley, head of policy and research at the Prostate Cancer Charity said: "This is very interesting research which may help to explain why prostate cancer is common in the westernised, developed world.

"It also suggests that if men make lifestyle changes and adopt a healthy, low cholesterol diet it might reduce their risk of prostate cancer. Further research is needed to confirm this, but in the meantime the health benefits of a varied diet are indisputable."

The research team, from the Istituto di Ricerche Farmacologiche Mario Negri in Milan, based their findings on data from 1991 and 2002 involving 1,294 men aged 75 and under with prostate cancer.

They found the association between the cancer and high cholesterol levels was strongest in men diagnosed with the disease before the age of 50 or after the age of 65.

Dr Francesca Bravi, lead author of the study, added: "We also found that prostate cancer patients were 26 per cent more likely to have suffered from gallstones than our controls, with an apparently higher relationship in thinner men."

"Although that figure was not statistically significant, gallstones are often related to high cholesterol levels."

M.D. Anderson Cancer Center Seeks Men for Prostate Trial of ‘Watchful Waiting’

Sometimes no treatment is the right option for low-risk prostate cancer these physicians say

Controversy seems to continue on treatment for prostate cancer

The subject of prostate cancer is a hot topic with senior citizens, since about two-thirds of all prostate cancers are found in men age 65 or older. It is also the number one cancer killer of men. What to do about prostate cancer, however, is controversial, according to the National Cancer Institute. Just last month research was released saying older men with early stage prostate cancer survive longer if they are treated, versus not being treated in the "watchful waiting" approach advocated by many physicians. Today, the noted M.D. Anderson Cancer Center is not giving up on "watchful waiting" and is looking for volunteers for further clinical trials.When Houston restaurateur Tony Masraff was diagnosed with early-stage prostate cancer, his life was packed with dancing, running marathons, playing tennis, gardening, leading a successful business and spending time with his family. But it wasn't until his doctor at The University of Texas M. D. Anderson Cancer Center advised "watchful waiting" as an option to invasive surgery and radiation that he realized he could continue his active life – free of treatment side effects, but with the cancer.

Masraff is one of about 200 men diagnosed with low-risk prostate cancer at M. D. Anderson on active surveillance for their disease, having changes monitored through regular Prostate Specific Antigen (PSA) tests, biopsies and check-ups. He also is one of hundreds of thousands of men nationwide who have had their prostate cancer detected by regular PSA tests at such an early stage that managing low-risk disease through surveillance outweighs the risks and possible side effects of treatments.

Now, a new study at M. D. Anderson will follow low-risk patients eligible for watchful waiting to determine if they can avoid or postpone therapy and related side effects, and still live as long as patients who immediately receive invasive therapy. The study will provide key information for the future development of clinical guidelines for watchful waiting.

"With the advent of the PSA test, we see prostate cancer detected much earlier but there is no evidence that early detection means longer survival. Because of the sensitivity of the test, clinically insignificant tumors sometimes are over-diagnosed and patients may, as a consequence, be over-treated with radiation and surgery," said Jeri Kim, M.D., principal investigator of the study and assistant professor in the Department of Genitourinary Medical Oncology at M. D. Anderson.

The study will enroll 650 prostate cancer patients who have been clinically defined either as low risk, or patients with localized prostate cancer who have refused early intervention, or patients with localized cancer who are precluded from therapy due to other serious health conditions. Patients who have had previous treatment for their prostate cancer are not eligible to participate.

Patients will have a biopsy at the beginning of the study to confirm the diagnosis of localized prostate cancer followed by PSA tests and digital rectal exams every six months. The need for additional biopsies will be determined at the end of the first year of surveillance, and participants on the study will be given a transrectal ultrasonography annually to detect any possible changes.

Patients also will be asked to complete a survey on their general health conditions as well as six other short surveys which will be used to monitor diet and behavior as part of related research.

Prostate cancer is one of only a few cancers that can be latent in the body for some time and not require immediate treatment," said Dr. Kim. "Many researchers have documented over the years that men die with their disease rather than from it, and while we need to intervene early, we also need to intervene appropriately with respect to the stage of disease, the man's age, his health in general and quality of life."

The most notable trend in prostate cancer treatment from 1986 to 1999, according to NCI, was the decreasing proportion of cases that received watchful waiting, surgical or chemical castration, or hormonal deprivation therapy as primary treatment. More aggressive treatments, including newer radiation techniques, were found to be on the rise. However, black men were found to receive substantially less aggressive treatment than white men.

Tony Masraff, now 68 years old, preaches "watchful waiting" to men diagnosed with early prostate cancer and has yet to regret not having a more invasive therapy to rid him of the cancer. He is diligent, however, in keeping his appointments and follow-up tests.

"I decided my quality of life was worth more than having a tumor taken out or radiated," said Masraff. "I don't worry about my prostate cancer. I really don't have time to worry about it."

For more information on the watchful waiting study for men with early-stage prostate cancer, call (713) 563-1602.

Weighing decisions about prostate cancer

Men with prostate cancer generally make treatment decisions based on differences in the information they receive rather than their own preferences, according to a new review to be published in the May 1 issue of Cancer, a peer-reviewed journal of the American Cancer Society.

The review findings suggest that a lack of medical evidence and consistent, comprehensive messages about therapeutic options compel men to turn to a wide variety of popular and biased sources that influence their decision. This approach often results in treatments that do not generally reflect patients' goals.

Despite new treatment options for prostate cancer, there is little evidence-based consensus in the oncology community about the most efficacious treatment. Newly diagnosed patients must still balance existing information about risks and benefits of available therapies with their own treatment objectives.

Studies have shown that prostate cancer treatment varies not only among men in general but also by race and ethnicity, suggesting that the guidance patients receive is variable and confusing and plays a part in their decision-making. Steven B. Zeliadt, Ph.D., M.P.H., and his colleagues at the Fred Hutchinson Cancer Center in Seattle synthesized data from other studies to examine how and why men with prostate cancer make treatment decisions.

The review of current literature shows that cancer eradication or control was the foremost objective of treatment for men. Minimizing side effects ultimately played a minor role in decision-making. However, studies report a gap between patient treatment objectives and the evidence supporting the efficacy of the treatment chosen.

Men's concerns about controlling the cancer correlated directly with the aggressiveness of the treatment they chose, regardless of actual disease severity. Yet in choosing treatment, patients did not consistently rely on scientific evidence of a therapy's efficacy to control disease or prolong life. As few as one in four patients in one study relied on evidence of a treatment efficacy for their decision.

Physicians and family, as well as race and culture, may affect patients' decisions, but the degree of their respective influence varies in the literature and is often poorly measured, according to the review. Notably, physicians tended to present therapies in ways that were both confusing and dismissive of patient concerns about risks. This either biased patients' decisions or turned patients to other sources of information.

Finally, studies fail to show how and if patients actually critically analyze the quality of information they receive. It is very likely, the authors added, that patients "have significant limitations in their ability to identify biased information, as well as their ability to weigh complex information about the outcomes that are important to them."

"The perceptions of treatment efficacy related to cancer control far outweigh available supporting evidence, and most patients appear to select a prostate cancer treatment primarily based on its perceived ability to control the tumor," the authors concluded.