Nutrition and prostate cancer: an overview

There is increasing evidence for a link between nutrition, lifestyle and prostate cancer development. There is also growing interest from patients, with significant numbers of men using complementary and alternative medicines, such as vitamins and types of diet. Obesity and metabolic syndrome are important risk factors for prostate cancer and their management is key. The amount and type of fats consumed are also clearly related to prostate cancer risk. Saturated fats and trans fats are identified as having a negative impact. Nutraceuticals and supplements, particularly antioxidants, polyphenols and soy have evidence for benefit for prevention of prostate cancer and progression of the disease. A selection of nutrients is highlighted in this article. Nutritional therapists advise patients on how to incorporate these beneficial nutrients into their diet and guide them on supplement use. Further research is required to elucidate the connection between diet, nutrients and prostate cancer, including the field of nutrigenetics.     

Monotherapy versus combined androgen blockade for advanced/metastatic prostate cancer

In advanced/metastatic prostate cancer, a standard treatment is androgen deprivation therapy, either by surgical castration/LH-RH agonist monotherapy or by combined androgen blockade (CAB) with an antiandrogen. Clinical improvement and survival after CAB with an antiandrogen (instead of monotherapy) has been investigated for 20 years in many randomized clinical trials conducted primarily in Europe and America. However, there were both positive and negative results regarding the efficacy of CAB therapy. Therefore, CAB has neither been recommended as, nor has it become, a common therapy. But, in 2000, a meta-analysis-conducted Prostate Cancer Trialists Collaborative Group (PCTCG)showed the survival benefits of CAB with nonsteroidal antiandrogen (nilutamide and flutamide). Moreover, the J-Cap phase III trial in Japan suggested that CAB with bicalutamide significantly prolongs survival, which has led to the placement of CAB as the treatment of choice for advanced/metastatic prostate cancer. Neverthless, the benefit of CAB compared to monotherapy remains controversial because of the many issues involving survival, safety profiles, QOL, and cost-effectiveness. In this article, we discuss the feasibility of CAB for advanced/metastatic prostate cancer by reviewing the results of RCT, and introduce novel treatment modalities involving androgen and the androgen receptor, which are still under development.     

Monotherapy with carbon ion radiation for localized prostate cancer

BACKGROUND: Radiation treatment for localized prostate cancer has become a prominent choice of monotherapy, and carbon ion beam is a powerful means for this purpose. METHODS: In total, 37 patients with localized prostate cancer were treated by monotherapy with carbon ion radiation and the outcome, more than 4 years later, was followed. RESULTS: PSA relapse-free survival was overall 85%, 5 years after radiation, and 96% in low-risk patients. Local control was mostly achieved, and no cancer-specific death was obtained. Except in cases of relapse, 1.0 ng/ml or less of PSA was shown in 78%, 3 years after radiation. Half of biopsy specimens out of 12 cases revealed non-viable or no cancer cells after a rather short time from treatment. CONCLUSION: Monotherapy with carbon ion radiation may be an excellent treatment for localized prostate cancer with low risk.     

Locally advanced prostate cancer

Opinion statement Standard therapy for clinically localized prostate cancer includes radical prostatectomy, external beam radiotherapy, or transperineal interstitial brachytherapy. Patients eligible for standard therapy are those with low risk features as defined by various risk group classifications, which generally include clinical stage T1 or T2a, serum prostate-specific antigen (PSA) less than 10 ng/mL, and biopsy Gleason sum of 6 or less. Although there has been important evolution in the performance of these techniques, particularly with respect to functional outcomes, these approaches for low-risk disease are relatively mature, and the cure rates with each of these therapies are similar in this patient population; locally advanced disease is more difficult to cure, however. Biochemical disease-free survival rates in men undergoing radical prostatectomy are clearly related to the pathologic stage. Prognostic groups can be defined based on pathologic stage with increasingly worse outcomes based on extracapsular extension (ECE), margin status, and the status of the lymph nodes and seminal vesicles. In patients with low risk features, the positive margin rate is generally low, making the presence or absence of ECE the dominant variable in predicting the likelihood of treatment failure. These observations suggest that more aggressive therapy is needed to cure those who are likely to have ECE or other adverse histologic features. Several nomograms predicting the likelihood of ECE or 5-year biochemical failure rates are now in routine clinical use, and can be used to select men at high risk of failure with single modality therapy for more aggressive treatment strategies. However, the optimal form of aggressive therapy for these patients is unknown.     

Post-cricoid cancer: an overview

Two retrospective studies of post-cricoid cancer are presented: study A, of 283 cases for demographic data, disease pattern, statistics and radiotherapy results; and study B, of 100 surgically treated cases for results of surgery and comparison of three methods of reconstruction. Study A revealed a male:female ratio of 1:2. Thirty-one percent of cases were too advanced at presentation for any form of treatment. Most patients were offered radiation therapy, but 21.7% did not complete it due to nutritional depletion. Disease-free survival (DFS) in patients who completed radiation therapy (137) was 66%, 21%, 4%, and 2% in stages I, II, III, IV respectively. Study group B showed that the DFS following surgery for stages III and IV was 28%. Reconstruction of the gullet by gastric transportation affected early swallowing but had the highest mortality; the pectoral myocutaneous flap method had the lowest mortality but a high leak rate and postoperative stenosis; the deltopectoral flap showed a high leak rate, delayed swallowing, and the longest hospitalisation of all 3 methods. Early diagnosis, nutritional support during radiation therapy, surgery in stages III and IV, and one-stage reconstruction are recommended.     

Anal cancer: an overview

Anal cancer is a rare tumor with an incidence that has been rising over the last 25 years. The disease was once thought to develop as a result of chronic irritation, but it is now known that this is not the case. Multiple risk factors, including human papillomavirus (HPV) infection, anoreceptive intercourse, cigarette smoking, and immunosuppression, have been identified. HIV infection is also associated with anal cancer; there is a higher incidence in HIV-positive patients but the direct relationship between HIV and anal cancer has been difficult to separate from the prevalence of HPV in this population. HIV infection is also associated with anal cancer; there are increasing numbers of HIV-positive patients being diagnosed with the disease. Treatment of anal cancer prior to the 1970s involved abdominoperineal resection, but the standard of care is now concurrent chemoradiation therapy, with surgery reserved for those patients with residual disease. We present a case of anal cancer followed by a general discussion of both risk factors and treatment.     

Newer therapies in advanced prostate cancer

Prostate cancer is a leading cause of morbidity and mortality among males. Androgen ablation as initial therapy for advanced prostate cancer provides high response rates but does not cure disease, as nearly all men with metastases will eventually progress to hormone-refractory prostate cancer (HRPC). Present chemotherapy regimens for HRPC can provide palliation and have recently demonstrated an increase in overall survival. Over the past 2 decades, these regimens represent clear advances in the treatment of metastatic prostate cancer but also demonstrate that newer therapies are needed. Studies are ongoing to provide viable alternatives among traditional cytotoxic therapies as well as among novel agents targeting specific molecular pathways. This article reviews some of the newer therapies being developed and evaluated, including the epothilone analogues, human epidermal growth factor receptor pathway inhibitors, angiogenesis inhibitors, and endothelin receptor antagonists.     

Chemotherapy in advanced prostate cancer.

In the United States, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in men. Prostate cancer is a rare disease before age 40; however, the prevalence increases quickly to 80% by the age of 80, and with increasing life expectancy, hormone-refractory prostate cancer (HRPC) will soon represent the most common cancer in the male population in the United States and other Western countries. The evolution of early prostate cancer is variable and extends over many years; some tumors progress slowly or not at all, whereas others may progress more rapidly and be fatal after a few years. A widely held view is that chemotherapy has no role in HRPC because no single agent or combination has been shown to prolong survival in a randomized trial. This concept may be obsolete, as preliminary results for a number of approaches, mostly derived from laboratory observations, show that prostate cancers are not as resistant to chemotherapy as traditionally believed. The population of early "geriatric" HRPC patients is rapidly increasing, posing an even greater challenge to oncologists in coping with this difficult-to-manage patient population. In this article, we analyze the most novel chemotherapeutic combinations for the treatment of HRPC in otherwise healthy elderly men.     

Depression in paediatric cancer: an overview

Research into depression in paediatric cancer is in its early stages, but nevertheless has presented interesting challenges regarding the recognition and measurement of depression in a medically ill population. In this article we discuss the complex interaction between physical and psychological variables, and the diagnostic difficulties arising from this. We review the epidemiological findings regarding prevalence, evaluating the apparently low prevalence rate in the light of methodological weaknesses. Hypotheses put forward to explain the findings are discussed. We conclude by highlighting areas for future research.     

Management of advanced prostate cancer

Most cases of advanced carcinoma of the prostate are hormonosensitive. The use of combined androgen blockade (CAB) seems to improve survival and quality of life, but only when combined with chemical castration by luteinizing-hormone-releasing hormone analog and without the use of steroidal antiandrogens. After CAB, further hormonal treatments remain efficacious, such as antiandrogen withdrawal followed by estrogens, aromatase inhibitors, and hormone-refractory prostate cancer multiple cytotoxic agents. For painful bone lesions, external beam radiotherapy, biphosphonates, and strontium 89 or samarium 153 provide pain relief. The use of new methods for the evaluation of response and quality of life will allow the rapid identification of effective treatments and permit powered phase III trials.     

Palliative prostate radiotherapy for symptomatic advanced prostate cancer

Background and purpose

To report the results for the use of short-course palliative radiotherapy to the prostate for localised symptoms.

Materials and methods

Fifty-eight patients were identified from radiotherapy records between 2003 and 2007. Data were collected retrospectively on patients’ demographics, radiotherapy details and response. Symptoms and toxicity were scored, retrospectively, according to the following scale: 0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, and 3 = severe symptoms.

Results

All the 58 patients had advanced prostate carcinoma. The median age at radiotherapy was 76.6 years (range 54-91). Fifty-six patients (97%) had hormone refractory disease. Twenty-seven patients (47%) had evidence of metastatic disease. 20Gy in 5 fractions was the most commonly used fractionation. The most frequent baseline symptom was haematuria (54%). Eighty-nine percent (31/35) of the patients had a complete or partial resolution of symptoms at 4 months. Response rates for individual symptoms (including unknown responses) were: rectal symptoms (75%), pelvic pain (69%), urinary obstruction (54%) and haematuria (42%). A >50% reduction in PSA occurred in five patients. Toxicity was mild to moderate only and was self-limiting.

Conclusion

Palliative radiotherapy to the prostate gland for local symptoms appears to be an effective means of palliation with minimal toxic side effects. Prospective studies are now required to assess its benefits in more detail.