Drug may slow growth of early prostate cancer (AP)

By MARILYNN MARCHIONE, AP Medical Writer Marilynn Marchione, Ap Medical Writer – Tue Feb 15, 6:55 pm ET

A new study suggests a way to help men with early, low-risk prostate cancer avoid being overtreated for a disease that in most cases will never threaten their lives. It found that a drug can slow the growth of these tumors in men who opt to be monitored instead of having treatment right away.

This is the first time that a drug for treating enlarged prostates also has been shown to help treat prostate cancer in a rigorous study. It may persuade more men to choose active surveillance, or "watchful waiting," instead of rushing to have treatments that can leave them with urinary or sexual problems, doctors say.

However, the results also show that most of these men do very well with no treatment at all.

"We're identifying men who are not likely to need even a pill," said Dr. Maha Hussain, a University of Michigan cancer specialist. But Americans fear cancer so much that they want some kind of treatment and underestimate the financial and medical risks of treating low-risk cases, she added.

She is program chair of a cancer conference in Florida where the study will be presented later this week. Results were released Tuesday in a telephone news conference sponsored by the American Society for Clinical Oncology.

Roughly half of the 218,000 men diagnosed each year in the United States with prostate cancer have low-risk disease — PSA blood levels under 10 and low tumor aggressiveness scores.

"The American view of cancer" is that it's always best to treat, so about 80 percent of these men choose to have that right away, said Dr. Otis Brawley, a prostate cancer expert who is chief medical officer of the American Cancer Society.

In Europe, though, most choose watchful waiting — close monitoring and treatment only if the cancer progresses or causes pain or other problems.

Doctors know that drugs that shrink the prostate — GlaxoSmithKline PLC's Avodart and Merck & Co.'s Proscar — can help prevent prostate cancer. But federal health advisers recently recommended against taking them for this purpose because of potential risks.

The new study tested Avodart "not to prevent cancer, but to prevent the progression" of it in men who already have the disease, which may be a much better use of such drugs, said the study's leader, Dr. Neil Fleshner of University Health Network and Princess Margaret Hospital in Toronto.

"We know the vast majority of these men are not destined to die from that cancer," and wanted to see if Avodart could make "watchful waiting" safer, Fleshner said.

The study enrolled about 300 men in the United States and Canada with low-risk cancer that was confirmed by a biopsy. They were given daily Avodart or dummy pills and new biopsies 1 1/2 and three years later.

Prostate cancer got worse in 38 percent of men taking Avodart and 49 percent of those on dummy pills. Final biopsies showed no signs of cancer in 36 percent of men on Avodart versus 23 percent of those on dummy pills. Doctors say this last result shows how tiny many of these cancers were to start with, that they couldn't even be found when new biopsies were done.

Doctors don't think Avodart can cure cancers, but it seems to suppress it, said Dr. Howard Sandler, a prostate cancer specialist at Cedars-Sinai Medical Center in Los Angeles. He had no role in the study but is involved with the cancer conference.

Researchers gave no details on Avodart's side effects, but said no new ones appeared in the study. Avodart and Proscar are known to cause sexual problems for some men, but many men over 50 have this anyway and only about 5 percent more do when taking these drugs, said Brawley, who helped test Avodart for cancer prevention.

The new study was sponsored by Avodart's maker, GlaxoSmithKline. Avodart and Proscar cost about $4 a pill; generic versions of Proscar are available for about $2. Proscar is similar to Avodart but has not been tested for treating early cancer as this study did.

Sandler said Avodart might relieve some men's anxiety about monitoring their disease and may make them more comfortable not having immediate treatment.

"If it was me, I'd choose active surveillance," he said. Avodart "has the potential to be an important help."

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Online:

Prostate cancer info: http://www.cancer.gov/cancertopics/types/prostate

and http://tinyurl.com/ASCOanswers

Risk calculator: http://tinyurl.com/riskcalculator

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Firefighters remember cancer victim, 6, in NYC (AP)

NEW YORK – A 6-year-old boy who was made an honorary New York City firefighter during his battle with cancer has been remembered at a solemn memorial service.

Little Liam Witt died Jan. 24 after enduring years of radiation and chemotherapy.

The firefighters of Ladder Co. 24 and Engine Co. 1 admired Liam's fighting spirit. They gave him his own locker in their midtown Manhattan firehouse.

Dozens of firefighters attended Monday's service at the nearby St. Francis of Assisi Church. Bagpipers played. Speakers included a doctor and a nurse from Memorial Sloan-Kettering Cancer Center who treated Liam.

Mementos from Liam's life on display at the church included his scooter and a Curious George book.

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Women on bone drugs have less colon cancer: study (Reuters)

NEW YORK (Reuters Health) – Women taking certain bone drugs after menopause appear less likely to develop colon cancer, Israeli and U.S. researchers said Monday.

The finding has them excited about the prospect of using the drugs -- called bisphosphonates -- to help prevent cancer in healthy people, but other experts are less enthusiastic.

"The lower risk of colorectal cancer risk seen among bisphosphonate users in this study is intriguing," Eric Jacobs of the American Cancer Society, who wasn't involved in the study, told Reuters Health by e-mail.

"However, these results should be interpreted with caution and require confirmation by additional studies."

The new work looked at 933 women with colon cancer, whose average age was just over 70. The researchers then found a comparison group of women without the disease, who matched the first group in age, ethnicity and clinics where they received treatment.

Earlier studies have found that women taking bisphosphonates have a lower risk of breast cancer. But it was unclear if that effect could be chalked up to the drugs, because the condition they are meant to treat -- bone thinning, or osteoporosis -- is tied to low estrogen levels, which also cuts breast cancer risk.

Colon cancer, on the other hand, has not been linked to estrogen, said Dr. Gad Rennert of the Carmel Medical Center in Haifa, whose findings are published in the Journal of Clinical Oncology.

His team found that women who had been taking bisphosphonates -- mainly the drug alendronate (Fosamax), which costs around $10 per month in the U.S. -- for at least a year had a considerably lower risk of developing colon cancer later on.

Even after considering other factors tied to the disease -- like aspirin or statin use and eating lots of vegetables -- their risk was 59 percent lower than that of women who hadn't taken the drugs.

According to the American Cancer Society, one in 19 men develops colorectal cancer at some point, and slightly fewer women do. The disease is the third leading cause of cancer deaths in the U.S.

Rennert said in an e-mail that alendronate is used by millions of women across the globe and has few side effects. The long-term effects are less well-known, however, and in rare cases it can cause bone death of the jaw, which would be important if healthy people were to take it.

Also, not all patients asked to participate in the study agreed, which could limit the results further.

Jacobs of the American Cancer Society added that one earlier study from the UK had found no link between bisphosphonate and colon cancer. Indeed, it found a higher risk of throat cancer in patients on the medication.

"Based on current evidence, bisphosphonates should not be used for prevention of colorectal cancer," Jacobs said. "Fortunately, there are proven ways to help prevent colorectal cancer. In particular, all Americans, 50 or older, should get a screening test so that precancerous polyps can be detected and removed before they turn into cancer."

SOURCE: http://bit.ly/aaGhWR Journal of Clinical Oncology, online February 14, 2011.

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