Prostate Cancer- Colorectal Cancer: An Overview-Part V of a VII Part Series

(9/7/07)-Prostate Testing-Medical costs continue to rise in the United States, especially costs associated with "gerontological disorders". Researchers are looking for ways to identify diseases at the earliest stage of the disorder in order to allay the downstream costs of treatment. One disease that is getting such attention is prostate cancer.

The American Urological Association has issued the first new prostate guidelines in 12 years. The new guidelines use a few well-designed research trials, but suggest that physicians discuss with patients the many options available and their side effects. The reason for this is that they cannot answer questions faced by men with localized disease. They know that each form of therapy has its own spectrum of complications. Thus men with prostate cancer will still have to face questions such as surgery or radiation therapy?, brachytherapy or radical prostectomy?.

Now along comes Dr. David Ulmert of Lund University in Malmo, Sweden who presented his results at the American Urological Association meeting from a longitudinal, case matched study of 21,277 Swedish men under the age of 50 who were enrolled in a nationwide screening program from 1974 to 1986. The study suggests that a single measurement of prostate-specific antigen (PSA) in men aged 44-50 was a powerful predictor of advanced prostate cancer late in life. Those who had a baseline PSA value of 1.22 ng/ml had a 60% chance of developing prostate cancer on the average of 17 years later when compared to those whose PSA measured 0.54 ng/ml. The higher the initial PSA level during the years 44-50, the greater the chance of developing advanced prostate cancer.

These findings will have to be replicated and ways found to get men to take the test earlier. It is reported that only 75% of men ever get a PSA, and only 50% get screened regularly. Screening could reduce the number of serious clinical cancers and can be treated more aggressively if found at this stage of life.

Prostate and Statins

Researchers in Finland involved with the Finnish Prostate Cancer Screening Trial did a longitudinal study of 23,320 men over a ten year period. They found a dose-dependent effect in users of statins. Statin use was associated with significantly lower incidences of all categories of prostate cancer stages and grades. There were significant decreases in median prostate-specific antigen (PSA) levels and median free/total PSA ratios.

Prostate Cancer and Diet

At a poster session at the American Association for Cancer Research, Stella Koutros of the National Cancer Institute found no association between prostate cancer and total consumption of meat, red-meat, chicken, bacon, sausage, processed meat, steak, hamburger, pork chops or ham steaks. The same was true of the way the meat was cooked except that the total intake of well-done or very well-done meat raised the risk of prostate cancer.

Colorectal Cancer Testing

Another research group looking at colorectal cancer think they have developed an noninvasive alternative to colonoscopic testing. This noninvasive technique is called PillCam COLON and is being developed by Given Imaging Ltd. The PillCam COLON video capsule to visualize the colon has been cleared for marketing in the European Union, and multi-center clinical trials are underway in Europe and the U.S. Quoting from an article in Family Practice News, June 12, 2007, the results of an initial research found "For significant lesions—those greater than a 6 mm in size or in patients with three or more polyps—the sensitivity of capsule endoscopy using the PillCam COLON was 79%, and the specificity was 78%, compared with conventional colonoscopy". These results still have to be replicated by independent research groups.

The capsule is the size of a large vitamin pill and has tiny cameras at both ends. The capsule is excreted by the end of the life of the camera battery.

Colonoscopy Guidelines

The Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) screening trial involved 154,942 people aged 55-74 years at entry, recruited through ten regional centers across the United States. According to the Web page of the Nation Cancer Institute, "The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, or PLCO, is a large-scale clinical trial to determine whether certain cancer screening tests reduce deaths from prostate, lung, colorectal and ovarian cancer. The underlying rationale for the trial is that screening for cancer may enable doctors to discover and treat the disease earlier." Many results are coming out of this screening trial. Dr. Robert E. Schoen, a professor of medicine and epidemiology at University of Pittsburgh and colleagues reviewed surveillance colonoscopy records of 3,607 participants and found that only 63% of the patients with advanced adenoma had undergone a surveillance colonoscopy, while 40% of those with no polyps had undergone a surveillance colonoscopy at 5 years. Dr. Schoen felt that this result suggests both an underutilization and overutilization of colonoscopy.

For our readers, the following is the recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer: "Patients with two or fewer small (less than 1 cm) tubular adenomas with only low grade dysplasia should have their next follow-up colonoscopy in 5-10 years. Patients with small rectal hyperplastic polyps should be considered to have normal colonoscopies and have their next follow-up colonoscopy in 10 years. Patients with 3 to 10 adenomas, any adenoma 1 cm or larger, any adenoma with villous features, or high grade dysplasia should have a follow-up colonoscopy in three years." (See: Gastroenterology 2006; 130:1872-1875)

For our other articles in this series please see:

Prostate Cancer- Part I
Predicting Survival after Prostate Surgery- Part II
Prostate Specific Antigen (PSA) - Part III
Prostate Specific Antigen- Part IIIa
Prostatitis - Part IV
New Drugs in the Battle Against Prostate Cancer -Part VII

Also see: Justice Ruth Bader Ginsberg and Colon Cancer 


By Harold Rubin, MS, ABD, CRC, Guest Lecturer
posted September 7, 2007

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