Surgery may not prolong life in men with early-stage prostate cancer

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July 13, 2017,
Source: https://medicine.wustl.edu/news/surgery-early-prostate-cancer-may-not-save-lives/

A major 20-year study provides further evidence that prostate cancer surgery offers negligible benefits to many men with early-stage disease. In such men, who account for most cases of newly diagnosed prostate cancer, surgery did not prolong life and often caused serious complications such as infection, urinary incontinence and erectile dysfunction.

The study, by a national research team including Washington University School of Medicine in St. Louis, was led by the Minneapolis Veterans Administration Health Care System. It is published July 13 in The New England Journal of Medicine.

In men with early prostate cancer, the study compared surgery with observation. With the latter, men only were treated if they developed bothersome symptoms, such as urinary difficulty or bone pain. Such symptoms may indicate progression of the cancer. Many men in the observation group received no treatment at all because early-stage prostate cancer often grows slowly and rarely causes symptoms.

"The findings will go a long way in helping to improve prostate cancer care," said co-author Gerald L. Andriole, MD, director of Washington University's Division of Urologic Surgery. "About 70 percent of patients newly diagnosed with prostate cancer cases are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors. As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary. We hope the findings will steer doctors away from recommending surgery to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it's necessary."

The American Cancer Society ranks prostate cancer as the second most common cancer in men and the third-leading cause of cancer deaths among men, after lung and colorectal cancer. In 2017, about 161,360 men will be diagnosed with prostate cancer, and 26,730 will die from it.

The study, known as the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, is one of the largest and longest involving cancer patients. It got underway in 1994 just as the prostate-specific antigen blood test for prostate cancer became routine. With many more men diagnosed with prostate cancer, the standard treatment for all prostate cancers became surgery or radiation, with the thinking that removing or irradiating the tumor would increase survival. But over the next decade, reports of treatment-related complications raised concerns, as did data indicating that most early-stage cancers grew so slowly they were unlikely to cause health problems.

To evaluate any potential benefits of surgery, the researchers randomly assigned 731 men in the U.S. with localized prostate cancer to receive either surgery or observation at one of 44 Department of Veteran Affairs Health Care Centers or eight academic medical centers, including Washington University. The average age of men in the study was 67 at the time of enrollment.

Of the men who had prostate cancer surgery, 223 (61 percent) died of other causes after up to 20 years of follow-up, compared with 245 men (66 percent) in the observation group – a difference that is not statistically different. Further, 27 (7 percent) men in the surgery group died of prostate cancer, compared with 42 men (11 percent) in the observation group, but that difference also is not statistically significant.

However, the data show that surgery may have a mortality benefit in some men, particularly those with a long life expectancy and intermediate-risk prostate cancer. (Such men generally have PSA scores of 10-20 ng/ml and a Gleason score of seven. The latter score signifies tumor aggressiveness.)

"It would be a disservice to dismiss surgery as a viable option for patients with intermediate-risk prostate cancer," said Andriole, the School of Medicine's Robert K. Royce Distinguished Professor of Urologic Surgery. He treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. "For these patients, and for some men with high-risk prostate cancer, surgery is often beneficial, as are other other treatments such as radiation."

Technology has advanced since the study began, allowing physicians to more accurately classify tumors and avoid overtreating patients who have prostate cancer.

Of the 364 men treated with surgery, 53 (15 percent) suffered from erectile dysfunction, and 63 (17 percent) reported having incontinence. Another 45 developed other complications.

"The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often," said senior author Timothy Wilt, MD, a physician-researcher with the Center for Chronic Disease Outcomes Research at the Minneapolis VA Health Care System and a professor of medicine at the University of Minnesota. "Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer."

 

Study reveals radiation therapy advantage for patients with right-sided colorectal tumours

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For patients with colorectal cancer that has metastasized to the liver, having a primary tumor on the left side, as opposed to the right side of the colon, is known to be a significant advantage in terms of treatment response.

But now a new study, presented here at the ESMO 19th World Congress on Gastrointestinal Cancer, suggests this imbalance may be at least partially
redressed.

Reversing the usual pattern, patients whose liver metastases had spread from rightsided primary tumors (RSP) had a 36% better survival rate after treatment with a combination of firstline chemotherapy and selective internal radiation therapy (SIRT) using Y90 resin microspheres, compared to chemotherapy alone, according to the study.

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BCNA free metastatic breast cancer consumer forum

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The forum for people living with metastatic breast cancer will highlight the medical, physical and emotional aspects of living well after a cancer diagnosis.

Find out about cancer services near you, meet people who have had a diagnosis and hear about treatment and care for metastatic breast cancer. Included in the line-up of speakers is Dr David Blakey – Radiation Oncologist from GenesisCare Victoria.

Download the flyer here

Date: Thursday 27 July 2017

Time: Registration and arrival 5:15pm
Forum 5:45pm - 8:45pm

Registration: Visit bcna.org.au/forums or call 1800 500258

 

Offering rapid access to world-class comprehensive cancer treatment at Cabrini Malvern

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  • Cabrini and GenesisCare have announced a partnership to deliver a new, state-of-art radiotherapy service to offer both in-patients and out-patients comprehensive cancer care in the one location
  • In-patients will no longer need to travel off-site to receive daily radiotherapy treatment
  • The service will provide the local community with greater access to cutting edge clinical trials

Oncology patients will soon have access to fully integrated, comprehensive cancer care at Cabrini Hospital in Malvern, with the addition of radiotherapy to the hospital’s existing suite of diagnostic, surgical and medical cancer care. The new, state-of-the-art radiotherapy service will deliver world-class treatment to both in-patients and out-patients when it opens in September.

Providing radiotherapy on site at the Malvern campus will mean that in-patients will no longer need to travel by medical transport or ambulance to receive daily treatments. The service will be linked across Cabrini’s Malvern, Brighton and Prahran campuses, improving access to radiotherapy services for all patients within the region.

Radiotherapy is a highly effective weapon in the fight against cancer, delivering more than 40 per cent of all cures. Using a highly sophisticated machine called a linear accelerator, GenesisCare will be providing non-invasive radiotherapy that precisely delivers radiation beams to eradicate cancer cells.

In an Australian-first, the innovative $7 million facility – being developed and operated by Australia’s largest radiotherapy service provider, GenesisCare – will use unique prefabricated building blocks to develop the contemporary radiotherapy bunker. The build will take less than four months.

GenesisCare Managing Director, Dan Collins, said the organisation was committed to innovating healthcare to make it easier for patients with cancer to access quality care.

“We’re incredibly pleased to be partnering alongside Cabrini to enable rapid access for cancer patients to state-of-the-art radiotherapy treatments and technologies. For patients in the community undergoing cancer treatment, our new on site services will make it simpler and easier to access the best care at the right time,” he said.

Highly experienced Radiation Oncologists, Dr Karen Taylor, Dr Ian Porter, Dr David Blakey and Dr Mario Guerrieri will be bringing their expertise to the campus to deliver patient-centred care.

“Cabrini is delighted with the Radiation Oncology medical team GenesisCare has assembled. They are all clinicians with strong, established clinical reputations, who will bring a diverse and comprehensive range of expertise to provide care to our cancer patients,” said Dr Simon Woods,
Executive Director, Cabrini Malvern.

The new service will create approximately 15 new jobs for specialist clinical and support staff, and it is anticipated that more than 7000 treatments will be provided at the facility during its first year of operation.

Building our resilience to support patients

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A cancer diagnosis can take a psychological toll on the individual and their family, with a rollercoaster of emotions along the way. Our patients have told us that their daily interactions with our team – whether it’s a welcoming smile on arrival or a chat over a coffee – can have a positive impact on what can be a sometimes testing journey.

To better support our teams to better support our patients, GenesisCare has partnered with clinical psychologist Dr Cath Adams to run a series of workshops focused on building resilience, eliciting and responding to emotional cues, and managing challenging conversations.

Our CancerCare Patient Experience Lead, Ada Ryan, said: “We monitor patient sentiment every month, and I’m always blown away by how much positive feedback there is for our teams. They have the most profound impact on the patient experience, so we are focused on looking for ways to better support them.”

The workshops were trialled in New South Wales and have been deemed an overwhelmingly success by participants. They will now be rolled out nationally.

GenesisCare recognises that the more positive and engaged our team are, the better the patient experience is. These types of initiatives help us continuously empower our team to deliver high quality care to patients.

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Genesis Logo Small.pngGenesisCare is Australia’s leading provider of radiation oncology, cardiology and sleep treatments. We exist to fill the treatment gap for the biggest disease burdens in Australia - cancer and heart care - in an environment of substantial unmet demand from an ageing population. Click here to learn more