by Daniel Dupuis
There are a number of risk factors of varying severity that can increase or decrease the odds that a man may contract prostate cancer. Recent efforts and initiatives, however, may help provide guidance and resources to help reduce the incidence of prostate cancer and work toward more effective treatment options. There are some substantial developments that may offer very effective treatment options and may even offer solutions that can mitigate the horrific side effects that are inherent to almost all cancer therapies.
Prostate Cancer Risk Factors
A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, for example a person’s age or family history certainly cannot be changed, while others, such as diet can be modified.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have no evident risk factors.
One key observation, however, is that a more rigorous testing regimen should be followed if one has more than a few risk factors.
Age
Prostate cancer is rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50. About 6 in 10 cases of prostate cancer are found in men older than 65.
No one can make themselves younger, but the need for more frequent testing increases every year. Additionally, if one is aware that they have elevated risk factors it would be wise to be tested on an annual basis.
New Developments
A new screening tool for prostate cancer has been shown to offer better accuracy than the test currently used by most physicians in the United States. The new test, called the 4Kscore™ test (OPKO Lab), offers various advantages over the more commonly used prostate specific antigen (PSA) blood test.
The new test improves on these common issues with the PSA blood test:
Isn’t specific to cancer; detects a variety of prostate issues
Doesn’t account for a natural tendency for PSA levels to rise with age
The current method for measuring PSA levels has led to a number of false positives in a number of men, which has led them to undergo unnecessary biopsies. The U.S. Preventive Service Task Force gave PSA screening a grade of D in 2012. They said the harm it brings outweighs the benefits.
The new 4Kscore™ test does not replace the current PSA test, but is a follow-up to a positive PSA. It can reduce biopsies, that are uncomfortable and may lead to infection, by 30 to 50%.
Race/Ethnicity
Prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races. African-American men are also more than twice as likely to die of prostate cancer as white men. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic whites. The reasons for these racial and ethnic differences are not clear.
This does not mean that Asian-Americans or Hispanics/Latino or Caucasian men should consider foregoing testing; it simply means that African Americans need to maintain a more rigorous testing regimen.
A New Study for African American Men
There has been a recent launch of an initiative that will try to ascertain why African American men are more likely to get, and die, from prostate cancer. It will be the largest study of its kind. It is backed by the National Cancer Institute and aims to enroll 10,000 study subjects. There is, of course, no cost to the participants; in fact, they will all receive a nominal payment of $50.
Simply search for “RESPOND study and prostate cancer.”
Family history
Prostate cancer seems to run in families, which suggests that in some cases there may be an inherited or genetic marker that may be categorized as a risk factor. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. (The risk is higher for men who have a brother with the disease than for those who have a father with it.) The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.
This simply means that individuals that fit this profile should have more frequent testing.
Diet
The exact role of diet in prostate cancer is not clear, but several factors have been studied.
Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors aren’t sure which of these factors is responsible for raising the risk. It may explain the low incidence of cancer in Asian men.
Some studies have suggested that men who consume a lot of calcium (through food or supplements) may have a higher risk of developing prostate cancer. Dairy foods (which are often high in calcium) might also increase risk.
Research, however, does indicate that some foods may decrease your chance of contracting prostate cancer.
Tomatoes. Tomatoes are high in lycopene, which could have a protective effect against prostate, lung, and stomach cancers. Multiple studies suggest that high levels of lycopene in the blood are linked with a lower risk of prostate cancer and may even help slow the spread of cancerous cells. Cooked tomatoes have a higher concentration of lycopene than raw.
Fruits. Diets high in fruits and vegetables have been shown to protect against many cancers. Lycopene-containing fruits including guava, papaya, and watermelon are recommended. Some research suggests that pectin — a common fiber found in apples, apricots, plums, and citrus fruits and used as a thickener in many jams and marmalades — may reduce the number of cancerous cells by as much as 40 percent.
Vegetables. A new study from the University of Colorado finds a high-fiber diet rich in vegetables might be why Asian men develop prostate cancer so infrequently compared to Western men. Additionally, researchers have reported that fiber-rich eating could slow the progression of the disease. Other studies have found broccoli and cauliflower to be especially effective in reducing cancer risk because cruciferous veggies slow the growth of cancer cells in the body.
Medications in Development
Aneustat Shows Promise as a Non-Toxic Drug for Prostate Cancer
Aneustat is an immunotherapy that is truly groundbreaking. It is taken orally and offers substantial efficacy,yet has a negligible side effect profile and presents no known safety risks. It is a multivalent, multifunctional platform drug. It is identified as a platform drug because it has been subject to studies that pair it with a number of currently utilized medications for prostate cancer. Studies indicate that it can significantly increase efficacy, while redicing side effects, and even more importantly, drug resistance. Combination therapy has become an increasingly popular option and Aneustat has been proven to be effective as both a stand-alone medication and as a component of combination therapy while being paired with numerous cancer drugs.
Aneustat is scheduled to begin a phase 3 study in collaboration with Johns Hopkins that will focus on Aneustat with enzalutimide for post-surgical, radiation recurrent prostate cancer, while another study at the Tisch Cancer Center at Mt. Sinai will examine Aneustat in combination with docataxel for metastatic castration resistant prostate cancer.
Darolutamide
Darolutamide (developmental code names ODM-201, BAY-1841788) is a nonsteroidal antiandrogen (NSAA) – specifically, a selective antagonist of the androgen receptor (AR) – which is under development by Orion and Bayer HealthCare for the treatment of advanced, castration-resistant prostate cancer.
It is an oral medication and appears to to neglibly cross the blood-brain barrier. This is beneficial due to the reduced risk of seizures and other central side effects. Another advantage is that it does not seem to increase testosterone levels in mice or humans.
The results of a recent study will soon be published, and early indications are that it compares favorably with enzalutamide (Xtandi) and apalutamide (Erleada), yet may have a more favorable side effect profile.
VISION Study
A new global phase 3 clinical research study in men with progressive metastatic castration-resistant prostate cancer (mCRPC), called the VISION study, will evaluate the effectiveness and safety of the investigational drug Lu-PSMA-617, in combination with the best standard of care, versus patients treated with best standard of care alone. This research is being conducted by physicians in approximately 80 institutions throughout the US, Canada, and Europe and will include approximately 750 men who are eligible for the trial.
New Combination Therapy
Pfizer and Astellas have announced that a recent study has indicated that the addition of enzalutamide to standard androgen deprivation (ADT) has led to improved outcomes in men with metastatic, hormone-sensitive prostate cancer (mHSPC). This is the first time that a “second-line” form of androgen deprivation has been shown to have meaningful efficacy in the treatment of any form of hormone-sensitive (as opposed to castration-resistant) prostate cancer.