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Whats new in prostate cancer? Highlights from the Institute for Prostate Cancer Research
2017 community symposium

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Whats new in prostate

cancer? 5 things to
watch
Highlights from the Institute for Prostate Cancer
Research 2017 community symposium
March 22, 2017

by Susan Keown / Fred Hutch News Service

 A sample of prostate cancer tissue, stained with dye and viewed under a
microscope
Photo by Robert Hood / Fred Hutch News Service
Cancer research can seem like it moves at lightning speed, with
hundreds of new studies published each week. How can patients
keep up with whats new?

Through its annual community symposium, the Institute for Prostate

Cancer Research helps patients and their families keep on top of the
latest developments in prostate cancer.

The IPCR is a collaborative effort of Fred Hutchinson Cancer

Research Center and UW Medicine. At the sixth annual
symposium March 18 on the Fred Hutch campus, researchers from
these two institutions presented their latest updates. (For those who
couldnt attend, the researchers presentations are posted to
YouTube.)

Here are five new developments to watch in prostate cancer:

 More than 150 people attended the 2017 IPCR community symposium.
Photo by Nola Klemfuss / Fred Hutch
Immunotherapy for prostate cancer
I think immunotherapy is going to be a very important component of
treatment [for prostate cancer] as we go into the future, said Dr.
Elahe Mostaghel, a clinical researcher at Fred Hutch.

Mostaghel envisions immunotherapies not, perhaps, as a cure for the

disease, but as part of a combination strategy to slow the growth of
the tumors so much that this cancer becomes a chronic disease
rather than a life-threatening one.

I think its going to be one of the most exciting and durable ways
were going to have to treat prostate cancer, she said.

Mostaghel highlighted three immunotherapy approaches that are

furthest along in development:

First is a therapeutic vaccine approach that turns on T cells to

fight cancer cells. This strategy is already in the clinic, and
many patients may be familiar with sipuleucel-T (better known
by its brand name, Provenge), which is approved by the Food
and Drug Administration for treating advanced prostate
cancer. In this strategy, patients white blood cells are
collected and exposed to a tumor protein to stimulate them
before being returned to the patients bloodstream to activate
tumor-specific T cells to kill cancer. Another strategy, still in
 trials, uses a harmless virus programmed with a bit of tumor
DNA to activate patients immune cells.

Second, drugs known as checkpoint inhibitors are FDA-

approved to treat a variety of cancers, including melanoma,
bladder cancer, and Hodgkin lymphoma. Tumors are pros at
shutting down cancer-killing immune responses. Checkpoint
inhibitors work by blocking the shutdown signals, allowing
immune cells to rev up to kill cancer cells. Although
checkpoint inhibitors arent yet FDA-approved for prostate
cancer, several ongoing clinical trials are testing them,
especially in combination with standard prostate cancer drugs
like the hormone blocker enzalutamide.

Third, and a bit further from the clinic, Mostaghel said, is an

experimental strategy in which patients immune cells are
genetically reprogrammed to kill cancers. The cells are
weaponized with an artificial molecule known as a chimeric
antigen receptor, or CAR, that enables immune cells to
recognize and kill cancer cells.

This strategy, while still not approved by the FDA for any
disease, has shown efficacy in other tumors, and I think it
just needs more time before it shows efficacy in prostate
cancer, Mostaghel said.

Exercise and prostate cancer survivorship

Regular exercise lowers your risk of developing many cancers,
including cancer of the prostate. But if youve already developed
prostate cancer, can exercise help?

Yes, said prostate cancer expert Dr. Jonathan Wright, a urologic

oncologist at UW and a Hutch faculty member. The American Cancer
Society recommends regular cardiovascular and strength training for
all cancer survivors, and it advises that survivors return to regular
physical activity as soon as possible after treatment. Exercise has
been shown to have numerous benefits for men who are being
treated for prostate cancer, from lowered anxiety to improved self-
esteem and large studies have also linked regular exercise to
slowed prostate tumor growth and improved survival.

One example of exercises benefits in prostate cancer is for men on

androgen-deprivation therapy, Wright said. This common treatment
deprives prostate tumors of their fuel testosterone and related
hormones but it can cause fatigue and other difficult side effects.
A study published earlier this year showed that many different types
of exercise help boost the energy level of men on long-term
androgen-deprivation therapy. And the more fatigued the men were
at the beginning of the yearlong study, the researchers found, the
bigger the boost they got from exercising.

Research by Wright and others is ongoing to strengthen the

evidence base for the benefits of exercise in prostate cancer.
(See this trial and this one.) His hope is that doctors in the U.S. soon
will be able to prescribe exercise for their patients with prostate
cancer, just as patients with heart problems can be prescribed
exercise-based rehabilitation. But first, Wright said, We need the
studies.

Personalized care through genomics

Emerging data are beginning to paint a picture of how genetic testing
could help doctors target therapies to the specific weaknesses of a
given patients prostate cancer.

Genetic testing will be increasing in prostate cancer care, said Dr.

Heather Cheng, the director of the Seattle Cancer Care
Alliance Prostate Cancer Genetics Clinic, which opened in 2016.
Were actively trying to maximize benefit, not only to patients but
also to their family members.

For example, Dr. Colin Pritchard and colleagues at UW Medicine

developed a genetic testing service called UW-OncoPlex, which uses
cutting-edge genetic-sequencing technologies (called next-
generation sequencing) to characterize more than 200 actionable
tumor genes actionable meaning that there are cancer drugs
available that target them. Pritchard and colleagues are testing a
version of UW-OncoPlex thats optimized for prostate cancer, with
promising early results, he said.

Among the many possible avenues for genetically targeted therapies

in prostate cancer, said Pritchard, perhaps most exciting is in men
with mutations in key genes that are involved in repairing damage to
DNA because we might already have therapies available.

Mutations in DNA-repair genes are thought to make cancers

particularly vulnerable to certain therapies, including drugs known as
platinum chemotherapies and PARP inhibitors. (These drugs have
been FDA-approved to treat patients with other cancers and are
under active investigation for patients with prostate cancer.)

Mutations in these genes, which can be passed on from parent to

child, are now known to occur in men with advanced prostate cancer
at rates much, much higher than anyone had previously thought,
Cheng said. She and colleagues are now studying treatment
strategies for men with these inherited mutations and considering
how to improve early cancer-detection strategies for their family
members.

We need to do larger trials to confirm this, but the preliminary data is

promising, Pritchard said.

New technology for prostate-cancer imaging

New technologies for imaging prostate tumors are in development to
help doctors detect tumors more effectively and, perhaps, improve
treatment outcomes, researchers at the symposium said.

One is a strategy known as multiparametric MRI, said Dr. Daniel

Lin, IPCR director and chief of Urologic Oncology at UW. This
complex MRI-imaging technique combines multiple different types of
MRI phases to create a 3-D image of a prostate that highlights an
area of likely tumor activity and indicates exactly where the doctor
should place biopsy needles to collect tissue for analysis. This may
help reduce the chance that a biopsy will miss a small tumor. The
UW had the first multi-parametric MRI setup in the five-state
Northwest region, Lin said, but the technology is now becoming more
widely available.

Multiparametric MRI doesnt yet replace standard-of-care biopsy

techniques that use a large number of biopsies in a grid pattern to try
to catch any cancerous areas. And it may turn out not to be useful or
cost-effective for every man. But stay tuned, Lin said.

Researchers are also developing new imaging compounds for use in

PET scans that are easier to use and more likely to detect cancers,
and research is ongoing to determine whether such scans can
improve patient outcomes by helping doctors plan treatments more
appropriately, said Dr. Evan Yu, a medical oncologist who treats
patients with prostate cancer at SCCA, Fred Hutchs clinical care
partner. PET, or positron emission tomography, uses radioactive
dyes that are injected into the patients vein and then taken up into
certain tissues, which are then revealed on scans. In 2016, the FDA
approved a PET-scan technique using a radioactive molecule called
FACBC that is taken up by prostate cancer cells to detect locally
recurrent cancers. Yu expects FACBC PET scans to be available to
patients locally as early as September.

The IPCR is dedicated to bringing these novel imaging and

therapeutic approaches to the Northwest, Yu said.

Is clinical trial participation right for you?

All of the research above was developed through clinical trials that
relied on volunteer participants. While patient volunteers are
indispensable for moving medical research forward, its common for
patients to be unfamiliar with clinical trials and have misconceptions
about participating in them.

Sandy Thompson and Scott Atkinson once did. Both metastatic

prostate cancer patients from Washington state, the men have now
participated in many trials. They spoke on a panel at the symposium
about their experiences.

I found that clinical trials are not exactly what I thought they were,
Thompson said. Heres what the two men learned:
First, clinical trials arent limited to patients who are out of all other
options trials are available to patients at all stages of disease. And
participating in a clinical trial of a new therapy doesnt mean that you
have a 50-50 chance of getting just a placebo or sugar pill in lieu of
treatment: Cancer clinical trials typically compare an experimental
strategy with the standard of care for that disease. In many cases,
trials are not blinded, meaning that the patient and his doctor know
which treatment he receives.

Both Thompson and Atkinson found great personal meaning in the

chance to help others by participating in research.

I try to donate my data when I can to help people in the future,

Atkinson said. Because of the trials in which he and others are
participating, he said, this cancer someday will be something that
people die with instead of because of.

This desire to help others is common among trial participants,

said Dr. Bruce Montgomery, clinical director of Genitourinary Medical
Oncology at SCCA. Other pluses for many are access to
investigational new drugs and the greater medical attention that often
is a part of trial participation. However, Montgomery said, men
should consider that any investigational treatment has unknown
effects, research protocols often require many more clinic visits than
would be required under standard of care and insurance may not
cover the costs of an experimental therapy.

Clinical research does not always test new therapies; this category
includes research ranging from studies of patients blood to develop
new early-detection tests, to surveys asking about mens
experiences with cancer, to tests of new imaging modalities for
visualizing tumors.

People interested in participating in clinical research can find trials on

the government-sponsored database, clinicaltrials.gov. Men
interested in prostate cancer trials through the Fred Hutch/University
of Washington Cancer Consortium can find current listings
on SCCAs clinical trials website.
Trial participation has been a wonderful journey for me, Atkinson
said. Id encourage anyone to talk to your oncologist to see if any
trials would be right for you at your stage.

Has prostate cancer affected your life or that of a loved one? Join the
conversation on Facebook.

Susan Keown, a staff writer at Fred Hutchinson Cancer Research

Center, has written about health and research topics for a variety of
research institutions, including the National Institutes of Health and
the Centers for Disease Control and Prevention. Reach her
at skeown@fredhutch.org or on Twitter @sejkeown.

Are you interested in reprinting or republishing this story? Be our

guest! We want to help connect people with the information they
need. We just ask that you link back to the original article, preserve
the authors byline and refrain from making edits that alter the
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at communications@fredhutch.org
A Collection of Related Diseases
Cancer is the name given to a collection of related diseases. In all types of cancer,
some of the bodys cells begin to divide without stopping and spread into surrounding
tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of
cells. Normally, human cells grow and divide to form new cells as the body needs
them. When cells grow old or become damaged, they die, and new cells take their
place.

When cancer develops, however, this orderly process breaks down. As cells become
more and more abnormal, old or damaged cells survive when they should die, and
new cells form when they are not needed. These extra cells can divide without
stopping and may form growths called tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the blood,
such as leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade,
nearby tissues. In addition, as these tumors grow, some cancer cells can break off and
travel to distant places in the body through the blood or the lymph system and form
new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues.
Benign tumors can sometimes be quite large, however. When removed, they usually
dont grow back, whereas malignant tumors sometimes do. Unlike most benign
tumors elsewhere in the body, benign brain tumors can be life threatening.

Differences between Cancer Cells and Normal

Cells
Cancer cells differ from normal cells in many ways that allow them to grow out of
control and become invasive. One important difference is that cancer cells are less
specialized than normal cells. That is, whereas normal cells mature into very distinct
cell types with specific functions, cancer cells do not. This is one reason that, unlike
normal cells, cancer cells continue to divide without stopping.
In addition, cancer cells are able to ignore signals that normally tell cells to stop
dividing or that begin a process known as programmed cell death, or apoptosis, which
the body uses to get rid of unneeded cells.

Cancer cells may be able to influence the normal cells, molecules, and blood vessels
that surround and feed a tumoran area known as the microenvironment. For
instance, cancer cells can induce nearby normal cells to form blood vessels that
supply tumors with oxygen and nutrients, which they need to grow. These blood
vessels also remove waste products from tumors.

Cancer cells are also often able to evade the immune system, a network of organs,
tissues, and specialized cells that protects the body from infections and other
conditions. Although the immune system normally removes damaged or abnormal
cells from the body, some cancer cells are able to hide from the immune system.

Tumors can also use the immune system to stay alive and grow. For example, with
the help of certain immune system cells that normally prevent a runaway immune
response, cancer cells can actually keep the immune system from killing cancer cells.

How Cancer Arises

Cancer is a genetic diseasethat is, it is caused by changes to genes that control the
way our cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also
arise during a persons lifetime as a result of errors that occur as cells divide or
because of damage to DNA caused by certain environmental exposures. Cancer-
causing environmental exposures include substances, such as the chemicals in
tobacco smoke, and radiation, such as ultraviolet rays from the sun. (Our Cancer
Causes and Prevention section has more information.)

Each persons cancer has a unique combination of genetic changes. As the cancer
continues to grow, additional changes will occur. Even within the same tumor,
different cells may have different genetic changes.

In general, cancer cells have more genetic changes, such as mutations in DNA, than
normal cells. Some of these changes may have nothing to do with the cancer; they
may be the result of the cancer, rather than its cause.
"Drivers" of Cancer
The genetic changes that contribute to cancer tend to affect three main types of
genesproto-oncogenes, tumor suppressor genes, and DNA repair genes. These
changes are sometimes called drivers of cancer.

Proto-oncogenes are involved in normal cell growth and division. However, when
these genes are altered in certain ways or are more active than normal, they may
become cancer-causing genes (or oncogenes), allowing cells to grow and survive
when they should not.

Tumor suppressor genes are also involved in controlling cell growth and division.
Cells with certain alterations in tumor suppressor genes may divide in an uncontrolled
manner.

DNA repair genes are involved in fixing damaged DNA. Cells with mutations in
these genes tend to develop additional mutations in other genes. Together, these
mutations may cause the cells to become cancerous.

As scientists have learned more about the molecular changes that lead to cancer, they
have found that certain mutations commonly occur in many types of cancer. Because
of this, cancers are sometimes characterized by the types of genetic alterations that
are believed to be driving them, not just by where they develop in the body and how
the cancer cells look under the microscope.

When Cancer Spreads

 ENLARGE
In metastasis, cancer cells break away from where they first formed (primary cancer),
travel through the blood or lymph system, and form new tumors (metastatic tumors)
in other parts of the body. The metastatic tumor is the same type of cancer as the
primary tumor.

A cancer that has spread from the place where it first started to another place in the
body is called metastatic cancer. The process by which cancer cells spread to other
parts of the body is called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original,
or primary, cancer. For example, breast cancer that spreads to and forms a metastatic
tumor in the lung is metastatic breast cancer, not lung cancer.

Under a microscope, metastatic cancer cells generally look the same as cells of the
original cancer. Moreover, metastatic cancer cells and cells of the original cancer
usually have some molecular features in common, such as the presence of
specific chromosome changes.

Treatment may help prolong the lives of some people with metastatic cancer. In
general, though, the primary goal of treatments for metastatic cancer is to control the
growth of the cancer or to relieve symptoms caused by it. Metastatic tumors can
cause severe damage to how the body functions, and most people who die of cancer
die of metastatic disease.
Tissue Changes that Are Not Cancer
Not every change in the bodys tissues is cancer. Some tissue changes may develop
into cancer if they are not treated, however. Here are some examples of tissue
changes that are not cancer but, in some cases, are monitored:

Hyperplasia occurs when cells within a tissue divide faster than normal and extra
cells build up, or proliferate. However, the cells and the way the tissue is organized
look normal under a microscope. Hyperplasia can be caused by several factors or
conditions, including chronic irritation.

Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is also a

buildup of extra cells. But the cells look abnormal and there are changes in how the
tissue is organized. In general, the more abnormal the cells and tissue look, the
greater the chance that cancer will form.

Some types of dysplasia may need to be monitored or treated. An example of

dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the skin. A
dysplastic nevus can turn into melanoma, although most do not.

An even more serious condition is carcinoma in situ. Although it is sometimes called

cancer, carcinoma in situ is not cancer because the abnormal cells do not spread
beyond the original tissue. That is, they do not invade nearby tissue the way that
cancer cells do. But, because some carcinomas in situ may become cancer, they are
usually treated.
Mens Sexual Health
30 Disember 2014 1:28 PM
KANSER satu perkataan yang cukup menggerunkan bagi setiap
masyarakat kerana merupakan antara penyakit yang berisiko tinggi
mengundang maut.

Tidak kira muda ataupun tua, lelaki mahu pun wanita, kanser akan
menyerang sesiapa sahaja malah penyakit ini menduduki tangga
teratas dalam carta jenis-jenis penyakit.

Kanser, sebenarnya ialah sejenis penyakit yang mampu menyerang

setiap tubuh badan kita, malah boleh dikategorikan sebagai penyakit
kronik dalam senyap.

Kanser prostat antara kanser yang cukup popular menyerang kaum

Adam yang berumur 50 tahun dan ke atas, malah kanser prostat
menduduki tangga keempat jika dibandingkan dengan penyakit
kanser lain.

Menurut Perunding Urologi, Hospital Gleneagles Kuala Lumpur, Dr.

Loh Chit Sin, di Malaysia angka bagi penyakit ini meningkat setiap
tahun.
Tambah beliau, hal ini terjadi disebabkan penyakit ini tidak boleh
dirasai dan dikesan pada peringkat awal. Mereka yang menghidap
penyakit ini juga tidak mempunyai tanda-tanda yang mereka
diserang penyakit tersebut.

Jika kita bercakap mengenai angka, di Malaysia setiap tahun

penyakit ini pasti meningkat dan tidak lari daripada 2,500 hingga
3,000 kes setahun.

Mengikut statistik yang dikeluarkan oleh Kementerian Kesihatan

Malaysia pada tahun 2005 kaum Cina mendahului dengan 15.8
peratus dan diikuti kaum India 14.8 peratus dan akhir sekali Melayu
7.7 peratus.

Untuk itu, saya menasihatkan orang lelaki yang berumur 50 tahun

dan ke atas agar segera menjalani pemeriksaan kesihatan kerana
golongan ini berisiko tinggi menghidap kanser prostat, ujarnya
ketika ditemui pada kempen Fight For Your Men di Kuala Lumpur,
baru-baru ini.

Katanya, pada dasarnya, usia dikenal pasti sebagai faktor utama

risiko kanser prostat dan penyakit ini bagaimanapun agak jarang
berlaku dalam kalangan mereka yang berusia 45 tahun ke bawah.

Begitupun ulas beliau, kepada mereka yang mempunyai sejarah

keluarga yang mempunyai penyakit ini yang berumur 40 tahun
seharusnya risau dan segera menjalani pemeriksaan kerana ada
kajian menunjukkan bahawa individu tersebut berisiko tinggi, dua kali
ganda untuk mendapat kanser yang sama.

Berbicara lebih lanjut mengenai penyakit tersebut, Dr.

lohmenjelaskan, biarpun punca sebenar berlakunya kanser prostat
masih menjadi tanda tanya, tetapi antara faktor risikonya ialah usia,
sejarah keluarga, bangsa, diet, obesiti, pendedahan kepada radiasi,
merokok, kurang bersenam, dan penyakit kelamin.

Pada masa yang sama, Dr. Loh memberitahu hubung kait antara
pemakanan dan kanser prostat juga belum boleh dibuktikan
sepenuhnya oleh para pengkaji dan saintis.

Namun terdapat data yang menunjukkan bahawa mereka yang

mempunyai pemakanan yang kaya dengan daging merah dan
barangan tenusu mempunyai kebarangkalian menghidap kanser
prostat lebih tinggi.

Bagaimanapun para penyelidik berpendapat gaya hidup sihat adalah

antara cara terbaik menghindari ancaman berbahaya ini.

Dengan dunia yang semakin canggih dengan pelbagai teknologi

yang ada hari ini, para saintis, doktor, dan komuniti perubatan
mendapati penyakit ini boleh dicegah, dikawal, dan disembuhkan.

Pesakit yang berada pada peringkat awal penyakit dan

mendapatkan imbasan mempunyai peluang yang lebih cerah untuk
sembuh, manakala mereka yang mengabaikan tanggungjawab ini
hanya memberi peluang kepada sel-sel kanser untuk membiak.

Kanser prostat mempunyai banyak kaedah rawatan seperti

pembedahan, terapi radio, dan kemoterapi tetapi biasanya
pembedahan adalah kaedah rawatan yang terakhir bagi pesakit
kanser kecuali mereka yang telah berada pada tahap kritikal.

Apa sekali pun rawatan yang ada, pesakit disarankan merujuk

kepada doktor masing-masing untuk menentukan jenis atau kaedah
rawatan yang paling sesuai dengan tahap penyakit pesakit, tuturnya
lanjut.

Sebagai garis panduan, adalah disarankan agar semua kaum lelaki

yang berumur 50 tahun ke atas mendapatkan nasihat doktor tentang
menjalani pemeriksaan untuk mengesan kanser prostat kerana boleh
diubati sepenuhnya jika dikesan awal.

Oleh yang demikian, adalah lebih baik seandainya kita dapat

mengenal pasti kanser tersebut pada tahap awal agar rawatan
setimpal dan sewajarnya dapat dijalani.

Sekiranya kanser prostat dapat dikesan awal, kita mempunyai

banyak pilihan rawatan berbanding dengan kanser yang dikesan
lambat dan gunakanlah kemudahan yang ada di negara kita untuk
membuat saringan kanser prostat.

Dalam hal ini ahli keluarga serta saudara mara wanita turut
disarankan agar memainkan peranan penting dalam menasihatkan
ahli keluarga (lelaki) untuk segera menjalani pemeriksaan kesihatan
dalam usaha mencegah lebih baik daripada mengubati.
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