Data supplement 1

March 21, 2018 | Author: Anonymous | Category: N/A
Share Embed


Short Description

Download Data supplement 1 ...

Description

MAY 2010

Evidence Concludes More Rapid Prostate Cancer Growth Rate And/Or Earlier Transformation From Latent To Aggressive Prostate Cancer In Black Men

by Virgil H. Simons We have heard consistently that African-American men (AAM) bear a much greater prostate cancer (PCa) burden than white men (EAM). Between 1997 and 2001, age-adjusted incidence and mortality rates among Black men are, respectively, 62% and 144% higher than among white men. There is concern that early screening and treatment for African-American men may be warranted; but there is disagreement on appropriate use of the PSA test and screening programs, especially for Blacks. Significant research exists indicating that Blacks face greater barriers to health care than whites. These obstacles can be at least partially surmounted by educating Black men, insuring equality of access to health care providers, having successful outreach programs available to them and, establishing a network they will trust and use. (continued)

In This Issue Evidence Concludes More Rapid Prostate Cancer Growth ...............................................................1 The Fridays Initiative ......................................................2 Cabazitaxel....................................................................3 Alternatives to PSA ........................................................3 PROVENGE® Approved..................................................3 Please Ask, Please Tell....................................................4 Are You a Gay Prostate Cancer Survivor ..........................5

Medicare Interactive ............................................................5 Focus on Research................................................................5 The European Perspective on PSA .........................................6 PSA and the PSA Test...........................................................6 How Do I Know if I’m a “High Risk” ....................................7 Tell Me Where It Hurts.........................................................8 Fight Prostate Cancer!........................................................10

THE FRIDAYS INITIATIVE

If you are an uninsured or under-insured patient who is seeking surgical treatment for localized prostate cancer, the Fridays Initiative was set up to help you. Uninsured and under-insured patients who need surgery for prostate cancer may have difficulty finding high-quality treatment of their choice that is within their economic means. Through the Fridays Initiative, pre-qualified, uninsured and under-insured patients can more easily overcome economic barriers and gain access to high-quality treatment. The Fridays Initiative relies for surgical capabilities on a specialized prostate cancer surgeon associated with Mobile Surgery International. This surgeon introduced minimally invasive prostate cancer surgery (also known as laparoscopic radical prostatectomy) into the United States in 1999. In experienced hands, this kind of prostate surgery is associated with minimal bleeding, minimal pain, and rapid post-surgical recovery. For more than 10 years this surgeon has focused only on minimally invasive prostate surgery, a service that he has provided to men from across the United States and from other countries. He has carried out more than 2,000 such procedures and is absolutely devoted to service and support at the highest level for all of his patients and their families. All surgical procedures offered by Mobile Surgery International (MSI) are provided at “all-in package costs” for uncomplicated surgery for appropriately qualified patients, and include such things as hospital costs, the fees for the surgical team, immediate postoperative care, etc. They do not include the costs for travel, lodging, long-term follow-up, and medical complications. For more information, contact Mobile Surgery International via email: [email protected] or by phone: Hope or Ruth at 305.936.0474

Page2

Evidence Concludes More Rapid Prostate Cancer Growth…

continued from page 1

However, we now have scientific research that shows genetic proof supporting clinical differences between African-American men and whites. In an article published in The Journal of Urology (May 2010), Dr. Isaac Powell from the Karmanos Cancer Center in Detroit concluded “…that age at prostate cancer initiation and clinical characteristics did not differ by race in our autopsy series, prostate cancer volume after radical prostatectomy was greater in black than in white men and Dr. Isaac Powell disease became distant disease at a ratio of 4 black men to 1 white man in the Detroit Surveillance, Epidemiology and End Results (SEER) population.” The research team evaluated many externalities. The article continues, “Lack of access to care was suggested as responsible for disproportionate advanced disease and mortality in AAM compared to EAM. Data indicate that in recent years AAM are as likely to be tested for PCa by PSA as EAM. However, AAM continue to present with more advanced disease and a higher mortality rate. Financial barriers or the lack of insurance were also suggested as potential causes of the disparity. SEER insurance rates for AAM and EAM older than 50 years are 81% and 89%, respectively. That difference is statistically significant but in our opinion does not account for the entire disparity. Socio-economic status (SES) was also reported as a factor contributing to PCa racial disparity but this issue is controversial. Studies that examined SES on multivariate analysis showed that SES does contribute to the racial outcome disparity. However, no difference in PCa recurrence after radical prostatectomy was identified in AAM when comparing lower vs. middle incomes. Nonfinancial barriers such as poor health seeking behavior were reported to delay PCa diagnosis in AAM. Fear of the PCa diagnosis and distrust of the health care system appear to be the most dominant factors. Evidence shows that PCa treatment differences contribute to the survival disparity. AAM are less likely to be treated for PCa than EAM for similar disease stages. Dr. Powell’s hypothesis is that a more rapid PCa growth rate and/or earlier transformation from latent to aggressive PCa in AAM than in EAM contribute significantly to the racial disparity of advanced disease at diagnosis and to the 2 to 3 times greater mortality rate in AAM than in EAM. The methodology utilized by Dr. Powell’s team evaluated prostates on deceased African-American and white men who died from non-prostate cancer related causes, which was compared with radical prostatectomy tissue of men with diagnosed prostate cancer. The study results found that age at prostate cancer initiation and clinical characteristics did not differ by race in our autopsy series, prostate cancer volume after radical continued page 5

Cabazitaxel: A New Weapon in the Fight against Advanced Prostate Cancer By Virgil H. Simons The recent meeting of the American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO-GU) provided a forum for discussion of many new protocols that are emerging to manage advanced stage prostate cancer. One of the most significant reports was that which highlighted the results of the Phase III TROPIC Trial in the use of cabazitaxel + prednisone versus mitoxantrone + prednisone in the treatment of metastatic castration-resistant prostate cancer (mCRPC) after previous first-line chemotherapy. Docetaxel (Taxotere) is the standard of care in treating first-line mCRPC; however, should the therapy fail and disease progression occurs, the patient is faced with: • No currently approved standard second-line therapy • Only treatment options: supportive care or investigational drugs • Palliative care • No protocols with Overall Survival (OS) benefit demonstrated The data generated through the TROPIC trial, proven at 146 sites in 26 countries, points the way toward Cabazitaxel showing advantages over current taxane therapy in improving overall survival, progression free survival and safety. The graph shown below demonstrates the primary endpoint of OS. !"#$%"&'()*+,#)-.'/01"%22'34"0#0%2'5677'8)%2&9#9: ' ' ' ' ' !",+,"B,) JFF ,C'/3'5D: '

;!

EF

The FDA has approved PROVENGE® (sipuleucel-T) as an autologous cellular immuno therapy for the treatment of men with asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. PROVENGE is designed to stimulate a patient’s immune system to target prostate cancer cells. Pre-approval data was presented at ASCO-GU by Dr. Phil Kantoff and can be viewed by clicking here.

HF

IF

;! [email protected]" '';! %-'"#9A ' ''! !

%)) %)!

The questions and contretemps over the use of the PSA test is focusing on the need for new bio-markers to detect the potential for and/or the progression of prostate cancer. The recent ASCOGU Symposium highlighted several developments in this area. Two key presentations based on new models focused firstly on the detection of TMPRSS2:ERG in urine for early detection of significant PCa; click here to view the abstract. Another presentation, viewed here, detailed the use of TMPRSS2:ERG to predict prostate biopsy outcomes using a mathematical model for greater Dr. Nicholas Vogelzang diagnostic accuracy. Building on data captured in the dutasteride REDUCE trial, the major presentation on the viability of the PCA3 molecular urine test generated significant interest in being able to predict repeat biopsy outcomes as well as providing a basis for increased diagnostic accuracy. The hypothesis is that PCA3 will be useful in identifying more aggressive PCa and detecting undiagnosed cancers. A summary of the presentation can be seen here. We had a brief conversation with Dr. Nicholas Vogelzang who commented on this new category of diagnostic tools. You can view the video of the interview by clicking here.

By editorial staff

#*+ #*+# # '+)' '+ )' '+ *&,'+!% '+*&,'+!% -+'''# -+ '''#

GF

F F'$,)-K9

By editorial staff

PROVENGE® Approved ! !

#"+) #"+)

;1*#%)'/3'5$,)-K9: ;1*#%)'/3'5$,)-K9: P%Q%"*'R%B, P% Q%"*'R%B, MND MND'
View more...

Comments

Copyright © 2017 UPDOC Inc.