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Medicine Science

Mayo Clinic Reports Dramatic Outcomes In Prostate Cancer Treatment 122

Posted by Soulskill
from the turns-out-the-tumor-was-his-sled dept.
Zorglub writes "Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced Friday. 'Cancer has a propensity for turning off T cells. Dr. Allison hypothesized that if you block the off-switch, T cells will stay turned on and create a prolonged immune response. Dr. Kwon, then at NIH, demonstrated that CTLA-4 blockage could be used to treat aggressive forms of prostate cancer in mice. There was one limitation to that concept — the worry that by simply leaving all the T cells on there may not be enough response aimed at the tumor. Dr. Kwon called Dr. Allison and designed the trial together. The idea: use androgen ablation or hormone therapy to ignite an immune approach — a pilot light — and then, after a short interval of hormone therapy, introduce an anti-CTLA-4 antibody that acts like gasoline to this pilot light and overwhelms the cancer cells.' After the treatment, the patients' tumors shrunk to such a degree that they could be successfully removed."
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Mayo Clinic Reports Dramatic Outcomes In Prostate Cancer Treatment

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  • by forgot_my_username (1553781) on Sunday June 21, 2009 @10:42AM (#28411091) Homepage

    If you told me just 1 year ago that steroids could be used to cure cancer rather than cause it, I would have laughed in your face.

    There are so many incidences of steroid users succumbing to cancer that it's not uncommon to see American body builders getting checked out in Mexican hospitals for various cancers. If this therapy really works, it is critical to find the balance point between androgenic steroid therapeutic use and outright abuse.

    It isn`t the androgen therapy that is doing it, it is the anti-ctla4 antibody that is doing the work.

    If anything the androgen therapy should be causing the prostate cancer to grow

    narf.

  • Re:Hmmmm (Score:5, Informative)

    by ceoyoyo (59147) on Sunday June 21, 2009 @11:23AM (#28411343)

    The immune system is constantly fighting cancer. Whenever something goes wrong when one of your cells divides, which happens relatively frequently, if the built in suicide mechanisms don't work then the immune system deals with it. What we call "cancer" is just the result when the cancerous cells get too far ahead.

  • Re:Smoke up America! (Score:5, Informative)

    by Grym (725290) * on Sunday June 21, 2009 @11:53AM (#28411527)

    Look, the study also says that this has applications against lung cancer as well. This is good, because, even if you quit smoking, you don't actually reduce your chances of getting lung cancer.

    That's not true.

    While it is true that previous smokers will always have (if only slightly) a higher lung cancer risk than non-smokers, the relationship is dose-dependent based upon the additive amount of tobacco exposure over time. So, those who quit smoking (particularly those who quit smoking earlier), are less likely to get lung cancer. In fact, one major study [bmj.com] found that those who quit smoking before the age of 30 had a lung cancer risk close to the non-smoker group. Those who quit smoking before the age of 50 had about half the risk of those who didn't.

    -Grym

  • One sided report (Score:2, Informative)

    by Anonymous Coward on Sunday June 21, 2009 @11:54AM (#28411543)

    There were 54 patients and only 3 had dramatic response.
    They are hoping that by adjusting the dosage that this
    will improve.
    http://www.minnpost.com/healthblog/2009/06/19/9659

    Ipilimumab failed a prior clinical trial for prostate cancer.
    http://pmid.us/17363537

    and failed a prior clinical trial for skin cancer. Also its
    side effects can include rashes, diarrhea and hepatitis.
    http://en.wikipedia.org/wiki/Ipilimumab

    It would be great if it worked but this is more likely
    one of the numerous "breakthroughs" that never
    pan out.

  • by shawb (16347) on Sunday June 21, 2009 @11:57AM (#28411581)
    Usually prostate cancer progresses at such a slow rate that an untreated patient will die of other unrelated causes before the prostrate cancer would kill them, or even cause significant quality of life issues. How many men would choose between impotence and a, say, 1/1000 (no idea if that is the actual chance) of dying earlier?

    Add in another possible side effect of cancer surgery: death. A small but significant number of patients die during prostrate sectioning surgery. Some patients die from sepsis caused by imperfect healing of the incisions (the large intestine is a very icky place, and you don't want what is inside there to get into the rest of the body.) For very mild cases of prostrate cancer, the risk of death due to surgery approaches the risk of death due to the cancer. Adding in other surgical complications involved, often times the best course of action with mild prostrate cancer is a wait and see policy, no matter how much the thought of this scares the patient (other types of cancer are usually "get it out as quick as possible" situations.) While surgery may indeed currently not be the best course of action in mild prostrate cancers, this will likely eventually change. The rates of surgical complications (including death) of course are going to keep going down as advances are made in surgical technique (such as cellular level laparoscopic microscopy allowing the surgeon to identify individual nerves to avoid sectioning, allowing for preservation of bladder control and sexual function.) However, these advanced procedures are indeed quite expensive and I think as a society we will eventually have to start asking whether extending a patients life is worth the financial cost.
  • Re:Smoke up America! (Score:4, Informative)

    by SquirrelsUnite (1179759) on Sunday June 21, 2009 @12:27PM (#28411855)

    The information you got is either wrong or very short sighted.

    I smoke and I've researched this issue into the ground. Its pretty accurate.

    Good, then it's going to be easy to provide some data.

    There's a reason why the "smoking benefits" timeline doesn't have a reduced cancer risk on it. It takes too long for lungs to clean themselves after you quit.

    I basically know nothing about this but a quick internet search turned up this:

    Stopping smoking can reduce your risk A large number of studies have shown that stopping smoking can greatly reduce the risk of smoking-related cancers.2 And the earlier you stop, the better. The last results from the Doctorsâ(TM) Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it.10 However, itâ(TM)s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life.30 The effects of stopping vary depending on the cancer. For example, ten years after stopping, a personâ(TM)s risk of lung cancer falls to about half that of a smoker.31 And the increased oral and laryngeal cancer risks practically disappear within ten years of stopping.2 But the risks of bladder cancer are still higher than normal 20 years after stopping.20 Cutting down the number of cigarettes you smoke slightly reduces your risk of lung cancer,32 but youâ(TM)ll only experience the full health benefits if you stop altogether. One study found that even smokers who halved the number of cigarettes they smoked had similar risks of dying from heart disease and only slightly lower risks of dying from cancer.33

    From http://info.cancerresearchuk.org/healthyliving/smokingandtobacco/howdoweknow/ [cancerresearchuk.org] You can actually follow some of the links and the abstracts of the cited studies do say that stopping smoking leads to decreased cancer risk down the line (though usually still higher than non-smokers)

    They don't publicize this, because of course, people will get the idea that you may as well keep smoking because you are going to get cancer no matter what you do, which is pretty true, but, they overlook the heart attacks, COPds and other bad things that can happen.

  • Re:Smoke up America! (Score:4, Informative)

    by Sensiblemonkey (1539543) on Sunday June 21, 2009 @01:01PM (#28412119)

    The information you got is either wrong or very short sighted.

    I smoke and I've researched this issue into the ground. Its pretty accurate.

    You were asked to produce a citation and failed to do so; citing your own research doesn't count for squat.

    Here's a citation I just pulled from the National Cancer Institute's website [cancer.gov]:

    "Quitting smoking substantially reduces the risk of developing and dying from cancer, and this benefit increases the longer a person remains smoke free. However, even after many years of not smoking, the risk of lung cancer in former smokers remains higher than in people who have never smoked"

    Emphasis placed there by me.

    So, unless you can produce a contrary citation, I think it's pretty safe to say you're a pathetic troll spreading misinformation.

  • Re:Nice analogy (Score:3, Informative)

    by linguizic (806996) on Sunday June 21, 2009 @01:16PM (#28412245)
    Thank God!!!!! At last someone in the universe remembers that Melllvar is spelled with 3 L's!!!!
  • Re:Smoke up America! (Score:4, Informative)

    by siddster (809752) on Sunday June 21, 2009 @01:57PM (#28412601) Journal

    I smoke and I've researched this issue into the ground. Its pretty accurate.

    No you haven't! This is a classic case of data dredging and selective presentation of data. For starters, amongst smokers with small primary lung cancers, smoking cessation is associated with an almost 3-fold reduction in cancer recurrence.
    (annals of internal medicine http://www.annals.org/cgi/content/abstract/119/5/383 [annals.org])

    Not only that, but sustained quitters (14.5 years in this study ... data in the pdf and you'll need a subscription to access it... http://www.annals.org/cgi/content/abstract/142/4/233 [annals.org]) had a 2.2 fold reduced incidence of lung cancer if they stayed cigarette free for that duration. Granted, that the risk never came back to baseline but its a far cry from declaring that smoking cessation doesn't reduce cancer mortality.

    Also, smoking cessation dramatically reduces heart disease and stroke mortality. The number one killer of smokers (surprise, surprise!) is not cancer but in fact heart disease. Heart disease is also the leading cause of death in the US with 1 in 3 people dying of heart trouble. Hence, even if the benefits in terms of cancer reduction are modest, smoking cessation considerably reduces the number of people dying.

    Get your facts right!

  • by nbauman (624611) on Sunday June 21, 2009 @09:42PM (#28415769) Homepage Journal
    FWIW, I recently sent the following email to a friend with prostate cancer who asked for my advice.

    The most useful parts are the links to the free NEJM articles.

    Note the study that followed men 55-59 with Gleason Grade 6 localized prostate cancer. 15% died from prostate cancer at 15 years. I think that's the number you're looking for.

    They said you can often make a good case for "watchful waiting," essentially no treatment. Good story about the guy who got off the table right before the operation and decided not to have surgery. (They deliberately chose a case where there isn't enough evidence to make an easy decision.)

    Note also that they had 1,200 surgeries with no fatalities, so the surgery is a lot safer than it was in your father's day.

    Dear _______

    The best, most reliable source of information to make a decision on prostate cancer that I ever found is The New England Journal of Medicine. There are 2 problems: (1) It can be difficult reading, although they know patients will be reading some of their articles and they try to edit those articles to be as understandable as possible. I think it's easier to read one difficult article that gives you the information you want than to read ten easy articles that don't. (2) Often in medicine, especially in prostate cancer, they don't have enough scientific evidence to make a clear, easy decision. But if you have to make a difficult decision, it's easier if you at least have the best evidence.

    I remembered 2 articles in the NEJM in particular. One was free online; I'm attaching a PDF of the other. These articles are technical but you should be able to understand them by reading slowly and carefully (as I do). They do a good job of telling you how a doctor thinks about prostate cancer. You can find an explanation of anything you don't understand on Wikipedia. I'm also giving you my own notes that I made when I read the articles, and it might be easier to scan them first for an overview. Your best source of information should be your own doctor, but these articles will help you talk to him.

    One article was a survey of patients and their wives on the outcomes of prostate cancer surgery and radiation. The standard question about prostate cancer surgery is, "What's the probability of sexual impotence?" You assume that you'r going to have the best odds, with a surgeon who does a lot of cases, at a hospital that does a lot of cases. Surgeons (and the American Cancer Society) like to make reassuring claims, so you have to be skeptical about how they define impotence. I got the impression that it was about 50%, and that's what this article reported. However, the results are better for younger patients -- 75-year-old men have low sexual functioning to start with. This article also discusses the problems of urinary incontinence, which as I recall wasn't as much of a problem. There is a basic tradeoff between surgery (radical prostatectomy) and radiation (either external beam radiation or brachytherapy): surgery is more likely to cause urinary problems, radiation is more likely to cause rectal inflammation. This article got a lot of press coverage so you can search Google News for further discussion and explanation.

    The other was a case history of a 55-year old man with a Gleason score of 6 (grade 3+3) who decided in 1996 to get surgery, and then changed his mind at the last minute and walked out of the operating room. He's been followed ever since and the cancer hasn't metastasized. The NEJM likes to give cases that are in the very grey area of the evidence, with the hardest decisions, and this is one of them. They have experts explain the evidence and their thinking behind each option, there isn't any right answer, and any of the options would be a reasonable choice. I've attached a PDF of that article.

    They followed up that article by inviting 3 more advocates for each of the 3 options to argue their case, and then invited readers to vote in an on-line poll. That article is free

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