Issue 4 / August 2015
September is National Prostate Cancer Awareness Month; it's about being aware and informed.  I hope this newsletter will provide interesting and helpful information about prostate cancer to you or someone you know.
For my long term patients, I will now be offering the ability to have follow up appointments over the phone.  I've had a few requests for this service and I think it is a great idea.  I hope you will find this service to be a convenient option.  Of course, I am still more than happy to have an "in person" visit as well.  My office staff will ask your preference when it is time to schedule your next appointment.
To your good health!
R. Alex Hsi, MD

PPI Nutrition Class Winter 2016  

Stay tuned for dates for our next nutrition class focusing on prostate health. Class will be held every other Wednesday from 11:00 am to 1:00 pm starting in January 2016. You may register yourself and a guest. Peninsula Cancer Center Conference Room


Increased Risk of Prostate Cancer Recurrence in Smokers - Another reason to throw away those cigarettes
A recent study examined the association of cigarette smoking and smoking cessation with recurrence of prostate cancer in patients who had undergone radical prostatectomy. Rieken et al. (Eur Urol 2015 Jun 4) performed a retrospective analysis of over 6,500 patients who had undergone radical prostatectomy as primary treatment for prostate cancer between 2000 and 2011. The group was composed of approximately one third each of never, former and currently smoking men. The authors examined various features about the men's cancer (e.g. Gleason score, PSA, and surgical margin status) and their smoking habits (e.g. cigarettes per day, years of smoking, years since quitting). All patients underwent radical prostatectomy without any neoadjuvant (presurgical) therapy. Regular PSA blood tests were obtained on each patient after surgery.
Results: The cancer features of all three groups were comparable. In a multi-variable statistical analysis, the study found that current smokers were 1.8 times more likely and former smokers 1.6 times more likely to have a PSA recurrence than nonsmokers. The good news is that if you quit smoking for 10 or more years, your risk returns to that of the nonsmokers.
The Bottom Line: Smokers and those who quit less than 10 years ago have a significantly higher risk of prostate cancer recurrence after radical prostatectomy compared to nonsmokers or those who quit more than 10 years ago. Just another reason for your doctors to nag you to stop smoking!
Vitamin D May Slow the Progression of Low Grade Prostate Cancer - Preliminary results of a small randomized trial

Researchers from the Medical University of South Carolina recently presented the early results of a small randomized trial investigating the effect of Vitamin D on patients with low grade prostate cancer undergoing radical prostatectomy. In this trial, 37 men who were waiting to undergo surgery for their prostate cancer were randomly assigned to receive either 4,000 IU (international units) of Vitamin D per day or placebo. All patients then underwent radical prostatectomy and their prostates were examined.
Results: Lead researcher, Bruce Hollis, PhD, reported that "In greater than 60% of those taking it, Vitamin D actually made the cancer better." He reported that in some cases the tumors shrank and in others the cancer went away. However, the study was small, and results from a larger trial aren't expected for several years, he added.
The Bottom Line: It is intriguing to think that Vitamin D, a vitamin that many physicians recommend for a variety of ailments, is also helpful in fighting prostate cancer. But results are preliminary and further study remains to be done to reach any definite conclusions about Vitamin D and its effect on prostate cancer.

Androgen Deprivation Therapy with or without Radiation Therapy for Node Positive Prostate Cancer

The role of radiation therapy in patients who are diagnosed with prostate cancer which has spread to the lymph nodes (node positive) in the pelvis is not well defined. However, a recent study published in the Journal of the National Cancer Institute (Lin et al., 107(7), July 1 2015) showed a significant survival advantage in patients who received both androgen deprivation therapy (ADT) and radiation therapy (RT) compared to those patients who received ADT alone.

The authors of the study used a patient data base called the National Cancer Data Base to assess the effect of adding RT to ADT in patients diagnosed with clinically node positive prostate cancer. A total of 3,540 patients treated between 2004 and 2011 were included in the study. In order to make sure the two groups of patients were equally matched in terms of the characteristics of the patients themselves and their cancers, a statistical analysis called propensity score matching was applied to the group. This allowed for an "apples to apples" comparison of the two treatments. After propensity score matching, 318 patients remained in each treatment group. The 5 year overall survival of the RT +ADT group was 71.5% versus 53.2% for the ADT alone group. This translated into a 50% decreased risk of mortality in the patients who received radiation therapy. The authors cautioned, however, that a randomized controlled trial would need to be performed to confirm the results of this retrospective study.

The Bottom Line: The addition of radiation therapy to androgen deprivation therapy significantly improves survival (by 50%) in patients diagnosed with lymph node positive prostate cancer. Results of this retrospective study should be confirmed in a randomized prospective trial.
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