Posts Tagged ‘urology’

Knowledge is power: Men who are uneducated about their prostate cancer have difficulty making good treatment choices

UCLA researchers found that men who aren’t well educated about their disease have a much more difficult time making treatment decisions, called decisional conflict, a challenge that could negatively impact the quality of their care and their long-term outcomes.

The study should serve as a wake-up call for physicians, who can use the findings to target men less likely to know a lot about their prostate cancer and educate them prior to their appointments so they’re more comfortable making treatment decisions, said study first author Dr. Alan Kaplan, a resident physician in the UCLA Department of Urology.

“For prostate cancer, there is no one right answer when it comes to treatment. It comes down to the right answer for each specific patient, and that is heavily dependent on their own personal preferences,” Kaplan said. “Men in general, and specifically economically disadvantaged men, have a hard time deciding what their preferences are, how they feel about any possible complications and what the future after treatment might be like. If you don’t know anything about your disease, you’ll have a really tough time making a decision.”

The findings from the one-year study appear in the early online edition of the peer-reviewed journal Cancer.

The research team surveyed 70 men at a Veterans Administration clinic who were newly diagnosed with localized prostate cancer and had enrolled in a randomized trial testing a novel shared decision-making tool. They collected baseline demographic and clinical such as age, race, education, co-existing medical conditions, relationship status, urinary and sexual dysfunction and their prostate cancer knowledge.

UCLA researchers talked one-on-one with the men after they had received their cancer diagnosis, but before they consulted with a physician. Median age of the men in the study was 63 years, 49% were African American and 70% reported an annual income of less than $30,000.

Kaplan said the team found that a low level of prostate cancer knowledge was associated with increased decisional conflict and higher uncertainty about what treatment to choose. Low levels of prostate cancer knowledge also were associated with lower perceived effectiveness — meaning the less they knew about their cancer, the less confidence they had that the treatment would be effective.

“Knowledge about prostate cancer is an identifiable target. Interventions designed to increase a patient’s comprehension of prostate cancer and its treatments may greatly reduce decisional conflict,” Kaplan said, adding that further study is needed to better characterize this relationship and identify effective targeted interventions.

“If you get shot in the gut, there aren’t many options. You go into the operating room to get fixed up,” he said. “With prostate cancer, there are lots of options and not all are right for everybody.”

Men with prostate cancer might need to decide between surgery versus radiation or opting for active surveillance, in which patients are monitored closely for changes in the progression of their cancer and are tested at regular intervals. Prostate cancers can also be treated implantable radioactive seeds or tumors may be burned or frozen as treatment.

Another benefit to reducing decisional conflict is that patients who feel comfortable with their decision may regret their decisions less down the line, Kaplan said. They’re less likely to sue their doctors and generally experience better outcomes.

“In a way, it’s like buying a car. You prepare, you read reports, do your homework,” Kaplan said. “If something goes wrong with the car, you feel OK because you knew what you were getting into. When patients take ownership of the decision-making process, their outcomes are better.”

Kaplan said economically disadvantaged men may be having more difficulty because they may not have as much experience negotiating the healthcare system and are less confident when communicating with doctors.

“Doctors, we know intuitively, should spend more time with their patients, especially when they’re making an important decision,” he said. “But all of us are challenged with the numbers of patients we must see in a day. If you know beforehand that a patient has a poor knowledge about his cancer, that’s someone you need to spend more time with.”

Doctors may also want to provide these patients with educational information before their consultation so they can begin to increase their prostate cancer knowledge, Kaplan said.

Prostate cancer is the most frequently diagnosed cancer in men aside from skin cancer. An estimated 233,000 new cases of prostate cancer will occur in the United States in 2014. Of those, nearly 30,000 men will die.

source : http://www.sciencedaily.com/releases/2014/08/140827090136.htm

Thunder God Vine, with assists by nanotechnology, could shake up future cancer treatment

Now a team of scientists, led by Prof. Taeghwan Hyeon at the Institute for Basic Science (IBS)/Seoul National University and Prof. Kam Man Hui at the National Cancer Center Singapore, has screened a library containing hundreds of natural products against a panel of HCC cells to search a better drug candidate. The screen uncovered a compound named triptolide, a traditional Chinese medicine isolated from the thunder god vine (Tripterygium wilfordii (Latin) or lei gong teng (Chinese)) which was found to be far more potent than current therapies. Studies from other researchers corroborate our findings as triptolide has also found to be very effective against several other malignant cancers including; pancreatic, neuroblastoma and cholangiocarcinoma. However this excitement was tempered when the drug was administered to mice as the increased potency was coupled with increased toxicity as well.

Maximizing potency, mitigating toxicity

Prof. Hyeon et al. endeavoured to alleviate the toxic burden by increasing the specific delivery of the drug to the tumor using a nanoformulation. The designed formulation was a pH-sensitive nanogel coated with the nucleotide precursor, folate. The researchers began by esterfying the polymer pluronic F127 with folate to make the coating material. They then polymerized β-benzyl-L-aspartate N-carboxy anhydride to make the core material pH-sensitive due to repulsive forces upon protonation under acidic conditions. “The combination of the two polymers forms a core/shell structured nanoparticle in water,” explains Prof. Hyeon. “We loaded triptolide into the hydrophobic core to produce a kind of drug-nanogel.”

A tumor model of folate-overexpressing HCC was then used to examine the effect of the nanogel formulation versus the free drug. As expected, the nanogel triptolide showed increased tumor accumulation and uptake into the tumor cells where the decreasing pH efficiently triggered release of the entrapped triptolide. The result was as hypothesized: In experiments on mice with HCC, the team found that its coated triptolide accumulated in the inflamed tumour tissues. Once there, the folate-targeted ligand enhances the HCC cells to take up the anticancer drug. Since the fluid inside tumour cells is more acidic (with a pH of around 6.8) compared to normal tissue (which has a pH of about 7.4), the drop in pH causes the coating to fall apart, and release the pure form of the triptolide, which then destroys the tumor cells, showing greater efficacy against the tumor and decrease the overall toxicity.

The mechanism of action of Nf-Trip-FR+ represents an auspicious therapeutic approach

While these initial proof-of-concept studies have been promising, many drugs fail to become an IND (Investigational New Drug); fewer still effectively replicate their results in human trials. However, a felicitous discovery occurred while the researchers were examining the mechanism of triptolide’s activity. Researchers at the National Cancer Center Singapore ran a profile on the effects triptolide had on protein expression in a variety of HCC cells. From this they learned triptolide primarily reduced the levels of two proteins, AURKA and CKS2, although the mechanism is still not known. The researchers then cross-checked these proteins against a clinical database of HCC patients and found an increased expression of these proteins correlates with the aggressiveness of the cancer. Thus it is hoped the negative effect triptolide has on these proteins could prove beneficial in terms of clinical outcomes when this drug finally becomes accepted for clinical studies in cancer patients.

The present work is detailed in ACS Nano.

source : http://www.sciencedaily.com/releases/2014/08/140827091946.htm

Fighting prostate cancer with tomato-rich diet

With 35,000 new cases every year in the UK, and around 10,000 deaths, prostate cancer is the second most common cancer in men worldwide.

Rates are higher in developed countries, which some experts believe is linked to a Westernised diet and lifestyle.

To assess if following dietary and lifestyle recommendations reduces risk of prostate cancer, researchers at the Universities of Bristol, Cambridge and Oxford looked at the diets and lifestyle of 1,806 men aged between 50 and 69 with prostate cancer and compared with 12,005 cancer-free men.

The NIHR-funded study, published in the medical journal Cancer Epidemiology, Biomarkers and Prevention, is the first study of its kind to develop a prostate cancer ‘dietary index’ which consists of dietary components — selenium, calcium and foods rich in lycopene — that have been linked to prostate cancer.

Men who had optimal intake of these three dietary components had a lower risk of prostate cancer.

Tomatoes and its products — such as tomato juice and baked beans — were shown to be most beneficial, with an 18 per cent reduction in risk found in men eating over 10 portions a week.

This is thought to be due to lycopene, an antioxidant which fights off toxins that can cause DNA and cell damage. Vanessa Er, from the School of Social and Community Medicine at the University of Bristol and Bristol Nutrition BRU, led the research.

She said: “Our findings suggest that tomatoes may be important in prostate cancer prevention. However, further studies need to be conducted to confirm our findings, especially through human trials. Men should still eat a wide variety of fruits and vegetables, maintain a healthy weight and stay active.”

The researchers also looked at the recommendations on physical activity, diet and body weight for cancer prevention published by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR).

Only the recommendation on plant foods — high intake of fruits, vegetables and dietary fibre — was found to be associated with a reduced risk of prostate cancer. As these recommendations are not targeted at prostate cancer prevention, researchers concluded that adhering to these recommendations is not sufficient and that additional dietary recommendations should be developed.

source : http://www.sciencedaily.com/releases/2014/08/140827100218.htm