Critical Review of Complementary Therapies for Prostate Cancer

2003 ◽  
Vol 21 (11) ◽  
pp. 2199-2210 ◽  
Author(s):  
Simon Wilkinson ◽  
Gerald W. Chodak
Keyword(s):  
Prostate Cancer ◽  
Health Care Professionals ◽  
Critical Review ◽  
Complementary Therapies ◽  
Treatment Strategies ◽  
Complementary Therapy ◽  
The United States ◽  
Sufficient Evidence ◽  
Current Evidence ◽  
Prostate Cancer Prevention

Despite its prominence as the most frequently diagnosed solid tumor among men in the United States, relatively little is known about the etiology of prostate cancer. Furthermore, research into treatment strategies for prostate cancer continues to lag behind research for the other most common cancers. At the same time, however, the popularity of complementary therapies among prostate cancer patients continues to grow. In this article, we provide a critical review of the most recent evidence for dietary modifications, food supplements, and herbs in prostate cancer prevention and treatment. Despite encouraging data for some of these interventions, even the strongest proponents of complementary therapy agree that only randomized controlled trials can provide sufficient evidence on which to create universal guidelines. However, such trials are highly complex and expensive, and they require lengthy follow-up. Until such trials are completed, an opportunity exists for health care professionals to improve their knowledge and understanding of the current evidence for or against complementary therapy in prostate cancer.

Overdiagnosis and Overtreatment of Prostate Cancer

2012 ◽  
pp. e35-e39 ◽  
Author(s):  
Ian M. Thompson
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
The United States ◽  
Assessment Tools ◽  
Low Grade ◽  
High Grade ◽  
Surveillance Strategy ◽  
Psa Testing ◽  
Prostate Cancer Prevention

Overview: Prostate cancer is a ubiquitous disease, affecting as many as two-thirds of men in their 60s. Through widespread prostate-specific antigen (PSA) testing, increasing rates of prostate biopsy, and increased sampling of the prostate, a larger fraction of low-grade, low-volume tumors have been detected, consistent with tumors often found at autopsy. These tumors have historically been treated in a manner similar to that used for higher-grade tumors but, more recently, it has become evident that with a plan of active surveillance that reserves treatment for only those patients whose tumors show evidence of progression, very high disease-specific survival can be achieved. Unfortunately, the frequency of recommendation of an active surveillance strategy in the United States is low. An alternative strategy to improve prostate cancer detection is through selected biopsy of those men who are at greater risk of harboring high-grade, potentially lethal cancer. This strategy is currently possible through the use of risk assessment tools such as the Prostate Cancer Prevention Trial Risk Calculator ( www.prostate.cancer.risk.calculator.com ) as well as others. These tools can predict with considerable accuracy a man's risk of low-grade and high-grade cancer, allowing informed decision making for the patient with a goal of detection of high-risk disease. Ultimately, other biomarkers including PCA3, TMPRSS2:ERG, and [-2]proPSA will likely aid in discriminating these two types of cancer before biopsy.

scholarly journals Integrative Oncology: Best of Both Worlds—Theoretical, Practical, and Research Issues

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Holger Cramer ◽  
Lorenzo Cohen ◽  
Gustav Dobos ◽  
Claudia M. Witt
Keyword(s):  
Complementary Medicine ◽  
Health Care Professionals ◽  
Complementary Therapies ◽  
The United States ◽  
Cancer Center ◽  
Integrative Oncology ◽  
Patient Centered ◽  
Research Issues ◽  
Medicine Research ◽  
Evidenced Based

More and more cancer patients use complementary therapies. As the majority of patients do not disclose their use of complementary therapies to their oncologists, they expose themselves to possible detrimental effects from the therapies due to drug interactions. To meet the needs of patients and health care professionals on valid information on complementary therapies, the collaborative research project “Competence Network Complementary Medicine in Oncology—KOKON”, an interdisciplinary network for complementary medicine research in oncology, was established. Moreover, Integrative Oncology, a combination of conventional and evidenced-based complementary therapies delivered using a comprehensive approach, is now increasingly used in the United States and Europe. A variety of different Integrative Oncology models have been established worldwide including an expert-based model at the Kliniken Essen-Mitte, Essen, Germany and a patient-centered, evidenced-based approach at The University of Texas MD Anderson Cancer Center. Both models are briefly reviewed. More research is needed and Comparative Effectiveness Research that places strong emphasis on the comparison of different treatment options in usual care settings by including more heterogeneous patients, using less standardized treatment protocols, and measuring patient-centered outcomes would provide useful information for decision-making. To improve the quality of care and research in Integrative Oncology, sustainable financial models for Integrative Oncology and more funding for research are needed.

scholarly journals Uncertainty and Quality of Life Among Men Undergoing Active Surveillance for Prostate Cancer in the United States and Ireland

2007 ◽  
Vol 2 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Josephine M. Hegarty ◽  
Meredith Wallace ◽  
Harry Comber
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
United States ◽  
Health Care ◽  
Active Surveillance ◽  
Psychological Health ◽  
Health Care Professionals ◽  
The United States ◽  
Management Option

Background. Prostate cancer continues to be the most common site of male cancers, particularly among older men in Europe and the United States, and the second most common male cancer worldwide. Active surveillance involves the use of no local or systemic therapy once prostate cancer has been diagnosed. A description of uncertainty and quality of life among men undergoing active surveillance in samples from both the United States and Ireland has the potential to enhance global health care delivery. Methods. The specific aim of this study is to enhance the understanding of the experience of active surveillance for prostate cancer among Irish and American men by measuring quality of life and levels of uncertainty among men over the age of 65 in receipt of the active surveillance management option for prostate cancer. A quantitative, descriptive survey design was used. Results. Twenty-nine men completed questionnaires. The results reveal that men undergoing active surveillance in the United States have slightly higher levels of uncertainty. Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries. Total affective and health-related quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences. Irish men had lower mean role and social function than U.S. men, and higher general health and energy. Irish men reported more urine bother and less sexual bother than U.S. men. Conclusion. To assist men with prostate cancer who are treated with the active surveillance management option, health care professionals must develop an awareness of how prostate cancer affects the man's physical and psychological health care outcomes.

Cardiovascular risk in men with prostate cancer

ESC CardioMed ◽  
2018 ◽  
pp. 1178-1181
Author(s):  
Daniel Perry ◽  
Megan Caram ◽  
Monika Leja
Keyword(s):  
Prostate Cancer ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Side Effects ◽  
Systemic Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Cardiovascular Risks ◽  
Prostate Cancer Treatment ◽  
Cardiovascular Side Effects

Among patients with prostate cancer, non-cancer-related deaths outnumber cancer-related deaths. Given that the majority of men with prostate cancer are over the age of 70 years, cardiovascular disease is one of the primary co-morbidities to consider when deciding on treatment strategies. This chapter discusses the current evidence on the cardiovascular risks of common treatments for prostate cancer, with emphasis on androgen deprivation therapy, chemotherapy, and newer secondary hormonal agents. Additionally it provides recommendations for monitoring patients for cardiovascular side effects when the decision is made to start systemic therapy. It is important to note that there are a limited number of randomized trials studying this field, and further research is needed given the continuous advancements being made in prostate cancer treatment.

National survey of practice patterns employing MRI-guided prostate biopsy for diagnosis of prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 104-104 ◽  
Author(s):  
Graham Tooker ◽  
Peter A. Pinto ◽  
Mohummad Minhaj Siddiqui
Keyword(s):  
Prostate Cancer ◽  
Geographic Location ◽  
Standard Of Care ◽  
The United States ◽  
Primary Objective ◽  
Sufficient Evidence ◽  
Targeted Biopsy ◽  
Urologic Oncology ◽  
Guided Biopsy ◽  
Targeted Mri

104 Background: Targeted MRI/Ultrasound (MR/US) guided biopsy is an emerging technology that has the potential to change standard of care for the diagnosis and management of prostate cancer. It is believed that this new technology is rapidly proliferating, however quantitative analysis to describe these trends is not available. The primary objective of this study was to assess nationwide urologist opinions and efforts to implement MR/US imaging into their prostate cancer practices. Methods: A questionnaire was generated and distributed using REDCap to 7341 practicing urologists within the United States. The twenty question survey was designed to gather information regarding demographics, current and recent changes in MRI use, opinions on targeted MR/US guided biopsy, and barriers to implementation. The survey results were then analyzed with ANOVA. Results: 291 practicing urologists completed the survey. Respondents were primarily trained in general urology (60%) or urologic oncology (22%) and well distributed across practice type and geographic location. 86% of respondents currently employ MRI in some capacity in their practice, and 60% report using MR/US guided biopsy. 67% of respondents report increased use of MR/US guided biopsy over the past 5 years and 81% believe it is appropriate to use MR/US guided biopsy for the diagnosis of prostate cancer. Academic centers had the greatest utilization of targeted biopsy (72%) and solo practitioners had the least (38%, p = 0.003). The northeast region also demonstrated greatest use of targeted biopsy (68%) and western region had the least (44%, p = 0.02). 24% of respondents feel there is sufficient evidence to employ MR/US as standard of care in all prostate biopsies, while 65% believe MR/US should be reserved for select cases such as men with prior negative biopsies. Of those not performing biopsies, 69% of respondents cited cost as a barrier to implementation. Conclusions: While there are some reservations about employing MR/US guided biopsy, the data suggests urologists support its use, and are making efforts to introduce targeted MR/US guided biopsy into their practice. Regional and practice setting variations exist in adaptation of this technology.

scholarly journals The current evidence on statin use and prostate cancer prevention: are we there yet?

2016 ◽  
Vol 14 (2) ◽  
pp. 107-119 ◽  
Author(s):  
Mahmoud A. Alfaqih ◽  
Emma H. Allott ◽  
Robert J. Hamilton ◽  
Michael R. Freeman ◽  
Stephen J. Freedland
Keyword(s):  
Prostate Cancer ◽  
Cancer Prevention ◽  
Current Evidence ◽  
Prostate Cancer Prevention ◽  
Statin Use

scholarly journals Diagnostic Strategies for Treatment Selection in Advanced Prostate Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 345
Author(s):  
Ciara S. McNevin ◽  
Anne-Marie Baird ◽  
Ray McDermott ◽  
Stephen P. Finn
Keyword(s):  
Prostate Cancer ◽  
Treatment Strategies ◽  
Treatment Selection ◽  
High Rate ◽  
Current Evidence ◽  
Diagnostic Strategies ◽  
Novel Treatment ◽  
Proven Efficacy ◽  
Novel Treatment Strategies ◽  
Poor Outcomes

Prostate Cancer (PCa) is a leading cause of morbidity and mortality among men worldwide. For most men with PCa, their disease will follow an indolent course. However, advanced PCa is associated with poor outcomes. There has been an advent of new therapeutic options with proven efficacy for advanced PCa in the last decade which has improved survival outcomes for men with this disease. Despite this, advanced PCa continues to be associated with a high rate of death. There is a lack of strong evidence guiding the timing and sequence of these novel treatment strategies. This paper focuses on a review of the strategies for diagnostic and the current evidence available for treatment selection in advanced PCa.

scholarly journals Finasteride to Prevent Prostate Cancer: Should All Men or Only a High-Risk Subgroup Be Treated?

2010 ◽  
Vol 28 (7) ◽  
pp. 1112-1116 ◽  
Author(s):  
Andrew J. Vickers ◽  
Caroline J. Savage ◽  
Hans Lilja
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
Treatment Strategies ◽  
Routine Care ◽  
Treatment Rate ◽  
Cancer Rate ◽  
Prostate Cancer Prevention ◽  
Numbers Needed To Treat ◽  
Treat All

Purpose Finasteride has been shown to reduce the incidence of prostate cancer. Yet the use of finasteride remains low, likely because of the risk of adverse effects. We sought to determine whether prostate-specific antigen (PSA) levels could identify a high-risk subgroup for which the benefits of finasteride treatment outweigh the potential harms. Patients and Methods Raw data from the Prostate Cancer Prevention Trial were used to model chemopreventive treatment strategies: treat all men, treat no men, or treat a high-risk subgroup based on PSA level. We weighted the benefits (reduction in cancer rate) and harms (treatment rate) of each strategy using numbers-needed-to-treat thresholds—the maximum number of men a clinician would treat with finasteride to prevent one cancer. Results Of 9,058 men, 1,957 were diagnosed with prostate cancer during the 7-year study. For the end point of all cancers, including both for-cause and end-of-study biopsies, the optimal strategy is to treat all or nearly all men. To reduce risk of cancers detected through routine care, treating men with PSA > 1.3 or > 2 ng/mL is optimal. For example, treating only men with PSA > 2 ng/mL reduced the treatment rate by 83% and resulted in a cancer rate only 1.1% higher than treating all men. Conclusion Clinicians wishing to reduce the risk of any biopsy-detectable prostate cancer should recommend finasteride to all men. Clinicians who believe that it is unnecessary to prevent all cancers, but that preventing those readily detectable by screening would be desirable, would be best off recommending finasteride only to a high-risk subgroup.

scholarly journals Clinical Application and Educational Training for Pharmacogenomics

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 163 ◽  
Author(s):  
Jason W. Guy ◽  
Isha Patel ◽  
Julie H. Oestreich
Keyword(s):  
Clinical Application ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Healthcare Providers ◽  
The United States ◽  
Current Evidence ◽  
Clinical Settings ◽  
Educational Training ◽  
Secondary Objective ◽  
Medication Selection

Pharmacogenomics—defined as the study of how genes affect a person’s response to drugs—is growing in importance for clinical care. Many medications have evidence and drug labeling related to pharmacogenomics and patient care. New evidence supports the use of pharmacogenomics in clinical settings, and genetic testing may optimize medication selection and dosing. Despite these advantages, the integration of pharmacogenomics into clinical decisions remains variable and challenging in certain practice settings. To ensure consistent application across settings, sufficient education amongst current and future healthcare providers is necessary to further integrate pharmacogenomics into routine clinical practice. This review highlights current evidence supporting clinical application of medications with pharmacogenomic labeling. The secondary objective is to review current strategies for educating health professionals and student trainees. One national organization predicts that most regions in the United States will soon contain at least one healthcare system capable of applying pharmacogenomic information. Applying genotype-guided dosing to several FDA-approved medications may help produce beneficial changes in patient outcomes. Identifying best practices for educating health care professionals and trainees remains vitally important for continuing growth of pharmacogenomic services. As pharmacogenomics continues to expand into more areas of healthcare, current and future practitioners must pursue and maintain competence in pharmacogenomics to ensure better outcomes for patients.

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