What else was in the news today?

Today’s news contained items that run the spectrum from the clinical value of tomatoes and lycopene via the cardiovascular side effects of LHRH agonists and antagonists to the question of whether proton beam radiation therapy is really cost-effective. So here are the “news shorts” for the day:

Wang et al. report that, based on data from the Cancer Prevention Study — II Nutrition Cohort in 1992 or 1993 and June 2011, they were able to show that neither pre-diagnosis nor post-diagnosis dietary lycopene intake was associated with risk for prostate cancer-specific mortality (PCSM) in two cohorts of nearly 9,000 and about 5,600 patients respectively. On the other hand, among the patients diagnosed and treated for high-risk prostate cancers (T3-4, or Gleason score 8-10, or nodal involvement), a consistently reported lycopene intake above the average (median) did seem to be associated associated with lower risk for PCSM compared to a consistently reported lycopene intake that was lower than average  (median). How meaningful are their findings? Frankly, we just don’t know, but if you like tomatoes, eat them!

Verma et al. have carried out a careful review of studies on the cost and cost-effectiveness of proton beam therapy (PBRT) in a spectrum of cancers. They are clear on the value of PBRT in selected cancers such as pediatric brain tumors, selected left-sided breast cancers in women at high risk of cardiac toxicity, locally advanced forms of non-small cell lung cancer (NSCLC), and selected head/neck cancers in patients at higher risk of acute mucosal toxicities. On the other hand, they state bluntly that, “The cost-effectiveness for prostate cancer — the single most common diagnosis currently treated with [PBRT] was suboptimal.” For safety, they then conclude by saying that, “Together with increasing PBT availability, clinical trial evidence, and ongoing major technological improvements, cost-effectiveness data and conclusions from this analysis could change rapidly.”

Ferring has announced the development of the so-called PRONOUNCE trial to see if they can learn whether treatment with an LHRH antagonist (degarelix/Firmagon) comes with lest risk for cardiovascular complications and side effect that treatment with an LHRH agonist (leuprolide acetate/Lupron and others). According to the trial protocol and the media release issued by Ferring, this trial will enroll about 900 patients, staring this month, and will follow the patients for a year, with projected trial completion some time in 2019. There are currently some 50 study locations, all in either the USA or Canada.

Finally, in a paper by Porcaro et al., it is suggested that men with high serum testosterone levels and Gleason scores of 6 or 7 on biopsy are at somewhat greater risk for upgrading after a radical prostatectomy than men with lower serum testosterone levels. However, it also appears clear from the same paper that, in the same men, elevated PSA density provides much greater insight into risk for upgrading (odds ratio [OR] = 23.3, P = 0.08) than the patients’ serum testosterone levels.

3 Responses

  1. Regarding lycopene and prostate cancer

    Low-risk men: It is likely that low-risk and favorable intermediate-risk men dominate the study population, and therefore it is not surprising that lycopene use would not register as an influencing agent for this overall study population (non-metastatic prostate cancer patients diagnosed between 1992 and 2011). A big part of this explanation is that extremely few such men are going to die of prostate cancer, and, even if they do, death from prostate cancer for those rare patients will almost certainly be after an extremely long period since diagnosis. (As of current data from the American Cancer Society, 94% of all patients survived prostate cancer at the 15-year point, and most of the 6% mortality had to be from those who had distant metastatic at diagnosis, of whom the current data show only 28% surviving to the 5-year point.)

    High-risk men: Unfortunately, while the results encourage lycopene intake with a 69% reduction in risk of death but low statistical confidence that this is or is near to the true number, it appears there were very few men in this group. Here’s a quote from the abstract: “… Among men with high-risk cancers (T3-T4, or Gleason score 8-10, or nodal involvement), consistently reporting lycopene intake ≥ median on both post-diagnosis surveys was associated with lower PCSM (HR = 0.41, 95% CI 0.17 - 0.99, based on 10 PCSM cases consistently ≥ median intake) compared to consistently reporting intake < median. Future studies are needed to confirm the potential inverse association of consistently high lycopene intake with PCSM among men with high-risk prostate cancers…."

    I have consumed at least two servings of lycopene daily (mostly from cooked or processed tomatoes) from shortly after my diagnosis in late 1999 until the present for my initially very high-risk case, now with evidence of a cure.

  2. Yes Jim … But there is no evidence that the lycopene consumption is in any way related to your long-term remission (especially with all the other things youy have been taking i=over the same time period).

  3. Agreed.

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