Obesity
and Weight Gain Tied to Prostate Cancer Death
Excess weight may not raise a man's risk of
developing prostate cancer, but it may make him more likely to die of
the disease
MONDAY, January 8
(Reuters Health) - Excess weight may not raise a man's risk of
developing prostate cancer, but it may make him more likely to die of
the disease, researchers reported Monday.In a study of nearly 288,000
U.S. men, researchers found that obese men were actually less likely
than their thinner counterparts to develop prostate cancer during the
5-year study period.
However, the heavier
a man was, the greater his risk of dying from the disease. Dr.
Margaret E. Wright and colleagues at the National Cancer Institute
report the findings in the journal Cancer.
Past studies have
come to conflicting conclusions about the role of excess weight in
prostate cancer. While some have suggested that increased weight is a
risk factor for the disease, most have found no relationship.
The new study
followed 287,760 men between the ages of 50 and 71 starting in 1995.
At the outset, the men completed a questionnaire about their overall
health, diet and lifestyle habits, height and weight. Over the
next five years, 9,986 men were diagnosed with prostate cancer.
Severely obese men had the lowest risk of developing the disease.
When it came to
prostate cancer deaths, however, the risk climbed in tandem with a
man's weight. Overweight men were 25 percent more likely than thin men
to die, while obese men were 46 percent more likely. Similarly,
the amount of weight a man gained through adulthood was unrelated to
his prostate cancer risk. But greater weight gain was linked to a
higher risk of death from the disease.
According to the
researchers, hormones might help explain why excess fat would be
linked to prostate cancer death, but not development. Obesity lowers
levels of testosterone, which helps fuel prostate cancer, so excess
weight may help prevent the disease in the first place.
On the other hand,
Wright and her colleagues explain, heavy men have higher levels of
insulin-like growth factor-1 and leptin -- two hormones that may aid
the progression of tumors. So once an overweight man develops prostate
cancer, it may be more likely to prove fatal.
The findings, they
conclude, suggest that prostate cancer progression could be added to
list of health consequences of obesity.
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Prostate
Cancer Symptoms
If the cancer is caught
at its earliest stages, most men will not experience any symptoms.
Some men, however, will experience symptoms that might indicate the
presence of prostate cancer, including:
- A need to urinate frequently, especially at night;
- Difficulty starting urination or holding back urine;
- Weak or interrupted flow of urine;
- Painful or burning urination;
- Difficulty in having an erection;
- Painful ejaculation;
- Blood in urine or semen; or
- Frequent pain or stiffness in the lower back, hips, or
upper thighs.
Because these
symptoms can also indicate the presence of other diseases or
disorders, men who experience any of these symptoms will undergo a
thorough work-up to determine the underlying cause of the symptoms.
Being
Active May Ward Off Prostate Cancer Death
Exercising may reduce a man's risk of developing advanced prostate
cancer and make him less likely to die from the disease
Exercising may reduce a man's risk of developing advanced prostate
cancer, a large study from Norway suggests.
In the study, men
who were the most active were 36 percent less likely to be diagnosed
with advanced prostate cancer than their sedentary peers, while they
were 33 percent less likely to die from the disease, Dr. Tom I. L.
Nilsen and colleagues from the Norwegian University of Science and
Technology in Trondheim report.
However, the men's
level of activity had no effect on their overall prostate cancer risk,
possibly because exercise influences the aggressiveness of a cancer,
rather than the likelihood of cancer developing in the first place,
they note.
Studies of exercise
and prostate cancer risk have yielded mixed results, Nilsen and his
team write in the International Journal of Cancer.
To investigate further, they looked at a group of 29,110 men who were
followed for 17 years, during which time 957 developed prostate
cancer.
There was no
relationship between men's level of recreational activity and their
prostate cancer risk overall, the researchers found. However, the more
active the men were, the less likely they were to be diagnosed with
advanced prostate cancer, and the less likely they were to die of the
disease. Compared to men who were sedentary, those who worked out once
weekly were 30 percent less likely to be diagnosed with cancer that
had spread beyond the prostate.
Two large US studies
had similar results, with no effect of exercise on prostate cancer in
general but a lower risk of advanced disease or death from the disease
for the most vigorously active men, the researchers note.
Prognostic
Model Identifies Low-Risk Prostate Cancer
An updated prognostic model can more accurately
identify prostate cancers that are unlikely to spread and do not
require aggressive treatment
By David Douglas
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-
An updated prognostic model can accurately
identify prostate cancers that are unlikely to spread and do not
require aggressive treatment, Dutch researchers report in The
Journal of Urology.
"This
model," lead investigator Dr. Ewout W. Steyerberg told Reuters
Health, "may help to identify a subgroup of men who are most
likely to have a rather indolent prostate cancer."
Steyerberg of
Erasmus Medical Center, Rotterdam and colleagues note that a variety
of features, including the results of a standard blood test, called
the prostate-specific antigen (PSA) test, and the number of cancer
cells at biopsy have been incorporated into prognostic models.
The researchers
tested one model in 247 patients with prostate cancer who were treated
with surgical removal of the gland. Indolent cancers were cancers that
had not spread outside of the prostate.
Overall, 49 percent
of the group had indolent cancer, a much higher percentage than the
average predicted probability, which was around 20 percent. This means
that by using the model many men could avoid aggressive treatments
that will not improve their survival rate, but may lower their quality
of life.
"Using this
model," Steyerberg concluded, "may contribute to reducing
the overtreatment of men with prostate cancer."
SOURCE: The
Journal of Urology,
January 2007
Prostate
Cancer Treatment Cost Varies Widely
An evaluation of healthcare utilization and direct
costs of prostate cancer-related treatments shows that the total cost
burden of prostate cancer varies significantly by treatment type
By Will Boggs, MD
-- January 18 (Reuters Health)
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- The total cost burden of prostate cancer varies
significantly by treatment type, according to a new report.
"I would like
this information to be used by clinicians to emphasize that,
especially, the initial costs of a prostate cancer treatment are not
reflective of the full cost over time of the treatment and, therefore,
should not be used to determine the best choice of treatment for a
patient or in decisions of treatment insurance coverage," Dr.
Leslie S. Wilson from University of California, San Francisco, told
Reuters Health.
Wilson and
colleagues compared patterns of healthcare utilization and direct
costs of prostate cancer-related treatments over a 5.5-year period in
4553 newly diagnosed patients, stratified by age, risk group, and
ethnic group
In the first 6
months after diagnosis, direct prostate-related costs per patient were
high ($11,495) and highly variable ($2586 for watchful waiting to
$24,204 for external-beam radiation therapy), the researchers report.
After the first 6
months, prostate-related costs were only $3044, ranging from $2418 for
radical prostatectomy to $6019 for androgen deprivation therapy.
Cumulative costs for
the entire period were highest for androgen deprivation therapy
($69,244) and external-beam radiation therapy ($59,455) and lowest for
watchful waiting ($32,135) and brachytherapy ($35,143), the
researchers note.
The most costly
treatments were generally reserved for the highest risk groups, the
report indicates, whereas the least costly treatments were primarily
used by the lowest risk groups.
"Our data
demonstrate that prostate-related costs per person are substantial and
sustained over time, and that short-term treatment cost comparisons
most commonly found in the literature do not truly reflect the cost of
treatment choices over the long term," the investigators
conclude.
"It appears
that current treatment is following clinical treatment guidelines from
our data," Dr. Wilson added. "Our paper also reminds us that
it is important to examine the downstream costs (which indicate more
care needs) of each of the different treatments."
January 10 (Reuters Health)
Removing
a prostate with so-called " insignificant" cancers
can also mean a life-threatening change was eliminated before
it happened. Overdiagnosing in young men is impossible to
prove because small, undistinguished tumors can acquire
aggressive features over time.