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Mayo Clinic Reports Dramatic Outcomes In Prostate Cancer Treatment
Zorglub writes "Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced Friday. 'Cancer has a propensity for turning off T cells. Dr. Allison hypothesized that if you block the off-switch, T cells will stay turned on and create a prolonged immune response. Dr. Kwon, then at NIH, demonstrated that CTLA-4 blockage could be used to treat aggressive forms of prostate cancer in mice. There was one limitation to that concept — the worry that by simply leaving all the T cells on there may not be enough response aimed at the tumor. Dr. Kwon called Dr. Allison and designed the trial together. The idea: use androgen ablation or hormone therapy to ignite an immune approach — a pilot light — and then, after a short interval of hormone therapy, introduce an anti-CTLA-4 antibody that acts like gasoline to this pilot light and overwhelms the cancer cells.' After the treatment, the patients' tumors shrunk to such a degree that they could be successfully removed."
So the immune system will actually fight cancer, but the cancer negates this by turning off the T-cells. This is fascinating. The problem, from what I understand, is that cancer cells reproduce indefinitely as their DNA does not slowly break down. It seems like this could be a real breakthrough for lots of cancer patients.
zosxavius photography
If you told me just 1 year ago that steroids could be used to cure cancer rather than cause it, I would have laughed in your face.
There are so many incidences of steroid users succumbing to cancer that it's not uncommon to see American body builders getting checked out in Mexican hospitals for various cancers. If this therapy really works, it is critical to find the balance point between androgenic steroid therapeutic use and outright abuse.
It isn`t the androgen therapy that is doing it, it is the anti-ctla4 antibody that is doing the work.
If anything the androgen therapy should be causing the prostate cancer to grow
narf.
Fry: Usually on the show, they came up with a complicated plan, then explained it with a simple analogy.
Leela: Hmmm... If we can re-route engine power through the primary weapons and configure them to Melllvar's frequency, that should overload his electro-quantum structure.
Bender: Like putting too much air in a balloon!
Fry: Of course! It's all so simple!
Photos.
The Miracle Whip Clinic announced a similar breakthrough last year and they did it with much more tang.
Know what else causes impotence?
Being dead from cancer.
True, it would be ideal to have a treatment that doesn't require any surgery, but if your choice is between impotence or death, I think most people will have the operation.
even if you quit smoking, you don't actually reduce your chances of getting lung cancer
Every source I've ever seen on this subject says that although ex-smokers have a higher chance of developing lung cancer than do lifelong nonsmokers, they're still less likely to develop lung cancer than are current smokers (of the same age and smoking history, of course.) If you have a citation to the contrary, please give it.
The correlation between ignorance of statistics and using "correlation is not causation" as an argument is close to 1.
That's not true.
While it is true that previous smokers will always have (if only slightly) a higher lung cancer risk than non-smokers, the relationship is dose-dependent based upon the additive amount of tobacco exposure over time. So, those who quit smoking (particularly those who quit smoking earlier), are less likely to get lung cancer. In fact, one major study found that those who quit smoking before the age of 30 had a lung cancer risk close to the non-smoker group. Those who quit smoking before the age of 50 had about half the risk of those who didn't.
-Grym
There were 54 patients and only 3 had dramatic response.
They are hoping that by adjusting the dosage that this
will improve.
http://www.minnpost.com/healthblog/2009/06/19/9659
Ipilimumab failed a prior clinical trial for prostate cancer.
http://pmid.us/17363537
and failed a prior clinical trial for skin cancer. Also its
side effects can include rashes, diarrhea and hepatitis.
http://en.wikipedia.org/wiki/Ipilimumab
It would be great if it worked but this is more likely
one of the numerous "breakthroughs" that never
pan out.
Usually prostate cancer progresses at such a slow rate that an untreated patient will die of other unrelated causes before the prostrate cancer would kill them, or even cause significant quality of life issues. How many men would choose between impotence and a, say, 1/1000 (no idea if that is the actual chance) of dying earlier?
Add in another possible side effect of cancer surgery: death. A small but significant number of patients die during prostrate sectioning surgery. Some patients die from sepsis caused by imperfect healing of the incisions (the large intestine is a very icky place, and you don't want what is inside there to get into the rest of the body.) For very mild cases of prostrate cancer, the risk of death due to surgery approaches the risk of death due to the cancer. Adding in other surgical complications involved, often times the best course of action with mild prostrate cancer is a wait and see policy, no matter how much the thought of this scares the patient (other types of cancer are usually "get it out as quick as possible" situations.) While surgery may indeed currently not be the best course of action in mild prostrate cancers, this will likely eventually change. The rates of surgical complications (including death) of course are going to keep going down as advances are made in surgical technique (such as cellular level laparoscopic microscopy allowing the surgeon to identify individual nerves to avoid sectioning, allowing for preservation of bladder control and sexual function.) However, these advanced procedures are indeed quite expensive and I think as a society we will eventually have to start asking whether extending a patients life is worth the financial cost.
I'll never make that mistake again, reading the experts' opinions. - Feynman
The information you got is either wrong or very short sighted.
I smoke and I've researched this issue into the ground. Its pretty accurate.
Good, then it's going to be easy to provide some data.
There's a reason why the "smoking benefits" timeline doesn't have a reduced cancer risk on it. It takes too long for lungs to clean themselves after you quit.
I basically know nothing about this but a quick internet search turned up this:
Stopping smoking can reduce your risk A large number of studies have shown that stopping smoking can greatly reduce the risk of smoking-related cancers.2 And the earlier you stop, the better. The last results from the Doctorsâ(TM) Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it.10 However, itâ(TM)s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life.30 The effects of stopping vary depending on the cancer. For example, ten years after stopping, a personâ(TM)s risk of lung cancer falls to about half that of a smoker.31 And the increased oral and laryngeal cancer risks practically disappear within ten years of stopping.2 But the risks of bladder cancer are still higher than normal 20 years after stopping.20 Cutting down the number of cigarettes you smoke slightly reduces your risk of lung cancer,32 but youâ(TM)ll only experience the full health benefits if you stop altogether. One study found that even smokers who halved the number of cigarettes they smoked had similar risks of dying from heart disease and only slightly lower risks of dying from cancer.33
From http://info.cancerresearchuk.org/healthyliving/smokingandtobacco/howdoweknow/ You can actually follow some of the links and the abstracts of the cited studies do say that stopping smoking leads to decreased cancer risk down the line (though usually still higher than non-smokers)
They don't publicize this, because of course, people will get the idea that you may as well keep smoking because you are going to get cancer no matter what you do, which is pretty true, but, they overlook the heart attacks, COPds and other bad things that can happen.
How many men would choose between impotence and a, say, 1/1000 (no idea if that is the actual chance) of dying earlier?
You'd need to have the whole picture before you could make an educated choice.
I lost my father to prostate cancer a couple of years ago. When it got bad he wanted to die at home. We arranged that for him. I was with him during his last day. I watched him die.
I can tell you this. It's a life changing event watching someone die from cancer. Most people happily have no idea what it's like. I know though. Tumors up and down your spine, eyedroppers full of synthetic morphine to deal with the pain...it's absolutely unreal. Honestly.
Believe me, if it came down to it and someone told me today that they'd have to remove everything from my balls to my bellybutton to avoid that fate, I'd go to the table with a smile. I'd happily sit to pee if it meant I could dodge that bullet. Anyone would if they knew what I know.
Oh yeah, on an unrelated note - people who smoke are bat shit insane. They have absolutely no idea what's at the end of a losing roll of the dice.
Weaselmancer
rediculous.
Regardless of what I like or dislike about the health care plan, exceptions or provisions in any plan need to be in place so normal people can get treatments like this when they become available- even if they are still experimental and turn out to be a hail marry pass with the hopes of doing something other then the alternative of death.
What prompts you to say that? This has been done on exactly two patients. If done on say, one hundred, maybe it helps five and kills the rest. The medical literature is quite full of therapies that held great promise but never lived up to their expectations for one reason or another. We waste an enormous amount of time and money on expensive, dangerous therapies that in the end, don't help patients much, and can hurt more patients then they help. Until and unless we do the real, long term, difficult and boring research (and the comparative research between different therapies) we're going to go off half cocked and fully broke.
Your attitude, common as it is, is about 1/2 of what is drastically wrong with American healthcare. There is no substitute for good science.
Faster! Faster! Faster would be better!
The information you got is either wrong or very short sighted.
I smoke and I've researched this issue into the ground. Its pretty accurate.
You were asked to produce a citation and failed to do so; citing your own research doesn't count for squat.
Here's a citation I just pulled from the National Cancer Institute's website:
"Quitting smoking substantially reduces the risk of developing and dying from cancer, and this benefit increases the longer a person remains smoke free. However, even after many years of not smoking, the risk of lung cancer in former smokers remains higher than in people who have never smoked"
Emphasis placed there by me.
So, unless you can produce a contrary citation, I think it's pretty safe to say you're a pathetic troll spreading misinformation.
I smoke and I've researched this issue into the ground. Its pretty accurate.
No you haven't! This is a classic case of data dredging and selective presentation of data. For starters, amongst smokers with small primary lung cancers, smoking cessation is associated with an almost 3-fold reduction in cancer recurrence.
(annals of internal medicine http://www.annals.org/cgi/content/abstract/119/5/383)
Not only that, but sustained quitters (14.5 years in this study ... data in the pdf and you'll need a subscription to access it... http://www.annals.org/cgi/content/abstract/142/4/233) had a 2.2 fold reduced incidence of lung cancer if they stayed cigarette free for that duration. Granted, that the risk never came back to baseline but its a far cry from declaring that smoking cessation doesn't reduce cancer mortality.
Also, smoking cessation dramatically reduces heart disease and stroke mortality. The number one killer of smokers (surprise, surprise!) is not cancer but in fact heart disease. Heart disease is also the leading cause of death in the US with 1 in 3 people dying of heart trouble. Hence, even if the benefits in terms of cancer reduction are modest, smoking cessation considerably reduces the number of people dying.
Get your facts right!
Your statement combined with your signature is rather disturbing...
The nation can't afford to fund every experimental or crazy expensive treatment for everyone - we'd go broke. It's a noble goal but just not possible.
Instead, I see this as an opportunity for private insurance to thrive. I welcome government insurance as it will allow me to disconnect my health care from my employer. But I see an opportunity for a private company to offer supplemental insurance. With no preexisting conditions and, say, $20 a month, you could be covered up to $500,000 for experimental surgeries, out-of-country treatment, or other options for things not covered by your government plan. It lets the rich folks spend their extra money on something.
And the government can continue to fund research studies, like they probably did this one, so that those too poor or without supplemental insurance have a chance to participate. It's a win-win situation.
It doesn't hurt to be nice.
I am saddened if this treatment is found to be a breakthrough that it has come too late for us who have lost a loved one
Rejoice. For two reasons.
1) Other people will be spared our experience.
2) We're both genetically predisposed to prostate cancer, which means that this cure may help us someday. We might dodge the bullet. As a father myself I know I'd rather get cancer than my son. Easy decision. Maybe our Dads would feel the same way. "At least my son doesn't have to have this."
Weaselmancer
rediculous.
The most useful parts are the links to the free NEJM articles.
Note the study that followed men 55-59 with Gleason Grade 6 localized prostate cancer. 15% died from prostate cancer at 15 years. I think that's the number you're looking for.
They said you can often make a good case for "watchful waiting," essentially no treatment. Good story about the guy who got off the table right before the operation and decided not to have surgery. (They deliberately chose a case where there isn't enough evidence to make an easy decision.)
Note also that they had 1,200 surgeries with no fatalities, so the surgery is a lot safer than it was in your father's day.
Dear _______
The best, most reliable source of information to make a decision on prostate cancer that I ever found is The New England Journal of Medicine. There are 2 problems: (1) It can be difficult reading, although they know patients will be reading some of their articles and they try to edit those articles to be as understandable as possible. I think it's easier to read one difficult article that gives you the information you want than to read ten easy articles that don't. (2) Often in medicine, especially in prostate cancer, they don't have enough scientific evidence to make a clear, easy decision. But if you have to make a difficult decision, it's easier if you at least have the best evidence.
I remembered 2 articles in the NEJM in particular. One was free online; I'm attaching a PDF of the other. These articles are technical but you should be able to understand them by reading slowly and carefully (as I do). They do a good job of telling you how a doctor thinks about prostate cancer. You can find an explanation of anything you don't understand on Wikipedia. I'm also giving you my own notes that I made when I read the articles, and it might be easier to scan them first for an overview. Your best source of information should be your own doctor, but these articles will help you talk to him.
One article was a survey of patients and their wives on the outcomes of prostate cancer surgery and radiation. The standard question about prostate cancer surgery is, "What's the probability of sexual impotence?" You assume that you'r going to have the best odds, with a surgeon who does a lot of cases, at a hospital that does a lot of cases. Surgeons (and the American Cancer Society) like to make reassuring claims, so you have to be skeptical about how they define impotence. I got the impression that it was about 50%, and that's what this article reported. However, the results are better for younger patients -- 75-year-old men have low sexual functioning to start with. This article also discusses the problems of urinary incontinence, which as I recall wasn't as much of a problem. There is a basic tradeoff between surgery (radical prostatectomy) and radiation (either external beam radiation or brachytherapy): surgery is more likely to cause urinary problems, radiation is more likely to cause rectal inflammation. This article got a lot of press coverage so you can search Google News for further discussion and explanation.
The other was a case history of a 55-year old man with a Gleason score of 6 (grade 3+3) who decided in 1996 to get surgery, and then changed his mind at the last minute and walked out of the operating room. He's been followed ever since and the cancer hasn't metastasized. The NEJM likes to give cases that are in the very grey area of the evidence, with the hardest decisions, and this is one of them. They have experts explain the evidence and their thinking behind each option, there isn't any right answer, and any of the options would be a reasonable choice. I've attached a PDF of that article.
They followed up that article by inviting 3 more advocates for each of the 3 options to argue their case, and then invited readers to vote in an on-line poll. That article is free