Hope For Cancer

The first major gene mutation associated with an increased risk for hereditary prostate cancer has been identified by scientists.

Men who inherit the mutation in the HOXB13 gene have a 10 to 20 times increased risk of developing prostate cancer, according to the study in the Jan. 12 issue of the New England Journal of Medicine.

The HOXB13 gene plays an important role in the development of the prostate during the fetal stage and in prostate function later in life.

The discovery of this gene mutation may help improve understanding about the development of prostate cancer and which men may require early screening for the disease, according to the team led by investigators at the Johns Hopkins University School of Medicine and the University of Michigan Health System.

The researchers analyzed DNA from the youngest prostate cancer patients in 94 families that had multiple cases of the disease among close relatives, such as fathers, sons and brothers. Members of four different families were found to have the same mutation in the HOXB13 gene. All 18 patients in those four families had the mutation.

The investigators then looked at 5,100 men who had been treated for prostate cancer and found that 1.4 percent (72) of them had the same HOXB13 gene mutation. The men with the mutation were much more likely to have at least one first-degree male relative (father or brother) who also had been diagnosed with prostate cancer.

When they looked at a control group of 1,400 men without prostate cancer, the study authors found that only one of the men had the mutation.

The researchers also looked at data from men enrolled in studies of early-onset or familial prostate cancer.

“We found that the mutation was significantly more common in men with a family history and early diagnosis compared with men diagnosed later, after age 55, without a family history. The difference was 3.1 percent versus 0.62 percent,” Dr. Kathleen Cooney, a professor of internal medicine and urology at the University of Michigan Medical School, and one of the study’s two senior authors, said in a Hopkins news release.

“It’s what we’ve been looking for over the past 20 years,” added fellow senior author William Isaacs, a professor of urology and oncology at the Johns Hopkins University School of Medicine. “It’s long been clear that prostate cancer can run in families, but pinpointing the underlying genetic basis has been challenging and previous studies have provided inconsistent results.”

An estimated 240,000 men in the United States will be diagnosed with prostate cancer this year. While the HOXB13 gene mutation may account for only a small number of prostate cancer cases, it may provide clues about how this cancer develops and help to identify a group of men who might benefit from early or additional prostate cancer screening, the researchers said. …source …more about prostate cancer

Among young women undergoing chemotherapy for breast cancer, use of the drug triptorelin to suppress ovarian function during treatment does not appear to improve post-treatment menstrual function. These results were published in the Journal of Clinical Oncology.

Fertility preservation is increasingly being recognized as an important issue for young people with cancer. In premenopausal women, many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Freezing embryos prior to cancer treatment is one of the most well established approaches to fertility preservation in young women, but is not always an option. One of the alternative approaches being evaluated involves the use of drugs known as gonadotropin-releasing hormone (GnRH) agonists to suppress ovarian function during chemotherapy. The hope is that this will protect the ovaries and improve post-treatment ovarian function.

To explore the effects of the GnRH agonist triptorelin during chemotherapy for breast cancer, researchers conducted a study among premenopausal women age 44 or younger. Study participants were assigned to receive either triptorelin or a placebo. The study was originally designed to enroll 124 women, but it was stopped after only 49 women were enrolled because preliminary results indicated no benefit from triptorelin.

• Menstruation resumed in 88 percent of women in the triptorelin group and 90 percent of women in the placebo group.
• Menstrual cycles resumed after a median of 5.8 months in the triptorelin group and 5.0 months in the placebo group.

These results suggest that triptorelin does not improve post-treatment menstrual function in young breast cancer patients. Other, ongoing studies will provide more information on this topic.

Premenopausal women who are interested in preserving their fertility during cancer treatment are advised to discuss their options with their physician before treatment begins.

Reference: Munster PN, Moore AP, Ismail-Khan R et al. Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology. Early online publication January 9, 2012. …source … more about ovarian cancer

Updated results from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial show no evidence that annual screening with the prostate-specific antigen (PSA) test reduces deaths from prostate cancer. These results were published in the Journal of the National Cancer Institute.

The PSA test is sometimes used as a screening test for prostate cancer. The goal of cancer screening is to reduce cancer mortality (deaths) by detecting cancer at an early stage, before symptoms develop. PSA levels tend to be elevated when prostate cancer is present, but levels can also be elevated in benign (non-cancerous) conditions affecting the prostate.

Although the PSA test is widely used, there has been little evidence that routine use of the test reduces deaths from prostate cancer. The risks and benefits of several cancer screening tests, including the PSA test, were evaluated in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The Study began in 1993 and enrolled people between the ages of 55 and 74 who had no personal history of one of these cancers.

To evaluate prostate cancer screening, more than 76,000 men were assigned to one of two groups: 1) a screening group, which received annual PSA testing for six years and annual digital rectal examination for four years; or 2) a comparison group, in which men received their usual medical care. For some men, usual care included PSA testing.

Study participants have now been followed for 13 years.

• Men in the screening group were 12 percent more likely to be diagnosed with prostate cancer than men in the comparison group.
• The rate of deaths from prostate cancer was similar in the two study groups.

These results suggest that organized, annual screening with the PSA test does not reduce prostate cancer mortality compared with usual care. Results from this study will be reanalyzed after study participants have been followed for 15 years.

Because each person’s situation is different, men may wish to discuss their individual risk of prostate cancer and need for screening with their physician.

Reference: Andriole GL, Crawford ED, Grubb RL et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: Mortality results after 13 years of follow-up. Journal of the National Cancer Institute. Early online publication January 6, 2012. …source …more about prostate cancer