Men opting for costly new prostate cancer treatment, study shows

Lindsey Konkel

NEW YORK (Reuters Health) - Men diagnosed with localized prostate cancer are more likely to be treated with proton beam therapy, a novel form of radiation therapy, if the technology is available nearby, a new study found.

Prostate cancer is the most common cancer in men -- the National Cancer Institute estimates that more than 240,000 men in the U.S. were diagnosed in 2011.

About nine out of 10 of those cases were localized prostate cancer, meaning the cancer hasn't spread outside the prostate gland. Nearly all men diagnosed with localized tumors survive at least five years after diagnosis.

In the study, researchers examined the treatment choices of nearly 20,000 men living inside or outside of a regional market for Loma Linda University, a hospital in Southern California with a proton beam facility. All men were diagnosed with low- to intermediate-risk prostate cancer between 2003 and 2006.

Currently, there are nine proton centers in operation in the United States and eight more in development, according to the National Association for Proton Therapy.

Touted as a technological advancement over other forms of radiation therapy, proton beam therapy allows radiated particles to more tightly target and destroy tumor cells, leaving more of the surrounding tissue intact.

The treatment is often billed as having lower impotence and incontinence rates than other radiation treatment options, but there's a lack of evidence to support this, according to Dr. David Aaronson, a urologist at Kaiser Permanente Medical Group in Oakland, California, and lead author of the study.

After taking into account factors such as tumor stage and year of diagnosis, Aaronson's team found that patients living near a proton beam facility were more than five times more likely to receive proton beam treatment than those living outside of the hospital's referral region.

Nearly nine percent of the patients living within the referral region for the facility received proton beam therapy, compared to less than two percent of patients throughout the rest of the state.

The researchers also found that younger and non-Hispanic white men were also slightly more likely to receive proton beam treatment.

"It's not surprising that men are more likely to be treated with a certain technology in an area where that technology is offered," Aaronson told Reuters Health.

While most insurers, including Medicare, cover proton beam therapy, it comes at a hefty price.

Previous studies have estimated that proton beam therapy costs twice as much as intensity-modulated radiation therapy, another form of external radiation therapy and about five times more than radioactive seed implants.

And side-by-side comparisons of proton beam therapy and other prostate cancer treatments have not been done, according to Dr. Leonard Lichtenfeld, chief medical officer for the American Cancer Society.

Despite the added costs, there's no evidence to suggest that proton beam therapy results in better outcomes than other forms of prostate cancer treatment, including other forms of radiation, surgery or hormone therapy.

Although proton beam therapy has been shown to be superior in targeting tumors of the brain, eye and spine, those cancers are rare.

Institutions with proton beam facilities often look to pad their numbers by treating prostate cancer, according to Dr. Anthony Zietman, a radiation oncologist at Massachusetts General Hospital in Boston who was not involved in the new study.

"People often think that technology is synonymous with 'better,' but in some cases, it's not," said Aaronson.

"With the healthcare crisis looming and multiple treatment options available, newer, more expensive procedures for prostate cancer should be validated before they are implemented," he said.

SOURCE: http://bit.ly/yHdxqN Archives of Internal Medicine, February 13, 2012

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The TV Watch: ‘Clinton’ on PBS Shows an Era That Feels Close Yet So Far

It’s remarkable, really, how little resonance that Clinton sex scandal has today. The White House intern who shook the world is barely ever mentioned in the 2012 presidential campaign. If her name comes up at all, it’s as an asterisk to Newt Gingrich. Critics like to point out that while Mr. Gingrich was leading the Republican charge to impeach President Bill Clinton in 1998, he was concealing his own extramarital affair with Callista Bisek, the young Congressional staffer who is now his third wife.

The Monica Lewinsky imbroglio is nonetheless at the center of a two-part, four-hour documentary called “Clinton” that will be shown Monday and Tuesday on PBS. It’s a long, solemn and supposedly reflective look back at the life and times of Bill Clinton that feels as if it were made the day he left office in 2001.

Amid all the furor over the Starr Report, Linda Tripp and a stained blue dress, it was hard back then to see what really mattered. Eleven years on “Clinton” doesn’t try to find out. The documentary is still too distracted by the Starr Report, Linda Tripp and the stained blue dress.

The film breathlessly chronicles every misstep and triumphant comeback of Mr. Clinton’s picaresque career in order to rue the damage his lifelong recklessness did to his reputation and his legacy. (Though actually, despite all that happened between 1992 and 2001, the former president is doing just fine.)

What the film doesn’t do is give viewers a more compelling reason to go back and relive that epoch. The film hits all the familiar Clinton milestones — childhood in Hot Springs, Ark.; abusive stepfather; Oxford; courtship of Hillary Rodham; the Arkansas gubernatorial races; Gennifer Flowers; Travelgate; Somalia; Whitewater; etc. — without exploring the deeper happenings that turned out to have had a more lasting impact on the world.

Yet two of the major cataclysms shadowing our times, the Sept. 11 attacks and the 2008 credit collapse, have roots that reach back to the Clinton administration.

The 1993 bombing of the World Trade Center, which turned out to be a dress rehearsal for Sept. 11, isn’t included in the narrative. The rise of Osama Bin Laden and the failed missile strikes against Al Qaeda training camps in 1998 are noted in passing and presented almost as a pesky foreign policy crisis that briefly distracted Mr. Clinton from the more enduring Monica Lewinsky scandal.

And there is no mention whatsoever of the repeal of the Depression-era Glass-Steagall Act, one of several fateful steps that the Clinton administration — in concert with Republicans — took in the name of deregulation. Some policies, like making home mortgages more accessible, helped fuel the economy, but they also heedlessly left Wall Street and other financial institutions free of adult supervision. With the help of the Bush administration that followed, those actions opened the way to derivatives trading that led to the collapse of Lehman Brothers and a domino line of multibillion-dollar bailouts to prevent the implosion of the world’s financial system.

Put it this way: Robert E. Rubin, the former Treasury secretary, is one of many Clinton administration alumni interviewed on camera, and while the PBS crew spoke to Mr. Rubin in 2010, he wasn’t asked about Glass-Steagall or any of the other decisions that he helped design and that after the 2008 credit debacle look so shortsighted. Mr. Rubin went on to become a top official at Citigroup and earned more than $100 million over 10 years — until Citigroup also teetered on the edge of self-destruction and had to be rescued with a $45 billion bailout.

Instead, Mr. Rubin is asked about the administration’s 1993 budget proposal to cut spending and raise taxes. “Twenty-two million new jobs were created,” Mr. Rubin says proudly. “Productivity went up. Incomes rose at all levels. And, for the first time in 30 years, we had a federal surplus.”

A lot of former allies are allowed to present themselves in the best possible light, without any hindsight, cautionary notes or credibility checks, including Dick Morris, a political strategist and former Clinton adviser who fell out of favor, had a change of heart and is now a contributor to Fox News.

“I said to him, ‘The problem that presidents have is not the sin, it’s the cover-up, and you should explore just telling the American people the truth,’ ” Mr. Morris recalls telling the president. (In Mr. Morris’s recollection Mr. Clinton was humbly grateful for his sage advice but didn’t have the nerve to follow it.)

Lucianne Goldberg, the literary agent who helped Linda Tripp entrap Ms. Lewinsky, is quoted at length, as is Michael Isikoff, the investigative reporter who first got wind of the White House affair. So are many of the journalists and biographers who made their reputations by chronicling how Mr. Clinton lost his.

Joe Klein, the author and journalist who wrote “Primary Colors,” a roman à clef about the Clintons’ first presidential campaign, is cited more than most and is also given the last word.

He disagrees with historians and former aides who say Mr. Clinton squandered his gifts and hobbled his potential for greatness. “I don’t know if you can say of a president who served us well and improved our material good that it was a wasted opportunity,” Mr. Klein argues. “And it was sure a lot of fun to watch.”

“Clinton” is fun to watch too, but mostly it’s a wasted opportunity.

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Patients Clamor for Cancer Drug That Shows Promise for Alzheimer's in Mice

PET_AlzheimerPET_Alzheimer

PET_Alzheimer1

PET image of an Alzheimer's brain

The pharmaceutical industry has beat a concerted retreat from developing drugs for diseases that affect the brain, stymied by the lengthy development times for these agents and a string of failures. Despite the evident risks, a new study shows how industry leaders should perhaps be taking the long view.

The report online last week in Science that an already approved cancer drug showed promise in mice in correcting both the molecular pathology and cognitive decline of Alzheimer’s has patients and their families clamoring for the compound.

Those suffering are asking by the hundreds for the drug despite warnings that evidence in mice often does not translate into later success in humans. Gary Landreth of Case Western Reserve University received a flood of requests from desperate families.

Landreth, the lead researcher on the study, did not hype the results. He acknowledged that bexarotene rapidly cleared the toxic amyloid peptides and seemed to improve cognition in mice. But he also emphasized that rodents differ from humans and that examining whether the drug can eliminate amyloid in a small human trial must be demonstrated now before moving forward to a larger test to ascertain whether cognition improves as well. In our story last Thursday, Landreth cautioned:

“Don’t try this at home because we don’t know what dose to give, we don’t know how frequently to give it, and there are a few nuances to its administration. So one shouldn’t be prescribing it off-label.”

It is also unclear whether a drug like bexarotene, even if it were a success for patients in the early stages of the disease, would work later as the pathology progresses and nerve cells start to perish.

The fallout from this story turned up in our comments section. One reader, identified only as Jeff_Davis, responded to another’s remarks by saying:

“You write: …’I'd be very worried about off-label use…’

“I guarantee you, this is way past ‘worry.’ A tsunami of off-label use is underway even as we speak. Friends, already in the grip of the Alzheimer’s horror — loved ones in their care, mostly — are already in contact with their physician, saying, ‘Will you prescribe this drug, or do I have to find someone who will?’”

The Case Western Reserve researchers are heading up an effort to move the drug quickly into human trials. Things should move along at a good clip because the safety profile is relatively well known for this nearly 13-year-old drug.

Patients and their families should hold tight because without drug trials that conform to well-established testing protocols, it will be impossible to know whether a drug originally approved for cutaneous T cell lymphoma will work for Alzeheimer’s. Using the drug off label now will be be like ingesting nothing more than a sophisticated dietary supplement. At the same time, drug manufacturers should take notice of the huge pent-up demand and think twice about scrapping their neuro development programs.

Image: Wikipedia Commons

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

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In Mice, Cancer Drug Shows Effect on Alzheimer's Symptoms

THURSDAY, Feb. 9 (HealthDay News) -- The cancer drug bexarotene quickly eliminates Alzheimer's disease-associated amyloid beta from the brain and reverses memory problems in mice, a new study finds.

The results suggest that bexarotene could possibly help the approximately 5.4 million Americans with Alzheimer's disease, according to the neuroscientists at Case Western Reserve University School of Medicine.

However, while studies involving animals can be useful, they often fail to produce similar results in humans.

Bexarotene is approved in the United States to treat skin problems caused by cutaneous T-cell lymphoma.

The body's inability to clear amyloid beta from the brain is a major factor in the development of Alzheimer's disease, according to a university news release. Previous research showed that the main cholesterol carrier in the brain, apolipoprotein E (ApeE), plays an important role in clearing amyloid beta proteins.

In this study, the researchers found that bexarotene increased ApoE expression, and the elevated levels of ApoE boosted clearance of amyloid beta from the brain. Bexarotene stimulates retinoid X receptors (RXR), which are proteins that control the production of ApoE.

Within six hours of receiving bexarotene, soluble amyloid levels in the mice fell by 25 percent and the effect lasted for three days. This decrease was associated with rapid improvement in a wide number of behaviors in mice with Alzheimer's, according to the release.

In addition, bexarotene treatment also rapidly stimulated the removal of amyloid plaques from the brain, the researchers said. The plaques are accumulations of amyloid that form in the brain and are a hallmark of Alzheimer's disease.

"This is a particularly exciting and rewarding study because of the new science we have discovered and the potential promise of a therapy for Alzheimer's disease," study senior author Gary Landreth, a professor of neurosciences, said in a university news release.

"We need to be clear; the drug works quite well in mouse models of the disease. Our next objective is to ascertain if it acts similarly in humans. We are at an early stage in translating this basic science discovery into a treatment," he added.

The study appeared Feb. 9 in the journal Science.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

View the original article here

Study on mice shows fasting weakens cancer

Early research on mice with cancer shows that fasting may weaken tumors and help chemotherapy work better, scientists said on Wednesday.

While it remains unknown if the same approach could work in humans, or if it would even be safe, researchers said the findings suggest a promising new route of study for improving response to cancer treatment.

In the mice experiments, "the combination of fasting cycles plus chemotherapy was either more or much more effective than chemo alone," said senior author Valter Longo, professor of gerontology and biological sciences at the University of Southern California (USC).

Longo and colleagues previously published findings in 2008 that showed how fasting protected normal cells against chemotherapy in a study that focused on one type of cancer and a single chemo drug.

The latest study expands on that research to show that fasting makes cancer cells more vulnerable, and spanned several different types of cancer in mice.

Types of cancers studied included breast cancer, melanoma, glioma and human neuroblastoma.

All cancers studied showed that fasting combined with chemotherapy improved survival, slowed the growth of tumors and/or limited their spread.

The study appears in the journal Science Translational Medicine.

"We don't know whether in humans it's effective," Longo said, adding that for now fasting should be "off-limits" to cancer patients, although they should feel they can ask their doctors about the possibility.

In 2010, a small study of 10 human cancer patients who tried fasting cycles with their drug treatment showed that they perceived fewer side effects from chemo, according to self-reported data. The study was published in the journal Aging.

The results of a phase 1 trial assessing the safety of fasting two days before and one day after chemotherapy in patients with breast, urinary tract and ovarian cancer, conducted at the USC, have been submitted for presentation at the annual meeting of the American Society of Cancer Oncologists later this year.

"A way to beat cancer cells may not be to try to find drugs that kill them specifically but to confuse them by generating extreme environments, such as fasting that only normal cells can quickly respond to," Longo said.

ksh/rl

View the original article here

In Mice, Cancer Drug Shows Effect on Alzheimer's Symptoms

THURSDAY, Feb. 9 (HealthDay News) -- The cancer drug bexarotene quickly eliminates Alzheimer's disease-associated amyloid beta from the brain and reverses memory problems in mice, a new study finds.

The results suggest that bexarotene could possibly help the approximately 5.4 million Americans with Alzheimer's disease, according to the neuroscientists at Case Western Reserve University School of Medicine.

However, while studies involving animals can be useful, they often fail to produce similar results in humans.

Bexarotene is approved in the United States to treat skin problems caused by cutaneous T-cell lymphoma.

The body's inability to clear amyloid beta from the brain is a major factor in the development of Alzheimer's disease, according to a university news release. Previous research showed that the main cholesterol carrier in the brain, apolipoprotein E (ApeE), plays an important role in clearing amyloid beta proteins.

In this study, the researchers found that bexarotene increased ApoE expression, and the elevated levels of ApoE boosted clearance of amyloid beta from the brain. Bexarotene stimulates retinoid X receptors (RXR), which are proteins that control the production of ApoE.

Within six hours of receiving bexarotene, soluble amyloid levels in the mice fell by 25 percent and the effect lasted for three days. This decrease was associated with rapid improvement in a wide number of behaviors in mice with Alzheimer's, according to the release.

In addition, bexarotene treatment also rapidly stimulated the removal of amyloid plaques from the brain, the researchers said. The plaques are accumulations of amyloid that form in the brain and are a hallmark of Alzheimer's disease.

"This is a particularly exciting and rewarding study because of the new science we have discovered and the potential promise of a therapy for Alzheimer's disease," study senior author Gary Landreth, a professor of neurosciences, said in a university news release.

"We need to be clear; the drug works quite well in mouse models of the disease. Our next objective is to ascertain if it acts similarly in humans. We are at an early stage in translating this basic science discovery into a treatment," he added.

The study appeared Feb. 9 in the journal Science.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

View the original article here

Study on mice shows fasting weakens cancer

Early research on mice with cancer shows that fasting may weaken tumors and help chemotherapy work better, scientists said on Wednesday.

While it remains unknown if the same approach could work in humans, or if it would even be safe, researchers said the findings suggest a promising new route of study for improving response to cancer treatment.

In the mice experiments, "the combination of fasting cycles plus chemotherapy was either more or much more effective than chemo alone," said senior author Valter Longo, professor of gerontology and biological sciences at the University of Southern California (USC).

Longo and colleagues previously published findings in 2008 that showed how fasting protected normal cells against chemotherapy in a study that focused on one type of cancer and a single chemo drug.

The latest study expands on that research to show that fasting makes cancer cells more vulnerable, and spanned several different types of cancer in mice.

Types of cancers studied included breast cancer, melanoma, glioma and human neuroblastoma.

All cancers studied showed that fasting combined with chemotherapy improved survival, slowed the growth of tumors and/or limited their spread.

The study appears in the journal Science Translational Medicine.

"We don't know whether in humans it's effective," Longo said, adding that for now fasting should be "off-limits" to cancer patients, although they should feel they can ask their doctors about the possibility.

In 2010, a small study of 10 human cancer patients who tried fasting cycles with their drug treatment showed that they perceived fewer side effects from chemo, according to self-reported data. The study was published in the journal Aging.

The results of a phase 1 trial assessing the safety of fasting two days before and one day after chemotherapy in patients with breast, urinary tract and ovarian cancer, conducted at the USC, have been submitted for presentation at the annual meeting of the American Society of Cancer Oncologists later this year.

"A way to beat cancer cells may not be to try to find drugs that kill them specifically but to confuse them by generating extreme environments, such as fasting that only normal cells can quickly respond to," Longo said.

ksh/rl

View the original article here

Study on mice shows fasting weakens cancer

Early research on mice with cancer shows that fasting may weaken tumors and help chemotherapy work better, scientists said on Wednesday.

While it remains unknown if the same approach could work in humans, or if it would even be safe, researchers said the findings suggest a promising new route of study for improving response to cancer treatment.

In the mice experiments, "the combination of fasting cycles plus chemotherapy was either more or much more effective than chemo alone," said senior author Valter Longo, professor of gerontology and biological sciences at the University of Southern California (USC).

Longo and colleagues previously published findings in 2008 that showed how fasting protected normal cells against chemotherapy in a study that focused on one type of cancer and a single chemo drug.

The latest study expands on that research to show that fasting makes cancer cells more vulnerable, and spanned several different types of cancer in mice.

Types of cancers studied included breast cancer, melanoma, glioma and human neuroblastoma.

All cancers studied showed that fasting combined with chemotherapy improved survival, slowed the growth of tumors and/or limited their spread.

The study appears in the journal Science Translational Medicine.

"We don't know whether in humans it's effective," Longo said, adding that for now fasting should be "off-limits" to cancer patients, although they should feel they can ask their doctors about the possibility.

In 2010, a small study of 10 human cancer patients who tried fasting cycles with their drug treatment showed that they perceived fewer side effects from chemo, according to self-reported data. The study was published in the journal Aging.

The results of a phase 1 trial assessing the safety of fasting two days before and one day after chemotherapy in patients with breast, urinary tract and ovarian cancer, conducted at the USC, have been submitted for presentation at the annual meeting of the American Society of Cancer Oncologists later this year.

"A way to beat cancer cells may not be to try to find drugs that kill them specifically but to confuse them by generating extreme environments, such as fasting that only normal cells can quickly respond to," Longo said.

View the original article here

Map Shows Where in U.S. to Beware of Lyme Disease

FRIDAY, Feb. 3 (HealthDay News) -- Areas in the United States where people have the highest risk of contracting Lyme disease are pinpointed in a new map created by the U.S. Centers for Disease Control and Prevention.

Lyme disease is one of the most rapidly emerging infectious diseases in North America. It's transferred by ticks and symptoms range from headaches, fever and a rash to arthritis and Bell's palsy, or damage to a facial nerve that can lead to temporary paralysis of the muscles on one side of the face.

The map shows that high infection risk is confined mainly to the Northeast and upper Midwest. There is a low risk in the South.

The map shows a clear risk of Lyme disease in large parts of the Northeast (including eastern Pennsylvania) from Maine going as far south as Maryland and northern Virginia.

The high risk area in the upper Midwest includes most of Wisconsin, a large part of northern Minnesota, and a small piece of northern Illinois.

The researchers also identified an emerging risk for Lyme disease along the Illinois/Indiana border, the New York/Vermont border, southwestern Michigan, and eastern North Dakota. There's also evidence that Lyme disease is moving into central Virginia.

The map was created after the most extensive Lyme-related field study ever conducted. The results, published in the February issue of the American Journal of Tropical Medicine and Hygiene, offer public health and other officials critical information on local risk.

"There has been a lot of discussion of whether Lyme disease exists outside of the Northeast and the upper Midwest, but our sampling of tick populations at hundreds of sites suggests that any diagnosis of Lyme disease in most of the South should be put in serious doubt, unless it involves someone who has traveled to an area where the disease is common," lead author Dr. Maria Diuk-Wasser, an assistant professor at the Yale School of Public Health, said in a journal news release.

"We can't completely rule out the existence of Lyme disease in the South, but it appears highly unlikely," she added.

More information

The American Academy of Family Physicians has more about Lyme disease.

View the original article here