This article will explore the progress being made by scientists who continue to study the genes responsible for familial ovarian cancer and a recent study of nearly 20,000 men aged 66 and older with early stage prostate cancer.
Ovarian cancer research is beginning to yield clues about how these genes normally work and how disrupting their action can lead to cancer. This information eventually is expected to lead to new drugs for preventing and treating ovarian cancer.
Research in this area has already led to better ways to detect high-risk genes and assess a woman’s ovarian cancer risk. A better understanding of how genetic and hormonal factors (such as oral contraceptive use) interact may also lead to better ways to prevent ovarian cancer.
New information about how BRCA 1 and BRCA 2 gene mutations increase ovarian cancer risk is helping women make practical decisions about prevention. For example, mathematical models have been developed that help estimate how many years of life an average woman with a BRCA mutation might gain by having both ovaries removed to prevent cancer from developing. However, it is important to remember that although doctors can predict the outcome of a group of women, it is still impossible to accurately predict the outcome for any individual woman.
Accurate methods of detecting ovarian cancer early could have a great impact on the cure rate. Researchers are testing new ways to screen women for ovarian cancer, and a national repository for blood and tissue samples from ovarian cancer patients is being established to aid in these studies. One method being tested is looking at a pattern of proteins in the blood (called proteomics) to find ovarian cancer early.
Two large studies are in progress now. One is in the United States, and the other is in the United Kingdom. Both studies look at using the CA-125 blood test along with ovarian (transvaginal) ultrasound to find ovarian cancer. These studies have found early cancers in some women. But, it is not known whether the outcomes of these women have been improved compared to women who haven’t undergone screening.
Treatment research includes testing the value of current treatment, and new chemotherapy combinations that may help combat cancers resistant to current treatments are constantly being investigated. For cancers to grow, blood vessels must develop to nourish the cancer cells. This process is called angiogenesis.
Drugs have been developed that are useful in stopping cancer growth by preventing new blood vessels from forming. One drug, called Avastin, has been able to shrink or slow the growth of advanced ovarian cancers. In general, Avastin has been even more effective in other cancers when combined with chemotherapy. Trials that test the effectiveness of Avastin, given along with chemotherapy are going on now. Patients with advanced ovarian cancer might consider the possibilities of entering these trials in a discussion with their doctors.
Hormone Therapy Not Shown To Benefit Older Patients With Early Prostate Cancer
A study of nearly 20,000 men aged 66 and older with early-stage prostate cancer found that those who were prescribed androgen deprivation hormone therapy instead of other treatments were no better off than their counterparts who adopted a “wait and see” approach. However, younger men who aren’t good candidates for surgery or radiation should still consider the therapy, which reduces androgen levels and often makes prostate cancers shrink or grow more slowly. For men with early stage cancer whose cancer has not spread to other parts of the body the usual treatment options are radiation, surgery, or “watchful waiting.” Men who choose watchful waiting monitor their cancer for changes, rather than aggressively treat the disease. Watchful waiting is often recommended if the cancer is slow-growing, the man is older, or if the cancer isn’t causing any problems, and is confined to one area of the prostate.
Hormone therapy is generally used on advanced or aggressive prostate cancers, or those that have come back after other treatments. When used along with radiation, it can also help men with early prostate cancer live longer. In recent years, though, androgen deprivation therapy has become an increasingly popular first line alternative to the three most common treatments, especially among older men with early stage disease. However, there hasn’t been any research to show it actually helps these men, and some studies have shown that it’s actually harmful.
“There have been more reports of health risks such as fractures, diabetes, heart disease, and other adverse effects associated with chronic use of this therapy; therefore, it is imperative that more exploration is done on the appropriate use of this treatment,” said lead researcher Grace Lu-Yao, Ph.D., MPH, cancer epidemiologist at the Cancer Institute of New Jersey and associate of environmental and occupational medicine at the University of Medicine and Dentistry-Robert Wood Johnson Medical School.
The research, in the Journal of the American Medical Association, was based on data from 19,271 men from the SEER program database as well as Medicare files. The researchers flagged men who were 66 and older, had been diagnosed with early stage prostate cancer between 1992 and 2002, and had not received radiation or surgery in the first 6 months of their diagnosis. The men were followed through 2006.
Forty-one percent of the men (median age 77) received androgen deprivation therapy, while the rest adopted watchful waiting. The researchers found no overall benefit for the men taking hormone therapy, and the risk of death was essentially the same for men in both groups, regardless of other factors such as race, class, or their family history.
“The significant adverse effects and costs associate with primary androgen deprivation therapy, along with our findings of a lack of overall survival benefit, suggest clinicians should carefully consider the rationale for initiating this therapy in elderly patients with T1-T2 prostate cancer,” write the authors. (T1-T2) refer to the two earliest stages of prostate cancer.