Search for genetic test to spot killer PCa

Gene-screening, like that used to detect breast cancer risks, could save thousands of mens’ lives. A national PCa screening service may emerge from this research. which would analyse men’s saliva for sign of genetic predispositions to prostate cancer.

According to a report in the Observer newspaper scientists have begun work that in a few years, middle-aged men could be tested to reveal their genetic susceptibility to the cancer, with those deemed to be under significant threat of developing it being offered treatment.

The service would tackle a disease that has become the nation’s most commonly diagnosed cancer and would parallel Britain’s breast cancer screening programme.

If this report is borne out the UK will be the first large population country in Europe to introduce a population-based screening and a genomic one at that.

Read more by clicking on this link.

Transperineal Prostate Biopsy Improves the Detection of Clinically Significant Prostate Cancer Among Men on Active Surveillance according to a study by Meyer AR et. al. . J Urol 205: 1069‐1074, 2021

Transperineal prostate biopsy offers improved sampling of the anterior prostate compared to the transrectal approach. The objective of this study was to determine if transperineal prostate biopsy is associated with an increased incidence of cancer upgrading among men on active surveillance (AS) for very low‐ or low‐risk prostate cancer (PCa).

The researchers’ AS registry was queried to identify men who underwent a surveillance biopsy following the introduction of transperineal prostate biopsy. Patients were divided by the type of biopsy performed. The baseline characteristics and rates of cancer upgrading were compared between groups.

Between November 2017 and June 2020, 790 men with very low. or low‐risk PCa underwent a surveillance biopsy. After adjusting for age, prostate specific antigen density, use of magnetic resonance imaging, and number of prior transrectal biopsies, transperineal prostate biopsy was significantly associated with upgrading in terms of ISUP grade.

The study concluded that among men on active surveillance for very low, or low‐risk PCa, transperineal prostate biopsy was associated with an increased likelihood of upgrading to clinically significant PCa. This is likely due to improved sampling of the anterior prostate with the transperineal approach.

Read more in the  Us TOO HotSHEET, May 2021, p. 2.

Video Presentations on PCa From the University of California, UCSF

Dr. Matthew R. Cooperberg Associate Prof, Urology hits out at blinkered approach to prostate screening in the United States.

This hour-long video in support of prostate cancer screening was made few years ago but Dr. Cooperberg gives a masterly account of how the US medical profession overtreated with PSA testing and then how the US Preventative Task Force USPTF took the wrong decision after misunderstanding the PLCO Study which reported at the same time as the larger European study ERSPC. The presenter’s laconic style makes for an entertaining if somewhat disturbing viewing. The presenter’s laconic style make for an entertaining if somewhat disturbing viewing.

To view Dr. Cooperberg’s talk use this link: Localized Prostate Cancer: Progress Toward Personalized Care – YouTube

In the American Urologic Association (AUA) Virtual Annual Meeting, Dr. Todd Morgan discussed the role of genetic testing in prostate cancer across the spectrum of the disease natural history from early detection to the treatment of localized disease and castration-resistant prostate cancer (CRPC).

Dr. Morgan highlighted that 1 in 10 men with metastatic PCa have germline DNA repair mutations. In other words the gene that would normally control the repair of a damaged gene fails to function properly and the mutation grows into a tumour he pointed out however, that not all men had a family history of PCa. His learning objectives included when to use genetic testing, how to counsel men, and how to interpret and utilise the result of genetic testing.

Dr. Morgan outlined his considerations that such data may be informative across a range of relevant questions such as:

1. risk assessment – what is the probability of developing cancer?
2. disease prevention – is the disease risk modifiable?
3. prognosis – how does carrying a mutation affect the natural history of prostate cancer?
4. Treatments – are some more or less efficacious due to the specific mutation?
5. familial risks- is there a need for testing of family members?

To contextualize his talk, Dr Morgan distinguished between somatic mutations that grow from their outset in your body, usually due to a mutation as opposed to the germline mutations which come with your genes. Germline mutations are present since birth and affect all cells in an organism. Further, these mutations are carried in gametes (the sperm or egg) and may be passed to subsequent generations. In contrast, somatic mutations are present in only a subset of an individual’s cells (for example, in a tumor) and are not transmissible. Because they affect all cells, germline mutations may be detected in samples unrelated to the tumor, most commonly a mouth swab (buccal smear), saliva, or blood sample.

Read more here.

For other video items that were highlights at this meeting click on this link.

Congratulations

Our colleague, Dr. Lionne Venderbos, who is one of the Erasmus Medical Centre team which has done such outstanding work on the Quality of Life Study EUPROMS, has had her Abstract on the study accepted as one of the top 5 abstracts for a poster by the EAU’s Patient Office for their Virtual Congress in July.

Europa Uomo Virtual General Assembly

The Board of Europa Uomo meets on Tuesday 18 May to review and finalize the draft Annual Report which will issue to all member organisations on the following day. The GA takes place on the 19th June.
Proposals for decision and nominations to the two vacant seats on the expanded Board should be with the Secretariat by Monday 17th May.

FEFOC Newsletter

Our Spanish member, FEFOC, has a regular and very informative newsletter. Members can use the translation facility on the website to change the text to your preferred language.

Men with prostate cancer (PCa) have not always followed the healthiest of lifestyles. But in PCa terms, a healthy lifestyle leads to less likelihood of getting PCa but in the event that you do will a healthy lifestyle provide some degree of protection from developing an aggressive form of PCa.

According to a new large-scale study presented by Anna Phym, PhD, at the American Association for Cancer Research (AACR) 2021, adhering to a healthy lifestyle may offset the heightened risk of lethal PCa in men with adverse genetic risk factors, according to results of this large U.S. study. “In men at the highest risk of PCa death, having the highest healthy lifestyle scores cut the risk of fatal disease in half,” Plym noted that genetic factors account for about 58% of variability in PCa risk.

Plym also observed that the study indicated there was a 10‐fold gradient in disease risk between the lowest and highest genetic risk men, and the pattern was consistent across ethnic groups. “In addition,” Plym noted, “previous studies have suggested that a healthy lifestyle reduces lethal PCa risk.

”What remains unclear is whether the risk for both PCa development and the risk of progression to lethal disease can be offset by adherence to a healthy lifestyle.”

To investigate further, Plym and colleagues used the more than 10,000 men enrolled in the Health Professionals Follow‐up Study. At a median follow‐up of 18 years, 2,111 cases of PCa cancer were observed.

Plym said that the results suggested that healthy lifestyle may counterbalance high genetic risk. She added that previous research has confirmed physical activity as a protective factor, but that more study is needed to shed light on the relative benefit of the healthy lifestyle components. In addition, further research is needed to explain why the benefit was limited to lethal PCa risk in men with the highest genetic risk.

Plym remarked in response to observations from attendees at the meeting that among those in the highest genetic risk group with an unhealthy lifestyle. The increased risk for prostate cancer exceeded the risk for other illnesses.

Read more: Healthy Lifestyle May Offset Risk of Lethal Prostate Cancer in Men With High Genetic Risk | AACR | News Releases

The ‘before and after’ of an operation for people over 65 years

We are grateful to Prof. Louis Denis for bringing the article to our attention. It is published by the American College of Surgeons in their Bulletin Brief – April 13th 2021.

Patient Summary:
We have probably all encountered occasions where our ‘elderly’ friends, loved ones or even ourselves have had an operation and we take a ‘knock’ and experience a noticeable decline in our ability to do things which impacts on our independence despite the operation being medically successful. The authors suggest that clinicians should assess the frailty and likely impact on a patient’s independence after the operation. This should be done before the procedure using standard instruments of assessment. These assessments can not only identify increased risk and how it can be reduced it can also be a major benefit in terms of the quality of life of the patients over 65 years.

Abstract:
This single-institution, retrospective analysis reported the relationship of frailty [detected by a pre-operative protocol embedded in the electronic health record] and the severity score of the operative procedure with postoperative loss of independence [need for admission to long term care facility or increased intensity of at home care] in patients older than 65 years. Frailty and operative procedure severity were assessed using standard instruments.
The study cohort consisted of 535 patience and loss of independence was observed in 7% of the cohort. Frailty and an operative severity score of three or higher were independently associated with postoperative loss of independence. Patient- reported depression, weight loss and limited mobility were also predictive of postoperative loss of independence. The authors concluded that preoperative assessments could identify increased risk of loss of independence that may be reduced by preoperative interventions such as detailed geriatric medicine evaluations.

Authors: Owodunni OP, Mostales JC, Qin CK, Gabre-Kidan A, Magnuson T, Gearhart S.L.. Preoperative frailty assessment, upper operative severity score and early postoperative loss of independence in surgical patients age 65 or older. Published by the Journal of American College of Surgeons 2021- 232[4]: 387-395.