What’s New in Prostate Cancer?

James Stark, MD, of Stark Oncology

James Stark, MD, of Stark Oncology

There has been an explosion of new information recently about prostate cancer, all of which is extremely relevant to men as they age.

Starting in the early 1990’s there was a hint that taking vitamin and mineral supplements would protect men from getting prostate cancer.  A pilot study suggested that taking selenium would be highly protective.  Subsequent small studies suggested that Vitamin A or Vitamin E might have a protective effect as well.  A recent study from Canada seems to refute this concept.  Over three hundred men with biopsy-proven pre-malignant changes were studied: half took soy, Vitamin E and selenium and half took placebos.  There was no protective effect of the supplements.  The study was small and one could argue that the men were not on the supplements early enough but the data suggest that this approach is a waste of time.  Other recent larger studies suggest this as well.

For years doctors have questioned whether all men need to be treated for prostate cancer or whether some could simply be observed.  There have been a series of Scandinavian trials that have shed light on this issue.  These trials have been criticized in the U.S. because prostate screening is not as rigorous in Europe and many men were diagnosed with more advanced disease than would be expected with annual surveillance.  Nonetheless, a recent update shows, especially in men under 65 (see graph), a rather striking reduction in mortality among men treated as soon as they were diagnosed.  As indicated in previous blogs, we still need a better marker for who needs treatment, but these new data are compelling evidence that men delay treatment at their peril.

From the New England Journal of Medicine 364:1708, 2011.

Finally, a provocative new study just published in the Journal of the National Cancer Institute shows that drinking at least six cups of coffee per day (regular or decaf) offers protection against getting prostate cancer.  From the Health Professionals Follow-Up Study of the Harvard School of Public Health, we learn that drinking six or more cups of coffee had an 18% reduction in prostate cancer, but, possibly more importantly, a 60% reduction in the most aggressive forms of this disease.   As with all HSPH studies the number of men in the trial was huge (47.911) and the statistical significance was high.  They postulate that the anti-oxidants in coffee offer this protection.

So let’s all get screened, drink coffee, and throw away the vitamins.

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