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Mayo Clinic Reports Dramatic Outcomes In Prostate Cancer Treatment

Soulskill posted more than 4 years ago | from the turns-out-the-tumor-was-his-sled dept.

Medicine 122

Zorglub writes "Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced Friday. 'Cancer has a propensity for turning off T cells. Dr. Allison hypothesized that if you block the off-switch, T cells will stay turned on and create a prolonged immune response. Dr. Kwon, then at NIH, demonstrated that CTLA-4 blockage could be used to treat aggressive forms of prostate cancer in mice. There was one limitation to that concept — the worry that by simply leaving all the T cells on there may not be enough response aimed at the tumor. Dr. Kwon called Dr. Allison and designed the trial together. The idea: use androgen ablation or hormone therapy to ignite an immune approach — a pilot light — and then, after a short interval of hormone therapy, introduce an anti-CTLA-4 antibody that acts like gasoline to this pilot light and overwhelms the cancer cells.' After the treatment, the patients' tumors shrunk to such a degree that they could be successfully removed."

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122 comments

Who would have thought ? (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#28411005)

Slashdot, fast forward 10 years into the future: stories about prostate cancer and excessive flatulence.
Who would have thought ?

FIST SPORT (-1, Troll)

ringbarer (545020) | more than 4 years ago | (#28411007)

All of this could have been prevented if these homosexuals weren't cramming things into their asses in the first place!

Re:FIST SPORT (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#28411023)

True dat, true

Re:FIST SPORT (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#28411219)

Can you do more anti-Islamic trolling? The best trolls always have that core of truth to them.

Hmmmm (4, Insightful)

ZosX (517789) | more than 4 years ago | (#28411021)

So the immune system will actually fight cancer, but the cancer negates this by turning off the T-cells. This is fascinating. The problem, from what I understand, is that cancer cells reproduce indefinitely as their DNA does not slowly break down. It seems like this could be a real breakthrough for lots of cancer patients.

Re:Hmmmm (4, Insightful)

moon3 (1530265) | more than 4 years ago | (#28411109)

immune system will actually fight cancer

You need to mark the cancer cells (in someway) so the immune system could recognize them as a threat. Many times big problems could have very simple solutions in biology.

Re:Hmmmm (4, Insightful)

ColdWetDog (752185) | more than 4 years ago | (#28411173)

Many times big problems could have very simple solutions in biology.

Simple

I don't think that word means what you think it means. Just because something is conceptually simple, doesn't mean that it's simple to use as a medical therapy.

Messing with the immune system is rarely "simple".

Re:Hmmmm (1)

Hurricane78 (562437) | more than 4 years ago | (#28411421)

But think about it: What is the best, most integrative, and most sense-making therapy of a disease?
Improving the own immune system, of course.

Give it updates (immunization), improve its heuristics, give it all the resources it needs.

It is funny and very telling of the real goal of pharma companies, that despite (or because of) all our "technology", the human immune system now is the weakest in the whole animal kingdom.
But the main driver behind this weak immune system, is the crap that we call "food" (but really isn't).

I for one, will hack and tune my own body, just like I do it to my computer and/or my car.

Re:Hmmmm (4, Insightful)

Daniel Dvorkin (106857) | more than 4 years ago | (#28411439)

the human immune system now is the weakest in the whole animal kingdom

[citation needed]

Re:Hmmmm (3, Funny)

MrNaz (730548) | more than 4 years ago | (#28412107)

You'll need to offer him some guidance on how to properly cite random bullshit pulled directly from the rectum.

Perhaps like this?

"The human immune system is now the weakest in the entire animal kingdom(1)."

1. Dr Bhul Schitt "A Diverse Collection of Utter Nonsense." Published: Oxford, 2007. pp34-38.

Not so! (1)

mac1235 (962716) | more than 4 years ago | (#28412253)

Actually, our immune system changed a lot once we started living in cities. I don't know how good it is compared to other creatures, but it's improved a lot recently.

Re:Hmmmm (4, Interesting)

TheLink (130905) | more than 4 years ago | (#28412231)

If the human immune system was really the weakest in the whole animal kingdom we wouldn't be living to 70+ years.

Even if you take real good care of mice, they tend to fall apart by 3 years - cancer etc.

Just see what happens to a patient with AIDS - all sorts of rare cancers appearing, dying from common cold etc.

The trouble with some of these tweaks is you could end up with an autoimmune response. Sure you might be able to get the immune system to blow away the cancer. But it might start to attack the normal cells as well.

When you get old, the "normal" cells after years of abuse and damage aren't quite as normal as they were when you were 20. It could be like pouring some new fangled super rust remover on an old car to find that most of the old car is made of rust... ;).

That's why there's reproduction - it's a bit like a reset. Start over from scratch with a sperm and egg.

With unicellular creatures like bacteria and protozoa it's not as vital for huge colonies of them to mutually cooperate - they can drift genetically on every generation as long as they can keep reproducing successfully. That's not true for complex multicellular organisms like humans. A bunch of cells striking out on their own = cancer.

Re:Hmmmm (1)

32771 (906153) | more than 4 years ago | (#28414447)

> That's why there's reproduction - it's a bit like a reset. Start over from scratch with a sperm and egg.

This has to be a geek friendly attempt at telling some of us to get out of the basement.

> That's not true for complex multicellular organisms like humans. A bunch of cells striking out on their own = cancer.

So the conclusion would be that we would never get as old as some much simpler tree that can get cancer but
hardly has much in the way of organs that can fail. We would have to evolutionary outrun it somehow.
To think that trees do produce successful offspring every year throughout their whole life (with variation)
puts this idea to rest.

Re:Hmmmm (0)

Anonymous Coward | more than 4 years ago | (#28416097)

Uhh, is that our immune system doing it's job to let us live that long? Or is it modern medicine and a germ theory? We don't consume food that is expired, we have supplements to make sure we get all our nutrients, we get check-ups, we have anti-biotics, vaccinations, blah blah blah blah. That's not really our immune system standing up to nature.

Re:Hmmmm (2, Insightful)

assert(0) (913801) | more than 4 years ago | (#28413029)

>But the main driver behind this weak immune system, is the crap that we call "food" (but really isn't).

You really bought into the "health food" & supplements party line, didn't you?

1. A stronger immune system is not always a good thing. See autoimmune syndrom, cytokine storms etc.

2. We don't eat crap food! Yes, we have easy access to carbs, which is not always a good thing (depending on genetic and social factors). But we also have easy access to nutrients! We, in the west, can and do eat greens any time of the year. Scurvy, beriberi, and kwashiorkor are unheard of today in developed countries.

3. Eating crap food doesn't cause your immune systems to become "weak". It results in malnutrition, which in turn causes very specific conditions (like scurvy, beriberi and kwashiorkor). Crap food -> weak immune system -> cancer (or whatever) is a "health food" store myth. It's basically a meme designed to extract money from insecure but basically healthy westerners (aka suckers).

Re:Hmmmm (1)

epine (68316) | more than 4 years ago | (#28414113)

It is funny and very telling of the real goal of pharma companies, that despite (or because of) all our "technology", the human immune system now is the weakest in the whole animal kingdom.

Wow. What we have here is a total collapse of the cognitive immune system responsible for thinking before typing.

Over all I think the human brain is a remarkable organ, but some of its failure modes defy rational analysis. Six billion counter examples. Maybe it's hard to count to six billion with your fingers.

Bonnie Bassler on how bacteria "talk" | Video on TED.com [ted.com]
* 10 times more bacterial cells in or on a human than human cells
* 100 times more bacterial genes in you or on you than human genes

So there it is. If our immune system was worth shit, it wouldn't permit all these freeloaders.

Re:Hmmmm (1)

sjames (1099) | more than 4 years ago | (#28414511)

The thing is, the immune system dispatches cancerous cells all the time. A diagnosis of cancer means the immune system has already failed in that case and has been overwhelmed. That implies that it's harder than just provoking a response. It's already BEEN provoked and that didn't fix it.

The key is to come up with a combination of immune boosters, better targeting of the immune system, radiation, chemo, and surgery that tips the game back in the immune system's favor without killing the patient in the process.

Of course, the chemo and radiation have the potential to kill the patient themselves, and ironically, can cause cancer. Triggering or targeting the immune system in the wrong way or too strongly can also kill the patient.

The immune system remains a tempting target because if modulated correctly, it is a magic bullet that can kill only cancer cells. But yeah, it's not "simple".

Re:Hmmmm (2, Insightful)

Anonymous Coward | more than 4 years ago | (#28411301)

It's not that their DNA doesn't slowly break down but that DNA in Humans is not fail-safe (intelligently designed? probably not). There are specific genes that suppress tumor growth, etc, when they fail you can get cancer.

Re:Hmmmm (1, Insightful)

Anonymous Coward | more than 4 years ago | (#28411775)

There are a lot of cellular and genetic causes of cancer. Telomerase is an generally an embryonic enzyme that is reactivated in cancer calls that prevents the 'breakdown' of DNA as cells replicate, leading to indefinite replecative capabilities. There are also tumor suppressor genes that when mutated or deactivated lose their ability to prevent cancerous cell growth. Examples of this include p53, which detects errors in the DNA and either stops the replicative cell cycle or promotes apoptosis (programed cell death). In ~50% of cancers this gene is altered or lost, allowing for cells with altered DNA to continue replicating. There are a wide variety of other genes/proteins involved in apoptosis that be altered. The immune system is often capable of recognizing cancerous cells do the their lack of 'self' signals that are normally expressed on all cells, when recognized, immune cells such as Natural Killer cells can cause Apoptosis of the altered cells (this is also how we fight virally infected cells). But if the proteins involved in apoptosis don't work, the cell becomes immortal and can avoid death via the immune system. There are also other 'proto'oncogenes that code for proteins involved in controlling cell growth and replication. If these genes become over activated, a large number of growth factors are released causing excessive growth and proliferation of cell groups...=Cancer. There are generally several gene alterations that lead to a cancerous growth, and these genetic alterations vary from tumor to tumor, and even from cell to cell within a single tumor. This is why no single cure for cancer exists, or will ever exist.

Re:Hmmmm (4, Informative)

ceoyoyo (59147) | more than 4 years ago | (#28411343)

The immune system is constantly fighting cancer. Whenever something goes wrong when one of your cells divides, which happens relatively frequently, if the built in suicide mechanisms don't work then the immune system deals with it. What we call "cancer" is just the result when the cancerous cells get too far ahead.

Re:Hmmmm (0, Flamebait)

Hurricane78 (562437) | more than 4 years ago | (#28411445)

The real reason behind this, is that this process of division goes wrong more and more often, because the whole system is already that damaged, from the trash we call "food" and our environment full of unhealthy materials. Which adds up to our already very weak immune system.

Re:Hmmmm (1)

maxume (22995) | more than 4 years ago | (#28411515)

No. Just no. People used to die much more often because of stupid things like bacterial infections and savagery (people still die of those things today, but not at anything even resembling historical rates. Not even soldiers). Now that we (on average) live longer, we get subtler diseases.

If we used human processes to create trillions of cells, most of the individuals would die of cancer before they were a year old (or something, take this as hyperbole, not as a fact). I'd say things are working pretty well.

Re:Hmmmm (1)

Hurricane78 (562437) | more than 4 years ago | (#28414037)

Don't you get it? They would not die of most of those bacterial infections, if they had a real immune system, instead of that "spark-emitting, red-alarm-lights-blinking, and rotting" rest of an immune system.

Same thing with cancer. Why do you thing the reproductive function of the cells starts to fail that early, and just at specific spots, instead of the whole body? This is no general thing of old age. It is all that trash fucking up the system.

Same as allergies. I have living proof, that stopping to eat milk-based (and usually heat-destroyed) proteins, cures Asthma! How about that?

But yeah. Most people survive the trash we call "food". But how? They lose hair, get blind, get arthritis, and organ failures all over the body. And apparently, all those diseases are supposed to be because of the age?
Well, NO. They aren't. And I have 50,000 patients, and 50 years of experience by Dr. M. O. Bruker, to prove it.

The only way that those diseases are subtle, is because they take decades of "doin' it wrong", to develop.

Sadly, nearly no doctor cares, or even knows about this, because they can't think that far.

Re:Hmmmm (1)

maxume (22995) | more than 4 years ago | (#28414225)

My allergies have attenuated as I have aged. Or so I figure. Maybe the fact that I am in (far) better cardiovascular condition than I was a decade ago has contributed, I don't really know, it could be lots of things. I don't think that I could prove either of those ideas using just my own experience as evidence though, and I never had asthma.

Also, arthritis is often caused by too much immune activity, so maybe you should leave that one out when you are talking about our ruined immune systems (which I think is oh so much bunkum).

(and as I understand it, cancer arises when the second order processes that take care of cells that fail to die as programmed become overwhelmed and most people naturally have thousands of potentially cancerous cells in their body, cells that are usually killed by the immune system).

Glad you decided to drop the name of your medical hero though, I can commit a logical fallacy and ignore you.

Re:Hmmmm (4, Funny)

Sponge Bath (413667) | more than 4 years ago | (#28411585)

...the trash we call "food"

On the plus side, the contents of all those Hot Pockets, Cheetos, and Twinkies will help preserve my cancer ridden corpse for centuries.
I just hope no joker poses me in an undignified position.

Re:Hmmmm (1)

maxume (22995) | more than 4 years ago | (#28411951)

Hilariously, preservatives often work by preventing oxidation. Ya know, like antioxidants, those things that are supposed to keep you healthy and strong.

Re:Hmmmm (1)

infaustus (936456) | more than 4 years ago | (#28411639)

Normal cells do not reproduce indefinitely not because their DNA is breaking down, but because of checkpoints in the cell cycle. In cancerous cells, these checkpoints fail because of problems such as the overexpression of oncogenes or the underexpression of tumor suppressors.

Re:Hmmmm (1)

reverseengineer (580922) | more than 4 years ago | (#28411781)

If you're wondering why it is cancer can gain the ability to turn off your T-cells, it's important to remember that overactive immunity can be just as dangerous as immune insufficiency. Mutations in the CTLA-4 gene that boost its activity are associated with autoimmune diseases like lupus (yes, sometimes it is lupus), type I diabetes, and rheumatoid arthritis. In fact, Bristol-Myers-Squibb, makers of the ipilimumab (anti-CTLA-4 antibody) investigational drug discussed here already make abatacept, which is CTLA-4 fused to antibody. Abatacept, marketed as Orencia, is FDA approved for the treatment of rheumatoid arthritis, and is under investigation for treatment of other autoimmune diseases, as well as for treatment of automimmune rejection of transplanted tissues. So on both ends of the spectrum, CTLA-4 and other T-cell regulatory genes play a big role in disease, and make for promising avenues of research.

Re:Hmmmm (1)

nbauman (624611) | more than 4 years ago | (#28415651)

Mod parent up.

An overactive immune system is just as dangerous as an underactive immune system.

An overactive immune system causes autoimmune diseases, like asthma, multiple sclerosis, lupus, etc.

Fortunately most of the snake oil peddled to "boost" the immune system has no effect at all.

Re:Hmmmm (1)

Ihmhi (1206036) | more than 4 years ago | (#28412287)

Aren't T-Cells that shit that made the zombies in Resident Evil? I don't think anyone should be fucking with that stuff man!

Re:Hmmmm (1)

sponzereII (1499199) | more than 4 years ago | (#28415583)

Cancer cells do not reproduce indefinitely because of their rate of DNA degradation. Cancer cells reproduce indefinitely because the intracellular signaling (http://en.wikipedia.org/wiki/Signal_transduction) that controls apoptosis, survival, proliferation or differentiation has gone awry. Mutations associated with cancer usually result in a gene product that causes the aberrant signaling.

One thing that concerns me about this study is that the authors use androgen ablation therapy (ABT) as a "pilot." ABT usually works well at first, shrinking a tumor so that it can be surgically removed, and this new therapy increases the speed with which that happens, which is great. However, ABT also causes transdifferentiation of prostate cancer cells into a neuroendocrine-like phenotype. This NE-like phenotype secretes growth factors that prostate cancer cells thrive on, and may even induce transformation in normal prostate cells. So while the therapy is successful at first, remission years down the road (and many times sooner) is not uncommon. So it seems to me that in order for this new therapy, and ABT in general, to truly cure patients, the transdifferentiation process to NE-like cells must be blocked. Luckily there are several groups already working on sorting the signaling pathway activation that occurs during this particular transdifferentiation, which could potentially identify some new drug targets. It will be interesting to see if the patients taking part in this new therapy will regress in the same way "successfully" ABT treated patients have in the past.

Re:Hmmmm (1)

Eris13 (647245) | more than 4 years ago | (#28416347)

It's great for the primary cancer tumour, but there is no indication though if it will help the patient long term. Normally when the tumour becomes inoperable it's already metastasized - in case of prostate cancer, into the bones.

Lyle Alzado is rolling in his grave (0)

BadAnalogyGuy (945258) | more than 4 years ago | (#28411025)

If you told me just 1 year ago that steroids could be used to cure cancer rather than cause it, I would have laughed in your face.

There are so many incidences of steroid users succumbing to cancer that it's not uncommon to see American body builders getting checked out in Mexican hospitals for various cancers. If this therapy really works, it is critical to find the balance point between androgenic steroid therapeutic use and outright abuse.

Re:Lyle Alzado is rolling in his grave (2, Informative)

forgot_my_username (1553781) | more than 4 years ago | (#28411091)

If you told me just 1 year ago that steroids could be used to cure cancer rather than cause it, I would have laughed in your face.

There are so many incidences of steroid users succumbing to cancer that it's not uncommon to see American body builders getting checked out in Mexican hospitals for various cancers. If this therapy really works, it is critical to find the balance point between androgenic steroid therapeutic use and outright abuse.

It isn`t the androgen therapy that is doing it, it is the anti-ctla4 antibody that is doing the work.

If anything the androgen therapy should be causing the prostate cancer to grow

narf.

Re:Lyle Alzado is rolling in his grave (1)

ColdWetDog (752185) | more than 4 years ago | (#28411183)

It's anti androgen (TFA uses the term "androgen ablation") therapy. Knock out the actions of testosterone since prostate growth (and often prostate cancer growth) is in part testosterone dependent.

These are not the steroids that you are looking for.

Ad for the Mayo clinic (0)

Anonymous Coward | more than 4 years ago | (#28411313)

Note that the work was done at the NIH, but the story gives the impression that the work was done mostly at the Mayo clinic.

Re:Ad for the Mayo clinic (1)

carlcmc (322350) | more than 4 years ago | (#28412687)

The treatment of humans was mostly done all at Mayo. I personally work with Dr. Kwon and referred many of my patients for this therapy.

Re:Lyle Alzado is rolling in his grave (0)

Anonymous Coward | more than 4 years ago | (#28411175)

it's hormone ablation therapy. they are lowering testosterone levels...

FTA:

Before receiving the MDX-010, both men underwent a hormone therapy called androgen ablation. It's a combination of a pill that blocks testosterone and an injection tells the brain to order the testicles to stop producing it. This removal of testosterone from the system usually shrinks the tumor to some degree.

Re:Lyle Alzado is rolling in his grave (0)

Anonymous Coward | more than 4 years ago | (#28411259)

If you told me just 1 year ago that steroids could be used to cure cancer rather than cause it, I would have laughed in your face.

There are so many incidences of steroid users succumbing to cancer that it's not uncommon to see American body builders getting checked out in Mexican hospitals for various cancers. If this therapy really works, it is critical to find the balance point between androgenic steroid therapeutic use and outright abuse.

Absolute nonsense. Firstly, this isn't relevant to the therapy dicussed here - their therapy reduces testosterone.

Secondly, your claims about anabolic steroids are simply false. Lyle Alzado claimed that his steroid use caused his brain cancer. However, this is incorrect, as *his own physicians* pointed out. Not only is there no known possible causal link between steroids and brain cancer, there is no statistical link either. It's just media hype.

Re:Lyle Alzado is rolling in his grave (0)

Anonymous Coward | more than 4 years ago | (#28411877)

There are a lot of different types of steroids...

Re:Lyle Alzado is rolling in his grave (1)

RightSaidFred99 (874576) | more than 4 years ago | (#28412885)

Good god. Could you please propagate any more myths? Lyle Alzado did not die from steroids, first of all.

I was actually kind. Your second sentence is just an outright fabrication, and a laughable one. Checked out of Mexican hospitals for various cancers, huh? Right... Cancer isn't really something you need to worry about with steroids, there are other health complications though.

Nice analogy (5, Funny)

metalhed77 (250273) | more than 4 years ago | (#28411103)

The idea: use androgen ablation or hormone therapy to ignite an immune approach â" a pilot light â" and then, after a short interval of hormone therapy, introduce an anti-CTLA-4 antibody that acts like gasoline to this pilot light and overwhelms the cancer cells.

Fry: Usually on the show, they came up with a complicated plan, then explained it with a simple analogy.
Leela: Hmmm... If we can re-route engine power through the primary weapons and configure them to Melllvar's frequency, that should overload his electro-quantum structure.
Bender: Like putting too much air in a balloon!
Fry: Of course! It's all so simple!

Mayo Clinic is falling behind (5, Funny)

Anonymous Coward | more than 4 years ago | (#28411179)

The Miracle Whip Clinic announced a similar breakthrough last year and they did it with much more tang.

Re:Mayo Clinic is falling behind (1)

Hurricane78 (562437) | more than 4 years ago | (#28411387)

But I wonder why the Baconnaise clinic still is in business. Especially since they specialized on chocolate chip pancakes and sausage on a stick therapy...

Re:Mayo Clinic is falling behind (3, Insightful)

TheLink (130905) | more than 4 years ago | (#28412439)

Well that's because Baconnaise, choc chip pancakes and sausage have anti-cancer properties. Really!

Eat enough of that and the odds of you getting cancer go way down.

You'd just die of heart disease or something else first ;).

Some people choose certain diets because they want to live longer. Others choose their diets based on how they want to die ;).

You're eventually going to die of something. Imagine a pie chart where the slices represent the odds of you dying of a particular problem. Whatever you do, the pie is there and it doesn't go away. You can change the sizes of the slices, but it's unlikely you'll ever get to a slice that says "ran out of resources due to Heat Death of the Universe".

So don't pick a diet or lifestyle that you can't grow to like. It's no point suffering your entire life just to die of cancer in the end. But it's probably not a good idea to die too early either, so find a decent balance and try to figure it out early enough so you can get on with more important stuff ;).

Re:Mayo Clinic is falling behind (0)

Anonymous Coward | more than 4 years ago | (#28413201)

Umm, there's also greatly reduced quality of life as you suffer from crippling diseases. If you stay healthy you may not get that many more years, but you'll certainly have more years that are worth living.

Re:Mayo Clinic is falling behind (1)

jabithew (1340853) | more than 4 years ago | (#28412993)

As a European just finding out about these wonders, I have to ask a couple of serious questions.

Why are you all still alive? Have you heard of food? Are you aware of the concept of vegetables?

Re:Mayo Clinic is falling behind (0)

Anonymous Coward | more than 4 years ago | (#28413629)

As a European, I smiled and salivated when I first heard of Baconnaise.

Hint: you're one out of more than seven hundred and thirty million people who can call themselves European.
You do not represent all of us, and your post was needless trolling.

The French invented terrible eating habits, and they seem to be thriving.

Re:Mayo Clinic is falling behind (1)

oldhack (1037484) | more than 4 years ago | (#28414347)

Serious question: are all Europeans jackasses like you? Any Europeans in house?

It still needs surgery (1)

Shin-LaC (1333529) | more than 4 years ago | (#28411261)

This is great news, but I was disappointed to read that they still had to operate in the end. Recently I've read stories about how doctors are reconsidering the need of surgical treatment of prostate cancer in benign cases, due to the bad side effects involved. In particular, prostate surgery has a very high risk of causing impotence. It would be nice if this new method could replace surgery altogether, at least for less severe cases.

Re:It still needs surgery (4, Insightful)

DeadPixels (1391907) | more than 4 years ago | (#28411311)

Know what else causes impotence?
Being dead from cancer.

True, it would be ideal to have a treatment that doesn't require any surgery, but if your choice is between impotence or death, I think most people will have the operation.

Re:It still needs surgery (0)

Anonymous Coward | more than 4 years ago | (#28411409)

I'm impotent.

Don't do it, man. Don't do it.

Re:It still needs surgery (4, Informative)

shawb (16347) | more than 4 years ago | (#28411581)

Usually prostate cancer progresses at such a slow rate that an untreated patient will die of other unrelated causes before the prostrate cancer would kill them, or even cause significant quality of life issues. How many men would choose between impotence and a, say, 1/1000 (no idea if that is the actual chance) of dying earlier?

Add in another possible side effect of cancer surgery: death. A small but significant number of patients die during prostrate sectioning surgery. Some patients die from sepsis caused by imperfect healing of the incisions (the large intestine is a very icky place, and you don't want what is inside there to get into the rest of the body.) For very mild cases of prostrate cancer, the risk of death due to surgery approaches the risk of death due to the cancer. Adding in other surgical complications involved, often times the best course of action with mild prostrate cancer is a wait and see policy, no matter how much the thought of this scares the patient (other types of cancer are usually "get it out as quick as possible" situations.) While surgery may indeed currently not be the best course of action in mild prostrate cancers, this will likely eventually change. The rates of surgical complications (including death) of course are going to keep going down as advances are made in surgical technique (such as cellular level laparoscopic microscopy allowing the surgeon to identify individual nerves to avoid sectioning, allowing for preservation of bladder control and sexual function.) However, these advanced procedures are indeed quite expensive and I think as a society we will eventually have to start asking whether extending a patients life is worth the financial cost.

True, but (5, Insightful)

Weaselmancer (533834) | more than 4 years ago | (#28411911)

How many men would choose between impotence and a, say, 1/1000 (no idea if that is the actual chance) of dying earlier?

You'd need to have the whole picture before you could make an educated choice.

I lost my father to prostate cancer a couple of years ago. When it got bad he wanted to die at home. We arranged that for him. I was with him during his last day. I watched him die.

I can tell you this. It's a life changing event watching someone die from cancer. Most people happily have no idea what it's like. I know though. Tumors up and down your spine, eyedroppers full of synthetic morphine to deal with the pain...it's absolutely unreal. Honestly.

Believe me, if it came down to it and someone told me today that they'd have to remove everything from my balls to my bellybutton to avoid that fate, I'd go to the table with a smile. I'd happily sit to pee if it meant I could dodge that bullet. Anyone would if they knew what I know.

Oh yeah, on an unrelated note - people who smoke are bat shit insane. They have absolutely no idea what's at the end of a losing roll of the dice.

Re:True, but (1)

TheLink (130905) | more than 4 years ago | (#28412595)

OK so you don't die of prostate cancer. But eventually you're going to die of something, and it could be a difference cancer (but very similar ending unfortunately) - in fact if your body is more prone to cancer, the odds are high you will get another cancer even if it's not related to the first one.

You can dodge bullets. But you can't dodge all of them.

See: http://www.cdc.gov/men/lcod/index.htm [cdc.gov]

Eventually you lose the die roll.

The people who smoke are not necessarily bat shit insane. They may figure the pleasure is worth the final pain. I don't think it's worth it so I don't smoke.

We all are building sand castles that will eventually be washed away. Learning to accept that is a good way to have more fun.

FWIW, I think having a massive heart attack isn't such a bad way to go. Sure it's excruciatingly painful. But it's only excruciatingly painful for 20 minutes or so. Not like needing pain killers for 6 months to put up with cancer chewing up your body and still it's not enough... Unfortunately, the same risk factors for heart attacks tend to raise the risk of getting a stroke which is unpleasant as well especially if it doesn't kill you...

Re:True, but (3, Insightful)

Weaselmancer (533834) | more than 4 years ago | (#28413161)

The people who smoke are not necessarily bat shit insane. They may figure the pleasure is worth the final pain. I don't think it's worth it so I don't smoke.

Yeah, that's kind of my point. They don't know what the "final pain" actually is. I'll betcha if they did they would feel differently.

We all are building sand castles that will eventually be washed away. Learning to accept that is a good way to have more fun.

Oh, I agree completely. We all die. But getting your end prematurely from something that painful...well, sucks.

My dad was a tournament tennis player and a black diamond downhill skier when he was diagnosed. Cancer took it all from him. Hell, if it wasn't for the cancer he'd probably be playing tennis today.

Re:True, but (0)

Anonymous Coward | more than 4 years ago | (#28414749)

Some women that have given birth keep doing it despite how much it hurts.

Re:True, but Suicide is Painless (0)

Anonymous Coward | more than 4 years ago | (#28414079)

Sung to the tune of the "MASH" Theme ...
The Game-Of-Life is Hard to Play
You're Going to Lose it Anyway
The Losing Card You'll Someday Lay
And so Here's What I Have to Say:

That Suicide is Painless
It Brings on Many Changes
Yes I Can Take or Leave it If I Chose!!!

Re:True, but (3, Interesting)

ShawnX (260531) | more than 4 years ago | (#28412861)

I know exactly what you went though, my dad had a very aggressive prostate cancer and seeing him slip away as he did was a horrible experience nobody should ever endure. I will always be forever haunted from those moments and to the last words he said to me during the day before he passed away that night. I am saddened if this treatment is found to be a breakthrough that it has come too late for us who have lost a loved one :`(

Don't be saddened by it (4, Interesting)

Weaselmancer (533834) | more than 4 years ago | (#28413127)

I am saddened if this treatment is found to be a breakthrough that it has come too late for us who have lost a loved one

Rejoice. For two reasons.

1) Other people will be spared our experience.

2) We're both genetically predisposed to prostate cancer, which means that this cure may help us someday. We might dodge the bullet. As a father myself I know I'd rather get cancer than my son. Easy decision. Maybe our Dads would feel the same way. "At least my son doesn't have to have this."

Re:True, but (1)

Have Brain Will Rent (1031664) | more than 4 years ago | (#28414597)

Thank you for saying that.

What pisses me off when the subject of prostate cancer and increased funding for research comes up, or subsidizing PSA tests, or... one of the standard responses is that it's a low priority for additional resources because "it's slow growing and you'll likely die of something else first." So it's ok to spend 20 years knowing this thing is growing inside you and that your best hope is that something else kills you first so you don't die an agonizing death. The attitude is mind-boggling and usually seems to come from people seeking to preserve funding for other gender specific cancers.

And since someone will usually bring it up, yes, I know that PSA tests have a somewhat high rate of false positives - so what, then you follow up with more or other testing to confirm the initial result.

Re:True, but (1)

shawb (16347) | more than 4 years ago | (#28414767)

I guess my post came off a lot more harsh against people and families suffering from cancer than I intended. I do support early diagnosis, and taking appropriate treatment where determined medically beneficial. It's just that with the current risks, which cases treatment would be beneficial can be hard to determine, so I also support research into better diagnostics in making those decisions. I suppose I did not made it clear enough that I am personally excited by advances in treatment, such as the topic of this article and improved techniques I mentioned which would make the surgical option safer and more effective, therefore an appropriate treatment at earlier stages of the disease when it can be early to know if the cancer will be benign, or the more malignant form you had unfortunately witnessed. I would be very happy if surgery or some other treatment was made safe, effective and affordable enough that it could be used pre-emptively for those who are at a high risk rather than waiting for cancer to take hold in the first place, such as we currently do by attempting to aggressively lower cholesterol levels in those patients who have a high risk for heart attack.

The comment I made about funding the surgery was a poorly thought through reaction about talks of nationalized health care. I do support society providing funding for treatment where it is likely to provide benefit to the patient in terms of length and/or quality of life, and we have to determine the appropriate mix of public insurance, private insurance, private health savings, and even good natured human charity in helping the sick afford to get better and in helping families prepare for and cope with the disease. I also urge the medical community to find more cost efficient ways to treat patients that have no means of affording top of the line medical services.

Re:It still needs surgery (1)

rhsanborn (773855) | more than 4 years ago | (#28411953)

Note that the cases cited were unusually aggressive forms of prostate cancer and had a high chance of mortality. So while it may be a very good idea to take the wait and see approach to many kinds of prostate cancer, there is new hope for people with life-threatening, aggressive prostate cancer. Also, possibly hope for similar applications in other cancers that aren't nearly so slow moving.

Re:It still needs surgery (1)

vandelais (164490) | more than 4 years ago | (#28413093)

So if you have non-agressive prostate cancer and could feel better if this works, wouldn't you choose the treatment?

Re:It still needs surgery (1)

sjames (1099) | more than 4 years ago | (#28414587)

True in many cases, but the cases in TFA were not like that. The cancer had already grown too large to surgically excise, meaning it was far more malignant and that watchful waiting was not an option.

Re:It still needs surgery (3, Informative)

nbauman (624611) | more than 4 years ago | (#28415769)

FWIW, I recently sent the following email to a friend with prostate cancer who asked for my advice.

The most useful parts are the links to the free NEJM articles.

Note the study that followed men 55-59 with Gleason Grade 6 localized prostate cancer. 15% died from prostate cancer at 15 years. I think that's the number you're looking for.

They said you can often make a good case for "watchful waiting," essentially no treatment. Good story about the guy who got off the table right before the operation and decided not to have surgery. (They deliberately chose a case where there isn't enough evidence to make an easy decision.)

Note also that they had 1,200 surgeries with no fatalities, so the surgery is a lot safer than it was in your father's day.

Dear _______

The best, most reliable source of information to make a decision on prostate cancer that I ever found is The New England Journal of Medicine. There are 2 problems: (1) It can be difficult reading, although they know patients will be reading some of their articles and they try to edit those articles to be as understandable as possible. I think it's easier to read one difficult article that gives you the information you want than to read ten easy articles that don't. (2) Often in medicine, especially in prostate cancer, they don't have enough scientific evidence to make a clear, easy decision. But if you have to make a difficult decision, it's easier if you at least have the best evidence.

I remembered 2 articles in the NEJM in particular. One was free online; I'm attaching a PDF of the other. These articles are technical but you should be able to understand them by reading slowly and carefully (as I do). They do a good job of telling you how a doctor thinks about prostate cancer. You can find an explanation of anything you don't understand on Wikipedia. I'm also giving you my own notes that I made when I read the articles, and it might be easier to scan them first for an overview. Your best source of information should be your own doctor, but these articles will help you talk to him.

One article was a survey of patients and their wives on the outcomes of prostate cancer surgery and radiation. The standard question about prostate cancer surgery is, "What's the probability of sexual impotence?" You assume that you'r going to have the best odds, with a surgeon who does a lot of cases, at a hospital that does a lot of cases. Surgeons (and the American Cancer Society) like to make reassuring claims, so you have to be skeptical about how they define impotence. I got the impression that it was about 50%, and that's what this article reported. However, the results are better for younger patients -- 75-year-old men have low sexual functioning to start with. This article also discusses the problems of urinary incontinence, which as I recall wasn't as much of a problem. There is a basic tradeoff between surgery (radical prostatectomy) and radiation (either external beam radiation or brachytherapy): surgery is more likely to cause urinary problems, radiation is more likely to cause rectal inflammation. This article got a lot of press coverage so you can search Google News for further discussion and explanation.

The other was a case history of a 55-year old man with a Gleason score of 6 (grade 3+3) who decided in 1996 to get surgery, and then changed his mind at the last minute and walked out of the operating room. He's been followed ever since and the cancer hasn't metastasized. The NEJM likes to give cases that are in the very grey area of the evidence, with the hardest decisions, and this is one of them. They have experts explain the evidence and their thinking behind each option, there isn't any right answer, and any of the options would be a reasonable choice. I've attached a PDF of that article.

They followed up that article by inviting 3 more advocates for each of the 3 options to argue their case, and then invited readers to vote in an on-line poll. That article is free online too. (I once interviewed Schroder, the European who argues for watchful waiting.)

My understanding of this is that Gleason score 6 is the cutoff. Below 6, watchful waiting is reasonable. But if you have another 40 years of life expectancy, that makes watchful waiting more difficult.

NEJM, 20 Mar 2008, 358(12):1250, Quality of life and satisfaction with outcome among prostate-cancer survivors, Martin G. Sanda et al.

Free full text at http://content.nejm.org/cgi/content/full/358/12/1250 [nejm.org]

Prospectively (not randomized) measured quality of life (QOL) outcomes in 1201 patients and 625 spouses/partners, with radical prostatectomy (RP), external beam radiation (XBR), brachytherapy. Neoadjuvant hormone therapy (NHT). Expanded Prostate Cancer Index Composite (EPIC-26). No treatment-related deaths. Confirmed previous studies.

Conclusions:

(1) Sexual QOL worse in non-nerve-sparing surgery, NHT. Overall sexual problem in 43% RP, 37% XBR, 30% brachytherapy. Partners reported distress over erectile dysfunction in 44% prostatectomy, 22% XBR, 13% brachytherapy.

(As I understand it, surgeons will do nerve-sparing surgery whenever possible. They do non-nerve-sparing surgery when the cancer is too close to the nerves. But I'm not sure of that and you should check it with your doctor. NB)

(2) Urinary incontinence worst at 2 months, then improved; worst with RP.

(3) Bowel function worse with radiation.

(4) NHT (N=90 XBR, N=21 brachytherapy) associated with worse vitality, worse outcomes across multiple QOL domains.

"Notwithstanding the survival benefit of androgen deprivation in randomized clinical trials involving high-risk patients with prostate cancer, our findings mitigate enthusiasm for adjuvant hormonal therapy in the setting of disease of low or intermediate risk."

By treatment:

(1) Prostatectomy (N=603). Sexual adverse effects better with nerve-sparing (N=561, sexual score about 40) than non-nerve sparing (N=41, sexual score about 20). Urinary obstruction worst at 2 mo, improved by 2y.

(2) External-beam (N=292, 90 NHT). Reduced QOL bowel function to 2y in 11%.

(3) Brachytherapy (N=306, 21 NHT). Reduced QOL bowel function to 2y in 8%. Long-lasting urinary irritation, bowel and sexual sx, transient problems with vitality or hormone function. Incontinence 4-6% at 2y.

NEJM, 15 May 2008, 358(20):2161, Case 15-2008: A 55-year-old man with an elevated prostate-specific antigen level and early-stage prostate cancer, Michael J. Barry, Donald S. Kaufman, and Chin-Lee Wu. (PDF attached)

Originally diagnosed in 1996, recommended RP then, but patient declined, concern over sexual ability.

Now some doctors believe observation of PSA is "reasonable choice." 55 year old man, urinary obstruction, PSA 6.6 ng/mL, biopsy adenocarcinoma, Gleason grade 3+3, score 6/10, 2/6 cores 10% and 1%.

Construction supervisor, lived with girlfriend and her children, frightened of cancer but concerned about sexual function.

Choices: Conservative treatment, radiation, surgery.

Life expectancy 24y.

Needle biopsy under-detects PCa. But elevated PSA may be due to benign prostatic hyperplasia (BPH), a non-cancerous inflammation of the prostate.

Favorable features: PSA PSA velocity would help but not known. (PSA velocity is the increase in PSA over time.)

Albertson cohort untreated men 55-59, localized Gleason 6, 15% die from prostate cancer at 15 years.

But death rate is lower now, because

(1) Overdiagnosis, estimated 27% for 55yo men.

(2) Lead time bias, estimated 12y. (Suppose people die 10 years after being diagnosed and treated for cancer, and a treatment is useless. Suppose a test then lets you diagnose cancer 12 years earlier. They then die 22 years after being diagnosed and treated. The treatment is still useless, but their survival time has increased. That's lead time bias. NB.)

(3) Grade inflation. Of 366 slides Gleason score 5 in 1990-1992, 91% were given Gleason score =>6 in 2002.

However,

(4) life expectancy longer. And

(5) Gleason score might be underestimated because biopsy undersamples.

Parker model estimates man 55-59yo, Gleason score Active surveillance "probably most reasonable" for man with favorable prognosis.

"Many early-stage cancers do not need to be cured," but "some cancers may become incurable during observation," and patients choosing this strategy must understand that.

Klotz followed early-stage pts In U.S., 2000-2002, 13% of men 55-59 Gleason 5-7 tx conservative management.

Anthony L. Zietman (Radiation Oncology), advocated XBR in 1996, today would include option of not treating.

W. Scott McDougal (Urology), strongly advocated RP, still do.

Pt "extremely concerned about his sexual dysfunction," had an "honest discussion," risks "not insignificant."

In 1996, pt decided on RP, "was taken to the operating room, but he abruptly changed his mind and canceled the procedure." Since then taking finasteride for BPH (which causes bladder outlet obstruction and difficulty urinating). 5y, PSA 2.3-3.1, stopped because of decreased libido.

Last PSA 5.2 ng/mL, continue with observation unless PSA rises.

No biopsy because it wouldn't alter management.

Robert H. Young (Pathology) says "trend" is that former Gleason grade 2 is now grade 3, more Gleason score 6.

Study of 38 RP specimens compared long active surveillance with immediate RP, no difference in high-grade ca, positive margins, other adverse features, concluded "deferred treatment does not close the window on the chance for cure in selected patients.

James A. Talcott (Hematology-Oncology) says initial observation is "arguably the best choice for most men."

Management of Prostate Cancer Extract | FREE Full Text | PDF N Engl J Med 2008; 359:2605-2609, Dec 11, 2008. Clinical Decisions http://content.nejm.org/cgi/content/full/359/24/2605 [nejm.org]

Management of Prostate Cancer â" Polling Results Schwartz R. S. Extract | FREE Full Text | PDF N Engl J Med 2009; 360:e4, Jan 15, 2009. Clinical Decisions http://content.nejm.org/cgi/content/full/360/3/e4 [nejm.org]

NEJM, 28 Feb 2008, 358(9):961, Editorials: Complexities of prostate-cancer risk, Edward P. Gelmann. Columbia U., New York.

(This article is of interest only to people who are following molecular biology and genetics, except for the following introductory paragraph. NB)

"As men age, prostate epithelial cells are subjected to substantial stresses, and these stresses can damage DNA, thereby causing cellular transformation. The aging prostate gland acquires numerous foci of cancer cells that arise from distinct clonal transformation events. That most of these foci never develop into clinically detectable cancer is consistent with the frequent finding of prostate cancer during autopsies of asymptomatic men in whom the condition was never diagnosed."

Re:It still needs surgery (0)

Anonymous Coward | more than 4 years ago | (#28413745)

Know what else causes impotence?

Being dead from cancer.

True, it would be ideal to have a treatment that doesn't require any surgery, but if your choice is between impotence or death, I think most people will have the operation.

Her are some real facts from someone who had the oporation. I,m not impotent just sterile. I dont set to pee. You do have some problems at frist but not for long. By the way sterile at 61 is a good thing.

Re:It still needs surgery (0)

Anonymous Coward | more than 4 years ago | (#28415451)

t I was disappointed to read that they still had to operate in the end.

Dude, that's where the prostate is. Duh.

Smoke up America! (0)

tjstork (137384) | more than 4 years ago | (#28411273)

Look, the study also says that this has applications against lung cancer as well. This is good, because, even if you quit smoking, you don't actually reduce your chances of getting lung cancer.

Re:Smoke up America! (4, Insightful)

Daniel Dvorkin (106857) | more than 4 years ago | (#28411469)

even if you quit smoking, you don't actually reduce your chances of getting lung cancer

Every source I've ever seen on this subject says that although ex-smokers have a higher chance of developing lung cancer than do lifelong nonsmokers, they're still less likely to develop lung cancer than are current smokers (of the same age and smoking history, of course.) If you have a citation to the contrary, please give it.

Re:Smoke up America! (1)

psnyder (1326089) | more than 4 years ago | (#28411479)

even if you quit smoking, you don't actually reduce your chances of getting lung cancer.

The information you got is either wrong or very short sighted.
Our bodies are not static and unchanging. After you quit smoking it's not like your lungs never change from that state. They may never be as healthy as if you had never smoked, but healthy habits will certainly have an affect on your chances of getting lung cancer.

Re:Smoke up America! (0, Troll)

tjstork (137384) | more than 4 years ago | (#28411565)

The information you got is either wrong or very short sighted.

I smoke and I've researched this issue into the ground. Its pretty accurate. There's a reason why the "smoking benefits" timeline doesn't have a reduced cancer risk on it. It takes too long for lungs to clean themselves after you quit. It's like asbestos... once those particles get into your lungs, a lot of them are not going to come out. So, quitting smoking now significantly reduces your chances of having a heart attack and stroke, keeps your COPD from getting worse, but, because your lungs are already covered in tar. By the time you go through the decades it takes for your lungs to really clean themselves out, those little particles of doom will have deluded a cell to mutate differently, and you are screwed.

They don't publicize this, because of course, people will get the idea that you may as well keep smoking because you are going to get cancer no matter what you do, which is pretty true, but, they overlook the heart attacks, COPds and other bad things that can happen.

Re:Smoke up America! (4, Informative)

SquirrelsUnite (1179759) | more than 4 years ago | (#28411855)

The information you got is either wrong or very short sighted.

I smoke and I've researched this issue into the ground. Its pretty accurate.

Good, then it's going to be easy to provide some data.

There's a reason why the "smoking benefits" timeline doesn't have a reduced cancer risk on it. It takes too long for lungs to clean themselves after you quit.

I basically know nothing about this but a quick internet search turned up this:

Stopping smoking can reduce your risk A large number of studies have shown that stopping smoking can greatly reduce the risk of smoking-related cancers.2 And the earlier you stop, the better. The last results from the Doctorsâ(TM) Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it.10 However, itâ(TM)s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life.30 The effects of stopping vary depending on the cancer. For example, ten years after stopping, a personâ(TM)s risk of lung cancer falls to about half that of a smoker.31 And the increased oral and laryngeal cancer risks practically disappear within ten years of stopping.2 But the risks of bladder cancer are still higher than normal 20 years after stopping.20 Cutting down the number of cigarettes you smoke slightly reduces your risk of lung cancer,32 but youâ(TM)ll only experience the full health benefits if you stop altogether. One study found that even smokers who halved the number of cigarettes they smoked had similar risks of dying from heart disease and only slightly lower risks of dying from cancer.33

From http://info.cancerresearchuk.org/healthyliving/smokingandtobacco/howdoweknow/ [cancerresearchuk.org] You can actually follow some of the links and the abstracts of the cited studies do say that stopping smoking leads to decreased cancer risk down the line (though usually still higher than non-smokers)

They don't publicize this, because of course, people will get the idea that you may as well keep smoking because you are going to get cancer no matter what you do, which is pretty true, but, they overlook the heart attacks, COPds and other bad things that can happen.

Re:Smoke up America! (0)

Anonymous Coward | more than 4 years ago | (#28413673)

Key word hilighted: halved the excess risk of cancer, in other words, you go from normal%+smoker% risk of cancer to normal%+(smoker%/2) risk of cancer.

Which is what the grandparent said, only in fewer words.

Re:Smoke up America! (4, Informative)

Sensiblemonkey (1539543) | more than 4 years ago | (#28412119)

The information you got is either wrong or very short sighted.

I smoke and I've researched this issue into the ground. Its pretty accurate.

You were asked to produce a citation and failed to do so; citing your own research doesn't count for squat.

Here's a citation I just pulled from the National Cancer Institute's website [cancer.gov] :

"Quitting smoking substantially reduces the risk of developing and dying from cancer, and this benefit increases the longer a person remains smoke free. However, even after many years of not smoking, the risk of lung cancer in former smokers remains higher than in people who have never smoked"

Emphasis placed there by me.

So, unless you can produce a contrary citation, I think it's pretty safe to say you're a pathetic troll spreading misinformation.

Re:Smoke up America! (4, Informative)

siddster (809752) | more than 4 years ago | (#28412601)

I smoke and I've researched this issue into the ground. Its pretty accurate.

No you haven't! This is a classic case of data dredging and selective presentation of data. For starters, amongst smokers with small primary lung cancers, smoking cessation is associated with an almost 3-fold reduction in cancer recurrence.
(annals of internal medicine http://www.annals.org/cgi/content/abstract/119/5/383 [annals.org] )

Not only that, but sustained quitters (14.5 years in this study ... data in the pdf and you'll need a subscription to access it... http://www.annals.org/cgi/content/abstract/142/4/233 [annals.org] ) had a 2.2 fold reduced incidence of lung cancer if they stayed cigarette free for that duration. Granted, that the risk never came back to baseline but its a far cry from declaring that smoking cessation doesn't reduce cancer mortality.

Also, smoking cessation dramatically reduces heart disease and stroke mortality. The number one killer of smokers (surprise, surprise!) is not cancer but in fact heart disease. Heart disease is also the leading cause of death in the US with 1 in 3 people dying of heart trouble. Hence, even if the benefits in terms of cancer reduction are modest, smoking cessation considerably reduces the number of people dying.

Get your facts right!

Re:Smoke up America! (4, Informative)

Grym (725290) | more than 4 years ago | (#28411527)

Look, the study also says that this has applications against lung cancer as well. This is good, because, even if you quit smoking, you don't actually reduce your chances of getting lung cancer.

That's not true.

While it is true that previous smokers will always have (if only slightly) a higher lung cancer risk than non-smokers, the relationship is dose-dependent based upon the additive amount of tobacco exposure over time. So, those who quit smoking (particularly those who quit smoking earlier), are less likely to get lung cancer. In fact, one major study [bmj.com] found that those who quit smoking before the age of 30 had a lung cancer risk close to the non-smoker group. Those who quit smoking before the age of 50 had about half the risk of those who didn't.

-Grym

Re:Smoke up America! (1)

maxume (22995) | more than 4 years ago | (#28411551)

Do you stop increasing them?

I haven't looked closely at such a thing, but I don't have the nicotine itch either.

Get a PSA Test (0)

Anonymous Coward | more than 4 years ago | (#28411397)

I am a 48 year old prostate cancer survivor who accidentally ordered a PSA test (simple blood test) which revealed that I had been carrying the slow growing cancer for 10 to 12 years. By the time of my discovery it was quite serious and I opted for surgery which I believe saved my life. While I was 'shopping' for treatments and surgeons, I found many teenagers and early adults with the disease. There has been controversy regarding the PSA test, and the medical establishment seems to not prescribe the test until patients are in their 50's (would have been dead by then). I was young once and never went to the doctor unless I could not function--but I urge you folks in your 20s and 30s to get a PSA test--cheap insurance & your life is worth a minor disruption.

This can't be (-1, Flamebait)

hrvatska (790627) | more than 4 years ago | (#28411427)

Everyone knows that advances in medical treatment can only come from profit motivated companies that can patent their treatment and then charge what the market will bear. It defies logic that an institution and its associated researchers would be motivated to advance knowledge and reduce suffering without being able to extract every last cent from desperate patients and their families.

Under the health care plan (1)

sumdumass (711423) | more than 4 years ago | (#28411523)

Under the health care plan currently circulating Washington and mentioned on slashdot [slashdot.org] earlier, a treatment like this still wouldn't be availible to people under the proposed coverage. It only allows standardized accepted treatments. This means that off label applications wouldn't be covered and you couldn't participate in a program like this until such time it becomes a standard treatment.

It sounds like this treatment, if it remains competent, has the potential to be a cheaper treatment then surgery as well as being effective in earlier detections and perhaps other cancers as well.

Regardless of what I like or dislike about the health care plan, exceptions or provisions in any plan need to be in place so normal people can get treatments like this when they become availible- even if they are still experimental and turn out to be a hail marry pass with the hopes of doing something other then the alternative of death.

Re:Under the health care plan (3, Insightful)

ColdWetDog (752185) | more than 4 years ago | (#28411973)

Regardless of what I like or dislike about the health care plan, exceptions or provisions in any plan need to be in place so normal people can get treatments like this when they become available- even if they are still experimental and turn out to be a hail marry pass with the hopes of doing something other then the alternative of death.

What prompts you to say that? This has been done on exactly two patients. If done on say, one hundred, maybe it helps five and kills the rest. The medical literature is quite full of therapies that held great promise but never lived up to their expectations for one reason or another. We waste an enormous amount of time and money on expensive, dangerous therapies that in the end, don't help patients much, and can hurt more patients then they help. Until and unless we do the real, long term, difficult and boring research (and the comparative research between different therapies) we're going to go off half cocked and fully broke.

Your attitude, common as it is, is about 1/2 of what is drastically wrong with American healthcare. There is no substitute for good science.

Re:Under the health care plan (1)

carlcmc (322350) | more than 4 years ago | (#28412713)

actually this is incorrect. this reported 2 recent patients. It has been used on 50+ patients in the recent couple of years.

Re:Under the health care plan (1)

ColdWetDog (752185) | more than 4 years ago | (#28413781)

That still doesn't change the gist of my argument - it's still an experimental therapy and needs to be treated as such. Experimental therapies often look promising in the first couple of hundred patients then, somehow, never seem to work as well in the 'real world'. Unintended side effects often take a while to show up. Sometimes the initial patient selection process winnows out the more typical complex patient taking other medications or having other concurrent problems - and the therapy doesn't work well for them.

We, as a society, need to get over the idea that just because it's new, doesn't necessarily mean it's better.

Re:Under the health care plan (1)

sumdumass (711423) | more than 4 years ago | (#28416015)

Lol.. I suppose you already know it's been done on more then two patients. But that doesn't really matter.

Here is what does matter, when the alternative is death because the condition is too far gone for existing treatments to be reasonably effective, experimental should mean nothing but here is another person to try it on. But if you think that only carefully selected people hand picked by researchers should be able to get these treatments until science has had their way, then please explain to me what the harm is giving someone who is already going to die a little hope for a cure?

I mean this treatment is off label usage of existing drugs to form another procedure application. It isn't using experimental drugs with unknown side effects, it isn't using cut up and feel around approaches, it isn't near as risky as you are making it to be. But under this new government plan, the default insurance is not allowed to participate in this, something else it isn't able to do is use Viagra in combination with heart medications as a supplement to the heart medications for sexually active patients with heart conditions. Here is something else you can't do which was recently the topic of an Ohio supreme court case in which the Planned parenthood of Cincinnati was cited for it's off label use of the u238 or whatever the day after pill was. When Planned parenthood was using the pill something like up to 2 weeks after the FDA approval terms and extended it's dosage from 20 some to 40 or 60 some days. Under ohio law, you have to follow the FDA approval guidelines for this drug, off label use was restricted, under this policy, it is too. Not that I'm for abortions or anything but crap like that is what this plan limits people to.

Your attitude, common as it is, is about 1/2 of what is drastically wrong with American healthcare. There is no substitute for good science.

Perhaps you should read the health car plan and get an idea of what I was talking about. There is no substitute for good science but there is also no reason to tell a person he or she is going to have to die because the common procedure won't work at your stage and the new procedures showing promise are restricted to certain privileged people because the science is superior to your life. Fuck, when death is your only options, even praying to God is a worthy experimental treatment. But when 2 or 10 people got better from X experimental treatment, then there is no reason why it can't be tried too.

Re:Under the health care plan (2, Insightful)

SydShamino (547793) | more than 4 years ago | (#28412905)

The nation can't afford to fund every experimental or crazy expensive treatment for everyone - we'd go broke. It's a noble goal but just not possible.

Instead, I see this as an opportunity for private insurance to thrive. I welcome government insurance as it will allow me to disconnect my health care from my employer. But I see an opportunity for a private company to offer supplemental insurance. With no preexisting conditions and, say, $20 a month, you could be covered up to $500,000 for experimental surgeries, out-of-country treatment, or other options for things not covered by your government plan. It lets the rich folks spend their extra money on something.

And the government can continue to fund research studies, like they probably did this one, so that those too poor or without supplemental insurance have a chance to participate. It's a win-win situation.

Re:Under the health care plan (1)

Hubbell (850646) | more than 4 years ago | (#28413019)

Those 'rich' folks won't have any extra money if government healthcare gets slammed through due to the enormous tax hikes that will be needed to fund it.

Re:Under the health care plan (1)

sumdumass (711423) | more than 4 years ago | (#28415661)

The nation can't afford to fund every experimental or crazy expensive treatment for everyone - we'd go broke. It's a noble goal but just not possible.

Your right but when the disease is too far gone and the medically accepted treatment is death, then what makes the difference if the person doesn't get the treatment because he can't afford the insurance or because the government can't afford the treatment? I mean isn't that what the entire problem is in the first place, people not getting treatments because it costs too much for the treatment and the insurance denies it or because the insurance costs too much and the person cannot afford it?

Sounds to me like this is nothing but a lateral move and the only difference is going to be the government being involved. Why the fuck do we need that when it won't change anything?

Instead, I see this as an opportunity for private insurance to thrive. I welcome government insurance as it will allow me to disconnect my health care from my employer. But I see an opportunity for a private company to offer supplemental insurance. With no preexisting conditions and, say, $20 a month, you could be covered up to $500,000 for experimental surgeries, out-of-country treatment, or other options for things not covered by your government plan. It lets the rich folks spend their extra money on something.

What world are you living in? Do you think if that was possible for $20 it wouldn't be an option right now? I'm seriously doubting you have thought that through much.

And the government can continue to fund research studies, like they probably did this one, so that those too poor or without supplemental insurance have a chance to participate. It's a win-win situation.

Wow. Are you saying that right now, the poor and people without insurance get treatment through government studies? Then why do we need government health care if they are already getting the treatment? I don't know, you have just completely confused me. You have went against the entire grain of why people think we need the government health care, talked about a $20 coverage option as if it would magically be possible after government health care when it isn't being offered right now, and then claimed that the poor and under insured would participate in government studies like they already do now.

It seems like too much smoke and mirrors for me.

Re:Under the health care plan (1)

jabithew (1340853) | more than 4 years ago | (#28413133)

It's a big problem in the British National Health Service. Essentially a lot of treatments aren't affordable on socialised healthcare, and so don't get rationed out by National Institute for Health and Clinical Excellence (NICE [wikipedia.org] ). Not necessarily a problem, but if individuals want to try the treatment then they must go private for the whole package, not just buy in the drugs they want. This is because NICE usually rejects treatments because of either their lack of cost-effectiveness (how many good life-hours can be saved per pound) or because of the costs of the side effects. The NHS would have to pay for the side effects.

The rules are not applied consistently, and what treatment the NHS will pay for depends a lot on where you are, with the most generous being in oil-rich Scotland and it varying significantly with Primary Care Trust (PCT, but the phenomenon is known colloquially as the postcode lottery [telegraph.co.uk] ). The disparity is caused by efficiency of management, the presence of renowned hospitals that can pull in patients and hence funding from outside the PCT and in the case of the different nations, disparity in the funding per head of population.

Socialised healthcare has many of the pitfalls associated with all government spending, with political interference leading to popular-but-ineffective treatments getting funding priority over cheaper and better programmes (a new cancer treatment that NICE refuses will sometimes be pushed out by the government anyway as a vote-winner, no matter how clinically effective it is, and the money will have to come from far more useful screening programmes). There are other issues to do with patient choice and quality of care (patients find it near impossible to judge whether the local hospital is actually competent at cancer operations, for example). It is no panacea.

Equally, the current American system sees the average American paying ten times more for healthcare than the average Brit, yet achieving only a similar outcome and without the universal coverage*. To a certain extent it's a personal choice, but the NHS (like the BBC) is more of a national religion than Christianity over here.

*Can't find the citation for this. Was either a WHO study or the Economist reporting on it. Will look more later.

Re:Under the health care plan (1)

sumdumass (711423) | more than 4 years ago | (#28415757)

Here is what I don't get.

Under the British system, if they decide not to cover a treatment and you do it privately, you are out of the system for the rest of your life. Under the System circulating congress, you can't have more, that has to be a separate and additional policy charged separately.

Now what makes the difference between the consumer not being able to pay for the treatment or make their own decisions regarding their health care verses the British or American government doing it. At best, the government should make a minimum acceptable coverage that an insurance company can offer, have it follow the same medicaid/medicare guidelines for treatment, allow policies to go over and above this, and make a stipulation of no disqualifications and no max coverage. If someone needs treatment, can't pay for it and doesn't have insurance, make it a retroactive coverage if the person commits to a 5 year policy. Problem solved, it still a personal choice and you have no problems getting private care outside the government mandates system.

As for the WHO study, I'm a little cautious about those. They seem to get reported a little different then they actually are and they keep disappearing. I wouldn't be to surprised to find that some of them are more or less propaganda tools and disappear when people start questioning the facts. I don't need to tinfoil hat to know it wouldn't be the first time an international organization was corrupted for personal gain or to achieve some goal counter to reality. The UN is one big example of this.

Re:Under the health care plan (1)

nbauman (624611) | more than 4 years ago | (#28415909)

Under the UK NICE system, they pay for a treatment if it saves life at a cost of about $55,000 a year or less. They make a lot of exceptions.

http://www.nytimes.com/2008/12/03/health/03nice.html [nytimes.com]

The New York Times
December 3, 2008
The Evidence Gap
British Balance Gain Against the Cost of the Latest Drugs
By GARDINER HARRIS

RUISLIP, England â" When Bruce Hardy's kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.

One sided report (2, Informative)

Anonymous Coward | more than 4 years ago | (#28411543)

There were 54 patients and only 3 had dramatic response.
They are hoping that by adjusting the dosage that this
will improve.
http://www.minnpost.com/healthblog/2009/06/19/9659

Ipilimumab failed a prior clinical trial for prostate cancer.
http://pmid.us/17363537

and failed a prior clinical trial for skin cancer. Also its
side effects can include rashes, diarrhea and hepatitis.
http://en.wikipedia.org/wiki/Ipilimumab

It would be great if it worked but this is more likely
one of the numerous "breakthroughs" that never
pan out.

Good news... (1)

Mashiki (184564) | more than 4 years ago | (#28411927)

Hey guys...get your ass checked!

Seriously. Not joking here, if you think that this shit won't kill you hard and fast you need a reality check. Get it young, you're probably going to die. Get it when you're older, probably going to live.

Re:Good news... (0)

Anonymous Coward | more than 4 years ago | (#28413435)

Hey guys...get your ass checked!

Seriously. Not joking here, if you think that this shit won't kill you hard and fast you need a reality check. Get it young, you're probably going to die. Get it when you're older, probably going to live.

For those who are confused after parsing the above, the "it" in "Get it" refers to "prostate cancer", not "checked out".

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