Workers in certain occupations may face an increased risk of cancer due to exposures that they encounter on the job. Exposure to radiation, potentially hazardous chemicals, or second-hand smoke may all carry risk. Some studies have linked work as a painter with an increased risk of bladder and lung cancer.

Using data from multiple studies, researchers associated with the International Agency for Research on Cancer (IARC) evaluated the risk for bladder cancer associated with occupational exposure to painting.

• Overall, occupational exposure to painting increased the risk of bladder cancer by 25%. The elevated risk remained after taking into consideration smoking and other risk factors.
• The longer the duration of exposure to painting, the greater the risk.

The IARC has classified occupational exposure as a painter as “carcinogenic to humans,” based primarily on increases in risk of bladder cancer and lung cancer. Although the researchers say that the increase in bladder cancer risk is “modest,” they note that any elevation is noteworthy “because several million people are employed as painters worldwide.”

Reference: Guha N, Steenland NK, Merletti F, et al. Bladder cancer risk in painters: a meta-analysis. Occupational and Environmental Medicine. 2010 Aug;67(8):568-73.

Statins are cholesterol-lowering drugs; they are the most commonly prescribed class of prescription drugs in the United States. Some studies have suggested that in addition to their cardiovascular effects, statins may provide a prostate cancer benefit. It’s unclear, however, whether statins might prevent prostate cancer, treat prostate cancer, or simply affect PSA levels alone.

A study recently published in the Journal of Clinical Oncology evaluated whether statin use could reduce the risk of prostate cancer recurrence among men who had received radiation therapy for localized or locally advanced prostate cancer.[2] The results of this study indicated that statin use was associated with a reduced risk of recurrence, as detected by a rise in prostate specific antigen (PSA) levels; a reduced risk of needing additional (or “salvage”) androgen deprivation therapy (ADT); and improved relapse-free survival.

The current study evaluated whether or not statin use following treatment of early-stage prostate cancer with radical prostatectomy was associated with a reduced risk of recurrence as detected by a rise in PSA levels. The researchers analyzed database records of 1,319 prostate cancer patients who had undergone a radical prostatectomy. For each patient, their use or nonuse of statins at the time of surgery was determined as well as PSA progression. Of the 1,319 prostate cancer patients analyzed, 236 were taking statins at the time of surgery.  PSA progression occurred in 16% of the statin users and 25% of the nonusers. After adjusting the data for clinical factors that impact cancer recurrence risk, the researchers determined that statin use was associated with a 30% lower risk of PSA recurrence. In addition, the lower risk of PSA recurrence was dependent on the statin dose with statin users at the highest doses experiencing the most benefit.

The researchers concluded that statin use may slow prostate cancer progression among men who have undergone radical prostatectomy. Further studies are warranted to confirm these results.

Reference:

[2] Gutt R, Tonlaar N, Kunnavakkam R, et al. Statin use and risk of prostate cancer recurrence in men treated with radiation therapy. Journal of Clinical Oncology [early online publication]. April 26, 2010.

Men with early-stage prostate cancer have the option of being treated with radiation therapy, surgery, or no therapy until symptoms appear (watchful waiting). The choice of treatment is difficult, as there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression. In part, this is because prostate cancer often occurs in older individuals who die of other causes before they die of prostate cancer. Watchful waiting may help some men avoid unnecessary treatment and potentially long-lasting side effects.

An observational study in Sweden included 6,849 patients, age 70 or younger with localized prostate cancer; 2,686 of these patients were considered low-risk (stage T1, Gleason score 2-6 and PSA <10 ng/mL). Among this cohort, 2,021 patients received active surveillance (or watchful waiting), 3,399 underwent radical prostatectomy, and 1,429 received radiation therapy.

After a median follow-up of 8.2 years, there were 413 deaths in the surveillance group (20.4%), 286 deaths in the prostatectomy group (8.4%), and 196 deaths in the radiation group (13.7%). There was a much higher rate of death from competing causes (i.e., causes other than prostate cancer) in the surveillance group (19.2%) compared with the prostatectomy group (6.8%) and radiation group (10.9%). This suggests that perhaps patients with an already shorter life expectancy were more often treated with surveillance rather than surgery or radiation.

When analyzing the data for the entire cohort (both low and intermediate-risk), the cumulative 10-year prostate cancer-specific mortality rate was 3.6% in the surveillance group compared with 2.7% in the surgery/radiation group. Among the low-risk group, the 10-year prostate cancer-specific mortality was 2.4% in the surveillance group and 0.7% in the surgery/radiation group. Based on these data, the researchers concluded that surveillance may be a suitable treatment option for men with low-risk prostate cancer.

Reference:

Aromatic amines are a group of well-known bladder carcinogens. Most countries have discontinued exposure to aromatic amines; however, research is ongoing to determine the long-term effects to workers who were exposed in the past.

One study examined the risk of bladder cancer among a cohort of 664 dyestuff workers in Italy who were heavily exposed to aromatic amines between 1922 and 1972. These workers were found to have a substantially increased risk of bladder cancer death.

The data from this study have now been updated by 14 years through 2003 (for 590 exposed workers) and now includes more than 30 years of follow-up since the last exposure to aromatic amines. Using national mortality rates and regional mortality rates, researchers computed the expected number of deaths from bladder cancers and other causes. There were 394 deaths in the group compared with the expected number of 262.7. Overall, there were 56 deaths from bladder cancer compared with 3.4 expected.

The risk of death from bladder cancer increased with a younger age at first exposure to aromatic amines and increasing duration of exposure. Although the risk of bladder cancer death steadily decreased with time since last exposure, the absolute risk remained constant. The researchers observed an increased risk of bladder cancer 30 years or more since last exposure to aromatic amines.

Reference:

[1] Pira E, Piolatto G, Negri E, et al. Bladder cancer mortality of workers exposed to aromatic amines: A 58-year follow-up. Journal of the National Cancer Institute. 2010; 102: 1-4.

Prostate cancer is a hormonally sensitive disease that can be controlled for long periods with androgen deprivation therapy (ADT) or castration. When prostate cancer stops responding to this treatment is it referred to as hormone refractory prostate cancer. Because hormone refractory prostate cancer can be difficult to treat, new agents and treatment approaches continue to be evaluated.

Jevtana is a new chemotherapy drug. To evaluate Jevtana in the treatment of metastatic, hormone refractory prostate cancer, researchers conducted a Phase III clinical trial (the TROPIC study) among 755 men in 26 countries. All of the study participants had experienced cancer progression in spite of Taxotere-based chemotherapy.

Study participants were assigned to receive treatment with either Jevtana plus prednisone or mitoxantrone plus prednisone.

• Median survival was 15.1 months among men treated with Jevtana compared with 12.7 months among men treated with mitoxantrone.
• Men treated with Jevtana also fared better in terms of progression-free survival and tumor response rates.
• Side effects of Jevtana included low blood cell counts, diarrhea, fatigue, nausea, and vomiting.

Jevtana provides another treatment option for men with a difficult-to-treat form of prostate cancer.

Reference: FDA news release. FDA Approves New Treatment for Advanced Prostate Cancer. June 17, 2010.

Locally advanced prostate cancer refers to cancer that has spread through the prostate capsule but not to distant sites in the body. Treatment of locally advanced prostate cancer often includes androgen deprivation therapy (hormone therapy). Hormone therapy blocks male hormones from stimulating the growth of prostate cancer.

To determine whether the addition of radiation therapy to hormone therapy results in better outcomes than hormone therapy alone, researchers conducted a study among 1,205 men with locally advanced or high-risk prostate cancer. Half the men received hormone therapy alone and half received hormone therapy and radiation therapy.

The combination of hormone therapy and radiation appeared to offer a benefit: seven years following treatment, 74% of men who received the combination treatment were alive compared with 66% of those who received hormone therapy alone.

Among patients who received the combination of hormone therapy and radiation, 10% died from their prostate cancer compared with 26% of men who received hormone therapy alone. Men who received radiation plus hormone therapy lived an average of six months longer than their counterparts who received hormone therapy alone.

The researchers concluded that men with locally advanced prostate cancer who received radiation plus hormone therapy lived longer and were less likely to die from their prostate cancer than those who received hormone therapy alone.

Reference: Warde PA, Mason MD, Sydes MR, et al. Intergroup randomized phase III study of androgen deprivation therapy (ADT) + radiation therapy (RT) in locally advanced prostate cancer (CaP) (NCIC-CTG, SWOG, MRC-UK, INT: T94-0220; NCT00002633. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract CRA 4504.

Radiation therapy is a commonly used treatment for early prostate cancer. External-beam radiation therapy (EBRT) refers to radiation that is delivered to a specified area from a machine outside of the body. External-beam radiation therapy has been shown to raise the risk of hip fracture among women, leading researchers to question whether EBRT could also affect hip fracture risk among men.

Risk of fracture is a concern among men undergoing treatment for prostate cancer because androgen deprivation therapy (ADT)—a common treatment for prostate cancer—can result in loss of bone density and an increased risk of fracture. Due to this risk, men receiving ADT are also often treated to protect bone health.

To explore whether EBRT for prostate cancer may increase risk of hip fracture, researchers evaluated 166,162 men, age 66 years and older, from the Surveillance, Epidemiology and End Results database. Risk of fracture at the hip (within the radiation field) and risk of fracture at the wrist (outside the radiation field) among men who had undergone EBRT were compared with risk among men who had not.

• Overall, EBRT increased risk of hip fracture by 58 percent but did not increase risk of wrist fracture.
• Among patients treated with ADT, risk of fracture at the hip and the wrist were both increased.

The researchers concluded that, due to the risk of hip fracture associated with EBRT for prostate cancer, patients undergoing EBRT may benefit from measures to improve bone health.

Reference: Alanee S, Jarosek S, Virnig B, Elliott S. Three dimensional external beam radiotherapy for prostate cancer increases the risk of hip fracture. Presented at the 2010 annual meeting of the American Urological Association. May 29-June 3, 2010. San Francisco, CA. Abstract 48.

Volatile organic compounds (VOCs) are organic chemical compounds that are derived from a number of man-made and biologic sources, including cancer cells. Data have indicated that concentrations of VOCs differ according to age and produce a scent to which animals may be particularly sensitive. Researchers have been evaluating the capability among dogs to detect cancer by scent; previous research has focused on breast, lung, and bladder cancers.

To investigate whether prostate cancer tumors may excrete certain VOCs through urine that dogs can detect by scent, researchers in Paris trained dogs to recognize the scent of VOCs from prostate cancer cells. The dogs were then trained to distinguish between urine from prostate cancer patients and urine from individuals without cancer. Following this training, the dogs were presented with five urine samples, only one of which came from a patient with confirmed cancer. The animals were instructed to identify the samples from cancer patients.

A total of 66 urine samples were used in the study; of these, the dogs correctly classified 63—meaning in 63 of the 66 samples, they accurately identified which samples were from prostate cancer patients and which were not. The dogs correctly identified 100% of urine samples from cancer patients and correctly classified 91% of samples from people without cancer.

According to the AUA Public Media Committee Chair Anthony Y. Smith, MD, “These data suggest that prostate cancer tumors may excrete certain VOCs that turn up in a patient’s urine and that this ‘scent’ may be specific to prostate cancer.” The next step will be to determine what those VOCs are and to develop a test that can identify them. Further development of accurate screening tests for prostate cancer is an important area of research, as the accuracy of the current primary screening method—the prostate-specific antigen (PSA) test—remains suboptimal.

Reference: Cornu J-N, Girardet C, Cancel-Tassin G et al. The use of canines for prostate cancer detection: towards a non-invasive alternative screening tool. Presented at the 2010 annual meeting of the American Urological Association. May 29-June 3, 2010. San Francisco, CA. Abstract 2159.

Each year in the United States, close to 53,000 men and 18,000 women are diagnosed with bladder.[1] Many bladder cancers are thought to be caused by exposure to cancer-causing agents that pass through the urine and come into contact with the bladder lining. The most important risk factor for bladder cancer is smoking, which increases risk by at least fourfold.

Dietary supplements such as multivitamins are used by many people in the hope of reducing the risk of cancer and other diseases. Evidence that dietary supplements reduce cancer risk is limited, however, and some studies have even suggested that certain types of dietary supplements may increase cancer risk.

To explore the relationship between commonly used vitamin supplements and risk of bladder cancer, researchers evaluated information from the VITamins And Lifestyle (VITAL) study.[2] The study enrolled more than 77,000 Washington State residents between the ages of 50 and 76. During five years of follow-up, 330 study participants developed bladder cancer.

After accounting for other known risk factors for bladder cancer, the researchers found no link between vitamin C, vitamin D, or vitamin E and risk of bladder cancer.

People who are considering the use of dietary supplements such as vitamins are advised to discuss the risks and benefits with their physician.

References:

[2] Hotaling J, Wright J, Pocobelli G, Porter M, White E. Risk of urothelial cell carcinoma of the bladder in the VITamins And Lifestyle study. Presented at the 2010 annual meeting of the American Urological Association. May 29-June 3, 2010. San Francisco, CA. Abstract 1162.

Since the late 1980s, the primary screening tool for early detection of prostate cancer has been the prostate-specific antigen (PSA) test. While this test is widely used, it remains controversial, due to both false positive and false negative test results. Produced by cells in the prostate, PSA levels in the blood tend to be elevated in men who have prostate cancer. However, not all men with prostate cancer have elevated PSA, and not all men with elevated PSA have prostate cancer. PSA levels can also become elevated as a result of noncancerous conditions of the prostate.

Men who have elevated levels of PSA are often referred for a prostate biopsy in order to determine whether prostate cancer is present. Many of these biopsies are negative (show no evidence of cancer). A goal of research into prostate cancer testing, therefore, is to reduce the number of men who undergo unnecessary prostate biopsies.

PCA3 is a test that could potentially help guide decisions about the need for prostate biopsy. PCA3 (prostate cancer gene 3) is overexpressed in men with prostate cancer but not in men with noncancerous prostate problems. The PCA3 test measures PCA3 expression in a sample of urine.

In the current study, PCA3 was evaluated among 1,994 men with elevated serum PSA and/or an abnormal digital-rectal exam.[1] All men underwent prostate biopsy, and 42% were found to have prostate cancer.

• The average PCA3 level was higher in men with prostate cancer than in men without prostate cancer. PCA3 level was also correlated with Gleason score and cancer volume.
• The PCA3 test had higher specificity than the PSA test (i.e. was more likely to correctly classify men without cancer), but lower sensitivity (was less likely to correctly classify men with cancer). Overall, PCA3 was more strongly linked with the likelihood of prostate cancer than PSA.

In another study presented at the AUA meeting, researchers assessed the ability of a test for free circulating DNA (fcDNA) to predict the presence of prostate cancer.[2] The results indicated that high fcDNA was linked with an increased likelihood of prostate cancer.

Tests such as these may eventually help guide decisions about the need for prostate biopsy.

References:

[2] Singal R, Gordian E, Ramachandran K et al. Serum free circulating DNA as a biomarker for prostate cancer diagnosis. Presented at the 2010 annual meeting of the American Urological Association. May 29-June 3, 2010. San Francisco, CA. Abstract 1736.