Four cups of coffee a day may keep prostate cancer away

Bioactive compounds in coffee may have anti-inflammatory and antioxidant effects

Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control.

Corresponding author Janet L. Stanford, Ph.D., co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease.

Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week.

They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately.

First study to assess the link between tea and prostate cancer outcomes

Regarding tea consumption, the researchers did not find an associated reduction of prostate cancer recurrence and/or progression. The study also did not draw any conclusions regarding the impact of tea drinking on prostate-specific death.

“To our knowledge, our study is the first to investigate the potential association between tea consumption and prostate cancer outcomes,” the authors wrote. “It is important to note, however, that few patients in our cohort were regular tea drinkers and the highest category of tea consumption was one or more cups per day. The association should be investigated in future studies that have access to larger populations with higher levels of tea consumption.”

The population-based study involved 1,001 prostate cancer survivors, aged 35-74 years old at the time of diagnosis between 2002-2005, who were residents of King County, Wash. Participants answered questions regarding their diet and beverage consumption two years prior to prostate cancer diagnosis using a validated food frequency questionnaire, and were interviewed about demographic and lifestyle information, family history of cancer, medication use and prostate cancer screening history.

The researchers followed up with patients more than five years after diagnosis to ascertain whether the prostate cancer had recurred and/or progressed. Those who were still living, willing to be contacted and had been diagnosed with non-metastatic cancer were included in the follow-up effort.

Of the original 1,001 patients in the cohort, 630 answered questions regarding coffee intake, fit the follow-up criteria and were included in the final analysis. Of those, 61 percent of the men consumed at least one cup of coffee per day and 12 percent consumed the highest amount: four or more cups per day.

The study also evaluated daily coffee consumption in relation to prostate cancer-specific death in 894 patients using data from the initial food frequency questionnaire. After the median follow-up period of eight-and-a-half years, 125 of the men had died, including 38 specifically from prostate cancer. Daily coffee consumption was not associated with prostate cancer-specific mortality or other-cause mortality, but with few deaths these analyses were limited.

“Our study differs from previous ones because we used a composite definition of prostate cancer recurrence/progression,” said first author Milan Geybels, a doctoral student at Maastricht University in the Netherlands who was a graduate student in Stanford’s Prostate Studies group at Fred Hutch when the study was conducted. “We used detailed information on follow-up prostate-specific antigen levels, use of secondary treatment for prostate cancer and data from scans and biopsies to assess occurrence of metastases and cause-specific mortality during follow up. Using these detailed data, we could determine whether a patient had evidence of prostate cancer recurrence or progression.”

The results are consistent with findings from Harvard’s Health Professionals Follow-up Study, which found that men who drank six or more cups of coffee per day had a 60 percent decreased risk of metastatic/lethal prostate cancer as compared to coffee abstainers.

Phytochemicals in coffee have anti-inflammatory and antioxidant effects

Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism. These naturally occurring compounds include:

  • Caffeine, which has properties that inhibit cell growth and encourage apoptosis, or programmed cell death. Previous studies have found that caffeine consumption may reduce the risk of several cancer types, including basal-cell carcinoma, glioma (a cancer of the brain and central nervous system) and ovarian cancer.
  • Diterpenes cafestol and kahweol, which may inhibit cancer growth.
  • Chlorogenic acid, which, along with caffeic acid, can inhibit DNA methylation, a biochemical process involved in the development and progression of many cancer types.

Additional studies needed to confirm whether coffee can prevent cancer recurrence

The researchers emphasize that coffee or specific coffee components cannot be recommended for secondary prevention of prostate cancer before the preventive effect has been demonstrated in a randomized clinical trial. Further, there’s ongoing debate about which components in coffee are anti-carcinogenic, and additional large, prospective studies are needed to confirm whether coffee intake is beneficial for secondary prevention.

Coffee drinking may even be problematic for some men, Geybels said.

“Although coffee is a commonly consumed beverage, we have to point out that increasing one’s coffee intake may be harmful for some men. For instance, men with hypertension may be vulnerable to the adverse effects of caffeine in coffee. Or, specific components in coffee may raise serum cholesterol levels, posing a possible threat to coronary health. Patients who have questions or concerns about their coffee intake should discuss them with their general practitioner,” he said.

The investigators also noted limits to their study, which included a lack of data on how coffee consumption might have changed following diagnosis, whether the coffee that participants consumed was caffeinated or decaffeinated, and how the coffee was prepared (espresso, boiled or filtered), a factor that may affect the bioactive properties of the brew.

Geybels et al., (2013). Coffee and tea consumption in relation to prostate cancer prognosis. Cancer Causes & Control, EPub Ahead of Print [Abstract]

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Subtypes of gastric cancer may require different therapies

Stomach cancer, one of the leading causes of cancer death worldwide, actually falls into three broad subtypes that respond differently to currently available therapies, according to researchers at Duke-NUS Graduate Medical School Singapore. The finding could greatly improve patient care with the development of a genetic test to classify tumors and match them to the therapies that offer the best outcomes.

“One of the features that makes gastric cancer so lethal is that it arises from many genetic alterations, creating differences in how the tumors respond to therapies,” said Steve Rozen, Ph.D., director of the Centre for Computational Biology at Duke-NUS. Rozen is senior author of the study published in the September issue of the journal Gastroenterology. “What our study has shown is that there are actually three distinct molecular classifications that appear to be biologically and therapeutically meaningful.”

Worldwide, only lung cancer is more lethal than stomach cancer. Rates in all countries have been dropping for decades, and are much lower in the United States than in Asia, but the malignancy still afflicts more than 21,000 people in the U.S. a year, according to the National Cancer Institute.

Despite differences in the way their tumors respond to treatments, patients often receive a “one-size-fits-all” treatment approach, resulting in a five-year survival rate of about 27 percent in the United States.

“There has been an urgent need for improved classification of gastric cancer that provides insight into the biology of the tumors that might help predict treatment response,” said co-senior author Patrick Tan, M.D., PhD., professor in the Cancer and Stem Cell Biology Program at Duke-NUS.

The gene expression analysis broadly sorts the tumors into three subtypes: proliferative, metabolic and mesenchymal. These subtypes also differ in their genomic and epigenomic properties.

Tumors of the proliferative subtype have high levels of genomic instability and a mutation in the TP53 tumor suppressor gene that occurs in many types of cancers. Cancer cells of the metabolic subtype are more sensitive to the chemotherapy agent 5-FU. Cancer cells of the mesenchymal subtype have some features of cancer stem cells, and are particularly sensitive to a class of therapies called PI3K−AKT−mTOR inhibitors.

“In terms of clinical treatment, there are two promising findings from our research,” Rozen said. “One is that 5-FU has been particularly effective against metabolic- subtype tumors, and the second is that drugs targeting the PI3K−AKT−mTOR pathway may be particularly effective against mesenchymal-subtype cancers.”

“If confirmed in future studies, the classification of gastric cancers reported here could guide development of therapies tailored to the molecular subtypes,” said lead author Zhengdeng Lei, PhD.

Lei et al., (2013). Identification of molecular subtypes of gastric cancer with different responses to PI3-kinase inhibitors and 5-fluorouracil. Gastroenterology145: 54-565 [Abstract]

Is growing MRI use leading to more invasive breast cancer surgery?

Heavy use of magnetic resonance imaging (MRI) may be leading to unnecessary breast removal in older women with breast cancer, according to a study by Yale School of Medicine researchers in the current issue of Breast Cancer Research and Treatment.

“These data are concerning because the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear,” said the study’s lead author Cary Gross. M.D., associate professor of internal medicine at Yale School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale Cancer Center.

“Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit of the more aggressive option,” Gross added.

The research team tracked the use of breast MRI and surgical care of 72,461 female Medicare beneficiaries age 67-94 who were diagnosed with breast cancer during 2000 to 2009.

The team found a considerable increase in the use of preoperative breast MRI over the study period from 1% in 2000-2001 to 25% in 2008-2009. The researchers also found that women who received an MRI were more likely to subsequently undergo more aggressive surgical treatment. In women who received mastectomy, 12.5% of those who had MRI received bilateral mastectomy, while only 4.1% of those who did not have MRI had bilateral mastectomy.

The study also revealed that women undergoing MRI were more likely to have a contralateral prophylactic mastectomy (surgery to remove both breasts when cancer was only found in one breast). Among women who underwent mastectomy, 6.9% of women who had an MRI underwent contralateral prophylactic mastectomy, compared to 1.8% in women who did not have an MRI.

“There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age,” said Brigid Killelea, M.D., assistant professor of surgery at Yale School of Medicine, and first author on the study. “Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer.”

Killelea et al., (2013). Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer. Breast Cancer Res. Treat., EPub Ahead of Print, doi:10.1007/s10549-013-2656-1 [Abstract]

Chemotherapy before radiotherapy for testicular cancer could reduce long-term side-effects

Giving men with testicular cancer a single dose of chemotherapy alongside radiotherapy could improve the effectiveness of treatment and reduce the risk of long-term side-effects, a new study reports.

As many as 96% of men with testicular cancer now survive at least ten years from diagnosis, but more advanced forms need to be treated with combination chemotherapy – which can have serious long-term complications. Researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust have therefore been searching for new treatments that would reduce the risk of relapse after initial treatment and so spare as many men as possible from needing combination chemotherapy.

The new pilot study, published in the August issue of prestigious journal the Annals of Oncology, tested a new treatment in a pilot study of men with stage IIA and IIB testicular seminoma – where the cancer has spread to the lymph nodes in the abdomen.

The researchers showed that giving chemotherapy drug carboplatin before radiotherapy could reduce relapse rates compared with radiotherapy alone – cutting the numbers of men who would need follow-up treatment. It also allowed radiation doses to be reduced. The study was funded by The Institute of Cancer Research (ICR), the Bob Champion Cancer Trust and Cancer Research UK, as well as through the NIHR Biomedical Research Centre at The Royal Marsden and the ICR.

Researchers gave 51 men with stage IIA and IIB testicular seminoma a single cycle of carboplatin – a low toxicity form of chemotherapy – followed three to four weeks later by radiotherapy. Most of the men were aged below 50, over a range of 18-73 years.

Adding carboplatin to patients’ treatment plans allowed doctors to give a lower dose of radiation over a smaller area of the body for most of the men in the study. Some 39 of the men in the study had their prescription of radiation reduced from the standard 35 Grays (Gy) of radiation to 30 Gy, delivered to a smaller area of the abdomen.

After an average of 4.5 years of follow-up, there were no relapses of the cancer compared with a relapse risk of 5-11% after radiotherapy alone. The side-effects from treatment were mild and only lasted a short time.

Dr Robert Huddart, Team Leader in the Division of Radiation and Imaging at the Institute of Cancer Research, London, and Consultant at The Royal Marsden, who led the study, said:

“The results of this study show great promise. Men who have this stage of testicular seminoma are normally treated with just radiotherapy, or in some countries with intensive combination chemotherapy, where several anticancer drugs are given at once. Relapse occurs in 5-11% of men after radiotherapy alone, and these recurrences have to be treated with combination chemotherapy, which is associated with a risk of serious long-term complications such as cardiovascular disease or second cancers.

“The aim of the study was to develop an effective non-toxic treatment with low risk of long-term treatment complications, and our findings suggest that a single cycle of carboplatin before radiotherapy may reduce the chances of cancer reappearing compared with radiotherapy alone. This will reduce the risk that these patients would need combination chemotherapy. Not only that, but by adding carboplatin to the therapy, the radiation dose and volume can be lowered.”

As this was a small, single-centre study, the researchers are recommending the approach is evaluated more widely.

Horwich et al., (2013). Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann. Oncol., 24 : 2104-2107 doi:10.1093/annonc/mdt148 [Abstract]

Standardizing guidelines for penile cancer treatment

Radical surgery not always necessary, which may improve quality of life.

Penile cancer is rare, with an average of 1,200 new cases per year in the United States, but it can be debilitating and lethal. Without evidenced-based treatment approaches, outcomes have varied widely. Philippe E. Spiess, M.D., an associate member in the Department of Genitourinary Oncology at Moffitt Cancer Center, presented new National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology to standardize care for penile cancer in an article that appeared in the July issue of the Journal of the National Comprehensive Cancer Network.

“We wanted to clarify controversies associated with penile cancer,” said Spiess. “The new protocol, created with input from experts from around the world, is intended to establish a foundation to standardize and optimize the care of patients with this potentially lethal cancer.”

The debate involves radical versus non-radical surgery. , which involves partial or total removal of the penis, is often performed regardless of the stage of cancer, said Spiess. However, by employing new biopsy techniques and combination therapies, radical surgery is not always necessary.

“Having standardized guidelines for treatment will likely impact patient treatment by encouraging less radical surgeries, extending survival time and providing better quality of life,” said Spiess.

The new guidelines offer a number of treatment options for various grades of penile cancer. Suggested treatments range from local excision to laser or radiation therapy and radiochemotherapy. Radical surgery remains the standard in managing invasive penile cancer, said Spiess. However, less invasive options that may improve quality of life are being considered based on the stage and grade of the tumor.

There is not much literature available about surveillance for men with penile cancer. But Spiess suggests patients treated with primary lesions be examined every three months for the first two years. Those who have had penile-preserving surgery should be followed up more stringently.

Spiess concluded that physicians should be cautious and not jump to surgery right away as penile cancer patients are at high risk for subsequent cancer progression.

Spiess PE (2013). New Treatment Guidelines for Penile Cancer. J. Natl. Compr. Canc. Netw.11: 659-662 [Abstract]

Pattern in lung cancer pathology may predict cancer recurrence after surgery

Findings could help identify patients most likely to benefit from lung-sparing surgery

A new study by thoracic surgeons and pathologists at Memorial Sloan-Kettering Cancer Center shows that a specific pattern found in the tumor pathology of some lung cancer patients is a strong predictor of recurrence. Knowing that this feature exists in a tumor’s pathology could be an important factor doctors use to guide cancer treatment decisions.

According to the study’s authors, the findings offer the first scientific evidence that may not only help surgeons identify which patients are more likely to benefit from less radical lung-sparing surgery, but which patients will benefit from more extensive surgery, potentially reducing the risk of lung cancer recurrence by 75 percent. The study will be published in the August 20 issue of the Journal of the National Cancer Institute.

Researchers retrospectively evaluated the clinical characteristics and pathology information of 734 patients who had surgery for early-stage adenocarcinoma — the most common subtype of non-small cell lung cancer — and found that tumors in 40 percent of those patients exhibited an abnormal cell pattern strongly associated with cancer recurrence after surgery. No study to date has investigated the prognostic utility of this classification, called micropapillary (MIP) morphology, for patients with small, early-stage lung adenocarcinomas. Currently there are no evidence-based criteria for choosing the most effective surgical approach for this group.

The findings suggest that limited resection may not be appropriate for patients with the MIP pattern, as they were found to have a 34 percent risk of the cancer returning within five years after lung-sparing surgery, or limited resection, in which the tumor is removed by minimally invasive means and lung function is preserved. In contrast, patients with the MIP pattern who underwent lobectomy — the standard approach in which up to a third of the lung is removed along with the tumor — had only a 12 percent incidence of recurrence over a five-year period.

The study observations may play a key role in deciding whether to perform lung-sparing surgery or lobectomy for patients with small lung adenocarcinomas. It currently takes an expert lung pathologist to identify the MIP pattern during an operation. If the surgeon performs lung-sparing surgery in the presence of the MIP pattern, the chance of recurrence is high within the spared lobe of the lung. A lobectomy can reduce this chance of recurrence by 75 percent. If the MIP pattern is not found, the surgeon can confidently perform lung-sparing surgery.

Only a handful of cancer centers in the country have the expertise needed to identify the MIP pattern during surgery. Patients whose tumors are later found to have the MIP pattern after lung-sparing surgery may require another excision or a full lobectomy to reduce their risk of recurrence. Researchers at Memorial Sloan-Kettering are working to develop new technology that can be used to precisely identify which tumors have the MIP pattern before or during surgery. This will not only help doctors recommend the most effective surgical approach for each patient, but will result in fewer patients requiring additional treatment.

Nearly 250,000 patients are diagnosed with non-small cell lung cancer each year in the United States. The detection of small, early-stage lung adenocarcinomas is expected to increase as a result of advances in imaging technology, the widespread use of CT screening, and professional guidelines recommending screening long-time smokers for lung cancer. The findings of the new study will have immediate implications for the management of these patients.

Nitadori et al., (2013). Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2cm or smaller. J. Natl. Cancer Inst., EPub Ahead of Print [Abstract]

Breast cancer surgery linked to swollen arm syndrome

Breast cancer survivors who have extensive surgery are four times more likely to develop the debilitating disorder arm lymphoedema, study has found.

The findings in a new paper Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis published in the prestigious journal The Lancet Oncology, reveal the invasiveness of surgery to treat breast cancer increases the risk of developing arm lymphoedema.

Lead author of the study Tracey DiSipio, from QUT’s Institute of Health and Biomedical Innovation, said women who had undergone an axillary lymph node dissection – an invasive surgery to remove lymph nodes under the arm – were four times more likely to suffer swollen or disfigured arms.

She said this was compared to women who had received a sentinel lymph node biopsy.

“Arm lymphoedema is typically characterised by swelling in one or both arms, causing pain, heaviness, tightness and a decreased range of motion,” Dr DiSipio said.

“The appearance of the swollen or disfigured arms provides an ever-present reminder of breast cancer and often contributes to anxiety, depression and emotional distress in effected women.”

Dr DiSipio said the study, a systematic review of the incidence of arm lymphoedema after breast cancer, also found that one in five women (21.4 per cent) would be diagnosed with the condition.

“This is a significant research finding and provides us with the most accurate incidence rate to date,” she said.

“Until now the incidence rate has been reported anywhere from between zero to 94 per cent. With this information we can explore whether lymphoedema rates differ between breast cancer survivors.”

Dr DiSipio said the study also pinpointed a number of risk factors linked to arm lymphoedema.

“The risk factors increased when there was a lack of regular physical activity, or high body-mass index,” she said.

“These factors are potential targets for future prevention strategies or for more effective management of the disorder.”

Dr DiSipio said the results of the study added weight to calls to integrate prospective surveillance of arm lymphoedema into standard breast cancer care.

“Currently there are no standardised practices when it comes to detection and treatment of arm lymphoedema,” she said.

“Given most patients present with the arm lymphoedema within the first two years after breast cancer, more frequent surveillance throughout this time is recommended.”

DiSipio et al., (2013). Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol.14: 500-515. doi: 10.1016/S1470-2045(13)70076-7 [Abstract]