Published in the Journal of the American Medical Association (JAMA) Oncology online Oct. 20, the report shows that well over half of 32,518 men in Sweden diagnosed with prostate cancers least likely to spread chose monitoring during a recent, five-year period over immediate treatment.
Led by researchers at NYU Langone Medical Center and its Perlmutter Cancer Center, an international team concluded that men are likely to choose monitoring once presented with the choice.
Called active surveillance, the monitoring option relies on regular blood tests, physical exams, and the periodic biopsy, or sampling, of prostate tissue to screen for any signs of a tumor’s growth before therapy is considered. The move to active surveillance, say the study authors, averts the risk of sexual dysfunction, as well as bowel and bladder problems that frequently accompany traditional therapies.
“The main conclusion here is that if the majority of men in Sweden have adopted this management strategy for very low- to low-risk prostate cancer, then more American men might choose this option if it were presented to them,” says lead study investigator and urologist Stacy Loeb, MD, MSc.
Among the study’s key findings was that from 2009 to 2014 the number of Swedish men with very low-risk cancer choosing active surveillance increased from 57 percent to 91 percent, and men with low-risk cancer choosing this option rose from 40 percent to 74 percent. Meanwhile, the authors report, the number of men in both groups who chose to simply wait, do no further testing, and postpone therapy unless symptoms develop — a passive practice called watchful waiting — dropped by more than half.
For the study, researchers analyzed data from Sweden’s National Prostate Cancer Register, one of the few such national databases in the world (and for which nothing comparable exists in North America).
Loeb, an assistant professor in the urology and population health departments at NYU Langone, and a member of Perlmutter, says that while increasing numbers of American men diagnosed with early-stage disease are choosing active surveillance, they still account for less than half of those for whom it is an option.
“Our findings should encourage physicians and cancer care professionals in the United States to offer such close supervision and monitoring to their patients with low-risk disease,” says Loeb. More American men opting for active surveillance, she adds, “could go a long way toward reducing the harms of screening by minimizing overtreatment of non-aggressive prostate cancer.”
Loeb says recent studies have suggested that some men with early-stage disease who opted for treatment later regretted it because of lingering problems, such as incontinence and impotence.
A large study also recently showed no difference in death rates a decade after diagnosis between those who chose active surveillance and those who chose immediate treatment, Loeb says. Meanwhile, there is a greater risk of side effects among men undergoing therapy. She cautions, however, that this pattern has not been confirmed for the Swedish men in the current study.
The U.S. National Cancer Institute estimates that 26,000 American men will die from the disease in 2016, with 181,000 getting diagnosed, most in its earliest stages.
Racial disparities in prostate cancer are well documented with AA men having significantly higher risk of developing prostate cancer and significantly higher mortality rates than EA men. In addition, among patients presenting at the same disease stage, AA men often have higher prostate-specific antigen (PSA) levels and higher-grade tumors than EA men. However, the biological mechanisms underlying these substantial and persistent disparities are unclear.
Researchers at MUSC and VAMC noticed that racial disparities in prostate cancer mirror differences in circulating levels of vitamin D between AA and EA patients. Vitamin D3 is known to have multiple anti-cancer actions including suppression of cyclo-oxygenase-II (an independent predictor of cancer recurrence) and inhibition of IL-8 (an angiogenic, pro-inflammatory cytokine). Prostate cells express the vitamin D receptor, vitamin D-25-hydroxylase, 25 hydroxyvitamin D-1-alpha-hydroxylase, and 25-hydroxyvitamin D-24-hydroxylase. Thus, normal prostate cells can synthesize 25(OH)D3 (calcidiol) from vitamin D (cholecalciferol), and 1,25(OH)2D3 (calcitriol) from 25(OH)D3. 1,25(OH)2 D3 (calcitriol) is the bioactive, hormonal, and most potent form of vitamin D and facilitates cell-to-cell communication via paracrine/autocrine pathways.
Sebastiano Gattoni-Celli, M.D., Professor of Radiation Oncology at MUSC, and senior author on the article, explains how his team came to explore the therapeutic potential of vitamin D supplementation in prostate cancer, “A lot of previous work shows that D3 levels are much lower in African Americans than in European Americans and it’s well established that prostate cells are very sensitive to vitamin D levels. So this raised the possibility that long-term vitamin D deficiency may contribute to the progression of prostate cancer, especially among African American men. We began to wonder whether eliminating racial disparities in circulating levels of vitamin D, through supplementation, could help reduce the disparities we see in prostate cancer outcomes.”
One side effect of this marginalisation of women’s sport is that girls — with fewer role models to admire — are much less likely to take part themselves. They leave school half as active as young men, leading to potential health problems caused by obesity. Also, newspapers themselves could be missing a much-needed chance to boost readership, argues Ms O’Neill. More coverage of women’s sport could attract more female readers to the sports pages, she says.
Ms O’Neill, an ex-magazine journalist, has collaborated on several research projects dealing with the depiction of women in the media. She has examined the worlds of politics and celebrity as well as sport. Her latest co-authored academic article, written with Matt Mulready, is entitled The Invisible Woman? and is described as “a comparative study of women’s sports coverage in the UK national press before and after the 2012 Olympic Games.” It appears in the new edition of Journalism Practice.
The researchers investigated the UK’s seven main national newspapers and their Sunday stablemates in the period six months before the 2012 London Olympics and the six months that followed the games, analysing a full week’s worth of papers for both time periods. As a point of comparison, they also analysed the same papers for an equivalent week in the year 2002, so they could measure changes over the previous decade.
It was found that coverage of women’s sport averaged five per cent or less of the total sports coverage and there had been little change over the course of a decade, although the Olympics caused some statistical fluctuation and there is evidence of a slow upward trend in the quantity of women’s sports coverage.
“But however the results are viewed, coverage of women’s sport has not changed significantly in more than a decade,” conclude the authors. This backs up an argument that “sports media remain one of the last bastions of male domination.”
In addition to their statistical analysis, the article’s authors also discuss episodes of sexism in sport, such as the comments of TV football commentators Andy Gray and Richard Keys that led to them being fired by Sky Sports in 2011. The article also draws on interviews with a number of leading sportswriters, to discover the factors that prevent wider coverage of women’s sport.
Sue Mott — a pioneering female sports journalist — cited historical reasons, including past bans on women competing in the Olympics or in football, and that men’s sport had completely dominated the calendar for the past century. There was far less history, folklore or myth attached to women’s sport and therefore fewer heroines.
One problem identified by Ms O’Neill is a vicious circle which means that the lower profile of women’s sport means it has greater difficulty attracting sponsorship… and therefore less chance of generating publicity.
In her research, Ms O’Neill concentrates on the Press and she has recently completed a new article that deals with female sportswriters. She has also been working on the representation of female politicians and has made a recent presentation to the All-Party Parliamentary Group on Sex Equality. She was also invited to meet the Fawcett Society — which campaigns for women’s rights — to consider how to develop this work in the run-up to the 2015 election.
But in an age of rolling TV news and online publishing, how important are old-style printed newspapers?
“The business model might not be working particularly well, but people are still reading newspapers. They are not as unimportant as some like to suggest,” says Ms O’Neill.
“Where they are still very powerful is that they set the agenda.”
“Would you like to dance?” asked Patrick the sommelier. I met him earlier when he served the wine at dinner. He was now doubling as a GO (Gentle Organiser) at the night club. He was a good dancer and after a highly enjoyable 10-minute hip-shaking work-out to the grooves of Merengue music, he moved on to the next wallflower.
I was at the all-inclusive Club Med resort at Punta Cana, located in the palm-fringed coastal region of the Caribbean island of the Dominican Republic. Punta Cana, with its 21 miles of the whitest coral sand beaches, is simply the best eye-candy to be had. Families come in droves but so do couples who mingle in the adult-only areas courtesy of the Zen Oasis.
It’s family-friendly, but not noisy
Over seventy per cent of holiday-makers are families and the rest are couples. With so many kids around, you would expect bedlum. Instead the resort is filled with the happy hum of play around the pools, playgrounds and beach but mostly in the Mini Club Med – a large zone tucked neatly away in the heart of the huge resort leaving adults free to destress and relax.
The Mini Club Med is no ordinary daycare service – this is what makes Club Med the champion of family holidays. Kids activities are designed around different age groups and run by GO’s qualified in child care. For babies up to 23 months there’s Baby Club Med and it’s not unusual to see GO nannies walking babies around the resort in prams. Toddlers attend the Petit Club Med and the Mini Club Med keeps your 4 to 10 year olds pretty busy. The Club Med Pasworld is where teenagers can meet, enjoy sports, skateboarding and dance classes or simply chill together at the cinema or theatre.
Most parents drop them off after a leisurely breakfast at the nearby thatched roofed Hispaniola beach side restaurant and let the GO’s take over. You can spot them skipping away with joy as they head to their sun beds to top up their tans.
Or they head for what is probably the most relaxing place on the resort: the thoughtfully designed, enticingly scented Comfort Zone spa. It’s set on a higher elevation and slightly away from the rest of the resort. There are, of course, treatments to beautify and relax, but I opted for a simple Swedish massage. It took place in a curtained enclosure close to the beach with the front end open so I could see the sea and enjoy the coastal breeze while the masseuse undid the knots in my shoulders. Afterwards, clad only in a towelling robe, I lay on a comfy lounger to sip Indian tea and enjoy a quiet afternoon snooze.
Being active can be relaxing too, and the resort offers archery, basketball and roller blading. You can even run away with the circus for the afternoon and learn to be a trapeeze artist. Tempting, but the sway of the waves seemed to call out my name.
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Though the resort is indeed beautiful, it seemed wrong to spend all my time there. So, I opted for a day long excursion to see a little of the Dominican Republic. One in particular drives out for an hour or so by coach to the province of Higeuy where we mingled with the locals, saw how cigars are rolled and did a little shopping. Then a journey by truck led to a sugar plantation where we harvested some sugar cane followed by a boat trip over the protected river Chauon through lush vegetation. If the scenery looked familiar it was because this is where Hollywood blockbusters Apocalypse Now and Anaconda were filmed.
Wild Ranch, El Gato Village
The final destination was to the Wild Ranch in El Gato village, a conservation concern run by a charismatic Italian lady called Rossella Morella. The work encompasses reforestation, saving endangered species from extinction and offers a hospital for ill or mal-treated birds and animals.
A typically Dominican lunch of rice, beans, salad, pork and chicken was served with indigenous Arepo bread whose origins, we were told, predated Christ by 1800 years. Later we toured the ranch grounds and its canapy by foot though riding a bike was an option.
Wild Ranch relies entirely on tourism for its income but it’s a fair exchange – they get to continue their work and tourists get to tickle an iguana, stroke a snake and learn about the medical plants that make up the fauna and flora of the island.
A day out on the catamaran
There’s also a must-do catamaran trip on the excursion list that sails along the coastline while music permeates the air with international rythms. It finally stops at a beauty spot so that everyone can take a dip into safe, warm(ish) and shallow (waist high) waters. The crew wade in too with trays of rum tipples and nibbles, while the aromas of the BBQ waft into the air. This is simple, indulgent fun at its finest.
Back at the resort colonial style accommodation comprises flats and villas painted in typically Caribbean colours of orange, yellow and other bright pastels that seem to gleam in the sunshine. Floors are tiled, doors are dark wood, and the basic suite comprises a double bedroom, walk-in wardrobe, small sitting area, en suite shower with pizza sized shower heads and a terrace. Villas are plush, come with a luxury bath and have extra rooms for the kids.
Food and drink
Food in general is informal. There are BBQ’s on the beach of tasty steaks, salads and punches (and of course soft drinks), while the beach restaurant, Celeste, offers a little more choice of wraps and other snacks.
Dinner is buffet style at the Samana restaurant features international cuisine from curries, pizzas, pasta, fried chicken, seafood and salads galore with a decent range of veggie options. But you can go back for seconds as often as you like and wash it down with as much wine or soft drinks as you can manage. Lunch can be taken at the seafront at the Indigo Beach Lounge. For finer dining there the Hispaniola waterfront restaurant. Here good food can be enjoyed under shade of the palm trees, to the back drop of breath-taking views from the restaurant terrace.
GOs and Nightlife
Certainly part of the buzz of the place is created by the abundant presence of the GOs – Gentle Organisers. There’s one GO for every three guests and they spend a month each year in a school in France to learn the art of spreading a little happiness. You will see them everywhere with beaming smiles, saluting you by name at every turn.
Nightlife is basically at the stylish bar area or on the beach front or pool side dance floors and babysitters are on hand so that parents can come out to play. With the cocktails and champagne flowing throughout the evening into the early hours, everyone ends up strutting their stuff at some point, and if like me you find yourself in the shadows, you can be sure that the likes of Patrick will be on hand to help you jazz up your evening.
Airfrance flies from London to Paris, then from their direct to Punta Cana airport.
Club Med offers a seven night itinerary to Club Med Punta Cana the newly reopened four trident resort from £1466 per adult and £1076 per child
More information: www.clubmed.co.uk
Club Med’s all inclusive packages include:
Return flights and transfers between the airport and the Club Med ResortAccommodation ranging from comfortable Club Rooms to lavish SuitesFull board with fine cuisine, wine, beer and soft drinksOpen bar and snacksClub Med Baby Welcome facilities and children’s clubs from 4 to 17 years where availableGroup classes for sports and leisure facilities
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“Many studies have reported on PSA results after prostate cancer treatment, but they are not mature enough yet to determine if these results translate into prolonged survival,” said lead author Nicholas J. Giacalone, MD, a senior resident in Radiation Oncology at BWH. “We wanted to see if we could identify whether or not published randomized studies that show a benefit in the reduced risk of return of disease, as measured by PSA, will translate into higher rates of cure based on a man’s overall health.” Such studies include treating men with PSA recurrence after surgery for prostate cancer with both radiation and six months hormonal therapy (GETUG-16) as opposed to radiation therapy alone.
The team examined data from 206 men over the course of 16 years. Over that period of time, 156 men (76 percent) died, 29 as a result of prostate cancer. The team found that PSA failure (the rise of PSA levels after treatment) was associated with a 1.6-fold increased risk of death among men with no other or minimal health conditions, but not among men with other moderate to severe diseases. The team concludes that men with co-existing significant medical conditions, such as heart disease, are unlikely to benefit from treatments shown to reduce only PSA failure, whereas healthy men are more likely to benefit from these treatments.
“Healthy men should be given information based on early results of clinical trials and decide whether or not they want that treatment after hearing about the possible benefits and risks,” said Giacalone.