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EPAD 2017 - Bertrand Tombal

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Prevention of Prostate Cancer
Bertrand Tombal, President of the European Organisation for Research and Treatment of Cancer (EORTC)

Published in: Health & Medicine
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EPAD 2017 - Bertrand Tombal

  1. 1. Prevention of Prostate Cancer. An utopia ? President European Organisation for Research and Treatment of Cancer (EORTC) Brussels, BE Chairman Urology Cliniques universitaires Saint Luc, Brussels, BE
  2. 2. The goal. 2  Primary prevention aims to prevent disease or injury before it ever occurs.  e.g. education about healthy and safe habits  drugs  Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.  e.g. personal strategies to prevent recurrence, or implementation of programs to return people to their original health and function to prevent long- term problems.  Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.  rehabilitation programs, chronic disease management programs  support groups that allow members to share strategies for living well
  3. 3. The Magic Pill doesn’t exist; why have we failed ?  Unselected population.  Naïve assumptions on the role of hormones, diet, and lifestyle.  Pill approach, versus education and precision approaches. 3
  4. 4. The Magic Pill doesn’t exist; why have we failed ? Hormonal prevention: the dutasteride trial,  Crude rate absolute risk reduction of Pca: 5.1% at 4 years, But  No difference in PCa or overall mortality  No reduction in the risk of aggressive cancers (i.e., Gleason 7–10) But  decreased libido (3.3% vs. 1.6%); loss of libido (1.9% vs. 1.3%); decreased semen volume (1.4% vs. 0.2%); erectile dysfunction (9.0% vs. 5.7%); gynecomastia (1.9% vs. 1.0%). 4
  5. 5. The Magic Pill doesn’t exist; why have we failed ? 5 Chemoprevention with selenium and vitamin E  Large randomized placebo-controlled trial of vitamin E and selenium.  Show no reduction in PCa period prevalence, but an increased risk of PCa with vitamin E alone (17%).
  6. 6. Paving the future for better prevention strategies Actions Plan 1. Identify a population any higher risk, then design prospective trials with new drugs. 2. Enact basic life adjustment at every stage the PCa care pathway (PRI, SEC, TER prevention) 6
  7. 7. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk  Gene  Lifestyle 7 SNP Reference rs4430796 Zheng, N Engl J Med 2008 ; 358 :910-9 Beebe-Dimmer, Int J Cancer 2008 ; 122(12) : 2876-79 Eeles, Nat Genetics 2008 ; 40(3) : 316-21 rs1859962 rs16901979 rs6983267 rs1447295 rs7501939 rs4242382 rs10090154 rs10993994 Eeles, Nat Genetics 2008 ; 40(3) : 316-21 Camp, Canc. Epid. Biomarkers Prev 2009 ; 18(4) rs266849 Eeles RA et al Nat Genetics 2008 ; 40(3) : 316-21 rs2171492 Ross, BMC Cancer 2009, 9 :69 rs104548 (D302H) Lubahn, The Prostate 2010 ; 70 :646-653 rs9282858 (A49T ) Makridakis NM et al Lancet 1999 ; 354 :975 Li J et al Am J Epidemiol 2010 ; 171 :1-13 rs623419 Lindström S et al Prostate 2006 ; 66 (22) : 11077-83 rs4045402 Lindström S et al Prostate 2006 ; 66 (16) : 1729-43 rs11569681 Thomae BA et al Pharmacogenom J 2002 ; 2 :48 G289S Margiotti K et al The Prostate 2002 ; 53 :65
  8. 8. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk  Gene  Lifestyle 8  There are men at higher risk of PCa because they carry germline or somatic gene abnormalities.  RNASEL, formerly known as HPCI  BRCA1 and BRCA2, which have also been linked to breast and ovarian cancer in women  MSH2, MLH1, and other DNA mismatch repair genes  HOXB13 IMPORTANT TO DEFINE A TARGET POPULATION !
  9. 9. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk  Gene  Lifestyle 9 It is urgent to produce, validate, and implement similar recommendations for Prostate Cancer.
  10. 10. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk  Gene  Lifestyle 10 Evidence Decreases Risk. Increases risk Suggestive BMI (low grade PCa) BMI (advanced, mortality) Spirits Dietary Calcium Weight Weak Total vegetable Fish Coffee Serum α-tocopherol Selenim Dairy food Milk Low-fat milk Dairy and dietary calcium Supplement calcium Waist circumference Height Adapted from Markozannes et al. Diet, body size, physical activity and risk of prostate cancer: An umbrella review of the evidence. Eur J Cancer. 2016 Dec;69:61-69. Daily Diet
  11. 11. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk  Gene  Lifestyle 11 Food supplement (FS) blend of pomegranate, green tea, broccoli and turmeric, Adapted from : A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer-- the U.K. NCRN Pomi-T study. Thomas R, Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6.
  12. 12. What causes prostate cancer ? About Nature, Nurture, and Prostate Cancer Risk 12  2,705 non-metastatic PCa from Health Professionals Follow-Up Study diagnosed observed from 1990 to 2008; 548 deaths, 20% of which were a result of PCa. categories of walking duration and pace after prostate cancer diagnosis. An easy pace is less than 2 mile per hour (MPH), a normal pace is 2 to 2.9 MPH, and a brisk pace is 3 MPH. Adapted from SA. Kenfield et al., J Clin Oncol 29:726-732. 2011 All Cause Mortality PCa Mortality -54% It is urgent to produce, validate, and activate lifestyle recommendation for patients with PCa and create a support network.
  13. 13. Will adherence to diet and physical activity really impact outcomes ? 13 “Adhering to cancer prevention guidelines for diet and physical activity is consistently associated with lower risks of overall cancer incidence and mortality, including for some site-specific cancers.” Cancer Epidemiol Biomarkers Prev; 25(7); 1018–28. 2016 AACR.
  14. 14. Paving the future for better prevention strategies Conclusions 1. The “Magic” pill, or food supplement doesn’t exist. 2. We must secure that every man concerned about PCa or treated for it: 1. Receives adequate counselling about genetic and other risk factors 2. Receives adequate counselling on lifestyle adjustment (including diet, food supplement and physical activity) and have adequate access to the infrastructure or health professional to activate these changes. 14
  15. 15. 15 3rd EORTC Cancer Survivorship Summit 1-2 March 2018 Brussels, BE

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