The Humble Aspirin to the Rescue! Or Does an Aspirin a Day Help Keep Cancer Away?

RALPH BLUM

There is reason to be grateful for this simple “wonder drug,” discovered in the mid-19^th century by Friedrich Bayer and his partner, Johann Friedrich Weskott, in Barmen (today a part of Wuppertal), Germany—a modification of salicylic acid or salicin, which is actually a folk remedy found in the bark of the willow plant.

We keep aspirin around. We take it for headaches, to relieve pain, as a deterrent to heart attack and stroke.  Now, a new light illuminates the potential value of this humble drug.  Studies have shown the possible efficacy of aspirin and other non-steroidal anti-inflammatory drugs acting to reduce the risk of dying from cancer. It is suggested that these drugs inhibit the accumulation of somatic genome abnormalities, also known as SGA’s, that result in uncontrolled cancer cell growth. It appears that aspirin acts to slow the speed of mutation.

According to a study published in The Journal of Clinical Oncology, men being treated for prostate cancer who were taking aspirin regularly for other medical conditions were likely to live longer than men who were not taking aspirin.

The 2012 multi-center study was not a randomized controlled clinical trial of the kind that is considered the gold standard, but it adds to an intriguing and growing body of evidence suggesting that aspirin prevents the growth of tumor cells in a variety of cancers, including prostate cancer. Especially in high-risk disease for which there is no very good treatment. The risk of the cancer returning, and of it spreading to the bones, was significantly lower, as was the risk of dying from the disease.

According to Peter Rothwell of Oxford University, one of the leading experts on aspirin and cancer, “Aspirin reduces the likelihood that cancers will spread to distant organs by about 40-50 percent.”

Dr. Kevin S. Choe, assistant professor of radiation at University of Texas Southwestern Medical Center in Dallas and lead author of the paper, said that while it would be ideal to conduct a randomized study, doing so with prostate cancer patients would be difficult because the natural progression of the disease is so slow that you would have to follow men for many years. He added, significantly, that little money is available for research on aspirin because it is cheap and easily available!

One of the problems with aspirin therapy is you have to be patient and consistent, as most studies have found that it only becomes effective in 2-3 years. Also there is a risk-versus-benefit equation due to aspirin’s gastric and bleeding effects. However, cancer survivors concerned about recurrence, and those being treated for cancer worried about metastases should discuss an aspirin regimen with their doctor.

Happy New Year Announcement from Prostate Oncology Specialists

Jeffrey Turner, MD, Medical Oncologist, Joins Prostate Oncology Specialists in Marina del Rey, CA.

MARINA DEL REY, Ca., December 31, 2012 - Prostate Oncology Specialists is pleased to announce that Jeffrey Turner, MD has joined the prostate cancer specialist team. Dr. Turner is a board-certified internist and medical oncologist and will be specializing exclusively in prostate cancer with Mark Scholz and Richard Lam. Dr. Turner has been specializing in prostate cancer since 2009. He graduated cum laude from USC. Thereafter, he worked in research at UCLA studying infectious disease and molecular biology.  He earned his medical degree in Canada at Memorial University of Newfoundland and completed his internal medicine residency at the University of British Columbia and fellowship in medical oncology at the Medical University of South Carolina. Dr. Turner has published several articles on urologic cancers with an emphasis on prostate cancer.  He is a sub-investigator of a number of ongoing prostate cancer clinical trials.

Dr. Mark Scholz, Medical Director of Prostate Oncology Specialists commented, “Dr. Turner joins us during a time when the number of new prostate cancer treatments is exploding. He will add his expertise and knowledge to help patients make informed decisions. In 2012, we conducted clinical trials with Zytiga and Xtandi, agents that are now FDA approved.  We are presently evaluating new agents such as Curstersin, XL-184 and Ipilimumab in combination with Provenge.  We are happy to welcome a talented new member to the team who is familiar with all the many new treatment options for patients—this also includes Active Surveillance which is rapidly gaining acceptance as a viable treatment for prostate cancer.”

Active Surveillance remains very popular given the alternative risk of permanent side-effects from surgery, radiation, or cryotherapy. Dr. Turner added, “With the dramatic evolution of today's imaging techniques (including color Doppler ultrasound and MRI), Active Surveillance is best for men with Gleason 6, PSA<10, and clinical stage less than or equal to T2a.  Due to the fact that men with Gleason 6 prostate cancer have an incredibly low risk of mortality, Active Surveillance should remain a strong alternative.”
As skilled leaders in treating prostate cancer, our medical oncologists use PSA monitoring and color Doppler scanning to accurately monitor men on Active Surveillance. These techniques can detect early disease progression in men who may need to pursue treatment intervention.  

For more information about Active Surveillance or Prostate Oncology Specialists - visit: www.keepmyprostate.com or www.prostateoncology.com/activesurveillance

Life After Combidex - Part 2

BY RALPH BLUM

If after my long association with prostate cancer, I could achieve one objective—strike one blow for all the thousands of men facing the uncertainty of lymphatic involvement—it would be to see the presently FDA scorned and excommunicated compound “Combidex,” restored to favor, in production and universally available for the Combidex MRI.

This contrast fluid consists of minute Fe nanoparticles (iron particles) that are injected into a vein in the arm. After 24 hours, metastases in lymph nodes (LN) that show less “uptake” of the iron oxide nanoparticles, are visible as a white structure in a dark background, whereas normal nodes display as black and are thus not distinguishable. The white metastatic lymph nodes light up like light bulbs in the darkness, and can hardly be missed by the radiologist.

I do my due diligence: regular PSAs. But lately, I have been anxious; concerned that my immune system is no longer doing its job as well as it did in the past. True, I have no compelling evidence that my cancer is “on the move,” changing color by Mark’s Blue Scale, edging from “Sky” to “Teal” to “Azure”, with each deepening “Shade” bringing heightened  “Risk.” And yet sometimes in the night I wonder: Is that a swelling I feel in certain lymph nodes?

What makes this a period of greater insecurity is the absence of my old ally “Combidex”.  It wouldn’t be that difficult to set my mind at ease about whether or not there is lymphatic involvement if, as I did five years ago, I could again take myself off to the clinic of Dr. Jelle Barentsz, Professor of Radiology at Radboud University in Nijmegen, The Netherlands, and undergo a Combidex MRI.

There are other tests available. But from what I’ve seen of the stats, either they don’t do the job the way Combidex did, or more research is required. Still, here are four you might want to check out. I confess that I am out of my depth here, reporting as a non-medical voice without pretension of authority or a guarantee of accuracy:

1. 11C Choline PET CT while effective to a point, is not good in detecting nodes <5 mm. In this regard, Combidex was clearly superior.

2. Feraheme (ferumoxytol) is not as effective going to normal nodes as Combidex, and thus has a significantly higher number of false positives! Anyone who uses this agent for nodal imaging should be aware of this, So again, this substance is not a good substitute for Combidex.

3. The new Prostascint Imaging (Indium-111: Labeled Capromab Pendetide) which shows promise (it is more specific PSMA) but is still in its early phases of testing. Indications are that  Prostascint may be useful to evaluate post-prostatectomy patients with rising PSA who have an otherwise negative or equivocal workup for metastases. Another potential role for Prostascint (controversial) is in the staging of newly diagnosed prostate cancer.

What is worth doing? My mind is preoccupied with thoughts of risk (doing nothing) versus trauma (the ghastly side effects). I have long thoughts about the “velocity of change.” I meditate about risk versus trauma. And I pine for Combidex.

Perhaps my Better Angels have been on the job. Because just as I finished this blog, I received a note from Dr. Barentsz in the Netherlands, informing me that maybe—just maybe—Combidex is about to stage a come back. And asking for my help. Did he ever come to the right man! I will lay out the strategy in my final “Life After Combidex” blog.

Hot dog! Combidex redux!