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Healthwatch
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Healthwatch
How Is Metastatic Prostate Cancer Detected And Treated In Men Over 70?
~5.5 mins read
Questions and answers about the specifics of diagnosing and treating older men whose cancer has metastasized.
National guidelines on prostate cancer screening with the PSA test are set by the US Preventive Services Task Force (USPSTF). This independent panel of experts in preventive and primary care recommends against screening for prostate cancer in men older than 70.
Why? Prostate cancer tends to be slow-growing. Men in this age group are more likely to die with the disease rather than from it. And in the view of the USPSTF, survival benefits from treating PSA-detected prostate cancer in older men are unlikely to outweigh the harms of treatment.
Still, that leaves open the possibility that men could be screened for prostate cancer only after their disease has advanced to symptomatic stages. For a perspective on PSA screening and advanced prostate cancer treatment in older men, we spoke with Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.
Q. How often should men over the age of 70 be screened for prostate cancer?
Such testing is performed outside of guidelines, and generally following a discussion with the patient’s physician. It's not unusual for us to find advanced metastatic prostate cancer in older men flagged by a PSA test. The disease might spread asymptomatically, but some men get a PSA test only after they have advanced prostate cancer symptoms such as trouble urinating, fatigue, or bone pain.
The USPSTF's PSA screening guidelines are long overdue for an update — they were last published in 2018. And with life expectancy increasing overall for men over 70, we are all anxiously awaiting the new guidelines, which are generally updated every six years.
Q. What sort of other tests follow after a positive result with PSA screening?
Typically, a prostate needle biopsy. And I also recommend a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland. President Biden was having urinary symptoms at the time of his PSA test, and he was reported to have had a nodule noted on his DRE. We do not know what his PSA score was.
Recently, we've been moving toward magnetic resonance imaging scans of the prostate that provide more diagnostic information, and can serve as a guide to more precisely identify abnormalities in the prostate gland that we can sample with a biopsy.
Q. How do we know if the cancer is likely to spread aggressively?
The more aggressive tumors have cells with irregular shapes and sizes that can invade into adjoining tissues. A time-honored measure called the Gleason score grades the two most common cancer cell patterns that pathologists see on a biopsy sample.
That system has now undergone some labelling changes. To simplify matters, doctors developed a five-tier grading system that ranks tumors from Grade Group 1 — the least dangerous — to Grade Group 5, which is the most dangerous. These Grade Groups still correlate with Gleason scores. For instance, a Gleason score of 3+3=6 correlates with Grade Group 1 for low-risk prostate cancer, whereas a Gleason score of 4+5=9 for high-risk disease correlates with Grade Group 5.
We can also evaluate how fast cancer cells are dividing — this measure is called mitotic rate — or order genetic tests that provide additional information. We know that men who test positive for inherited BRCA1 and BRCA2 gene mutations are at risk for more aggressive disease, for instance. BRCA test results also have implications for family members, since the same mutations elevate risks for other inherited cancers including breast cancer and ovarian cancer.
Q. How do you know if the cancer is metastasizing?
Traditionally, patients would get a computed tomography scan of the abdomen and pelvis along with a bone scan. These tests look for metastases in the lymph nodes and bones, but they are increasingly outdated. These days, doctors are more likely to scan for a protein called prostate-specific membrane antigen (PSMA) that can be expressed at high levels on tumor cell surfaces.
A PSMA scan is much better at detecting prostate tumors in the body that are still too small to see with other imaging tests. If the scans show evidence of metastatic spread, we classify men as having either high- or low-volume disease depending on the extent. Men with no more than three to five metastases are described as having oligometastatic prostate cancer.
Q. What treatment options are available for metastatic prostate cancer?
We generally don't begin with a single drug. Men with low-volume metastatic prostate cancer typically get doublet therapy, which is a combination of two drugs that each starve tumors of testosterone, a hormone that prostate cancer needs to grow.
One of the drugs, called leoprolide (Lupron), blocks testosterone production. The other drugs are drawn from a class of medications that prevent testosterone from binding to its cell receptor. Those drugs are called androgen receptor pathway inhibitors (ARPIs). They include enzalutamide (Xtandi), daralutamide (Nubeqa), apaludamide (Erleada), or another drug with a slightly different mechanism called abiraterone (Zytiga).
If the cancer progresses on doublet therapy, then we can add chemotherapy to the mix. This is called triplet therapy (Lupron + ARPI + chemotherapy). We may also recommend immediate triplet therapy depending upon the extent of the cancer spread.
Some men are eligible for other treatments as well. For instance, men with PSMA-positive disease (meaning their cells express the protein in high amounts) can be treated with an intravenously-delivered therapy called Lutetium-177. Known as a radioligand, this type of therapy seeks out PSMA-expressing cells and kills them with tiny radioactive particles.
Some men are eligible for metastasis-directed therapy (MTD). In such cases, we treat metastatic deposits with highly focused beams of radiation delivered from outside the body. MTD is generally reserved for patients with oligometastatic prostate cancer.
Q. What happens if a patient is positive on a genetic test for prostate cancer?
That opens up options for so-called targeted therapy — which is a term we use to describe treatments that target specific cell changes that cause tumors to grow. Patients with BRCA1 or BRCA2 mutations, for instance, can start on doublet therapy plus a targeted therapy called a PARP inhibitor. Two PARP inhibitors are approved for prostate cancer in BRCA-positive men: olaparib (Lynparza) and rucaparib (Rubraca). Men with a different gene mutation called microsatellite instability are eligible for a targeted drug called pembrolizumab (Keytruda).
Q. How is the outlook for metastatic prostate cancer changing?
It's improving dramatically! Metastatic prostate cancer used to carry a very poor prognosis. Today, it's not unusual for men to live 10 years or longer with the disease. We're even starting to treat cancer in the prostate directly — something we didn't do in the past since the cancer had already spread beyond the prostate gland. More recent studies have shown improvements from delivering radiation to the prostate gland itself in patients with metastatic cancer. We're including these treatments more often now, which is something we wouldn't have considered before.
Q. Any final notes?
I would advise men to undergo a cardiac evaluation prior to starting on hormonal therapy. Hormonal therapies can exacerbate cardiovascular risk factors, so these should be addressed before and during treatment.
Thanks for your insights!
You're very welcome, glad to help.
News_Naija
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News_Naija
MSMEs Are Critical Growth Engines
~2.8 mins read
AS Nigeria marked the 2025 International MSMEs Day on Monday, the call by UN agencies for greater investment in micro, small, and medium-sized enterprises is timely and essential. At an event to commemorate the day in Abuja, representatives from UNIDO, ILO, UNDP, and the World Intellectual Property Organisation collaborated to spotlight the vital role MSMEs play in Nigeria’s economic landscape. The consensus was that MSMEs are the lifeblood of the economy and must be supported to unlock their full potential. The numbers tell a compelling story. Nigeria is home to over 40 million MSMEs, accounting for approximately 96 per cent of all businesses and providing jobs for 84 per cent of the workforce. These enterprises contribute nearly half of the country’s GDP, with policymakers aiming to raise this to 70 per cent by the end of 2025. MSMEs are not just economic actors; they are critical growth engines. Varsha Redkar-Palepu of the UNDP aptly noted, “MSMEs are engines of job creation, innovation, and social inclusion, especially for women and young people. They must be placed at the heart of our development agenda to transform opportunities into tangible outcomes.” Yet, this critical sector faces daunting challenges. Access to finance remains a persistent barrier, with a funding gap estimated at over $32 billion. Many MSMEs are forced to borrow at interest rates as high as 27.5 per cent, making capital prohibitively expensive and stifling expansion. Infrastructure deficits, especially unreliable electricity and poor transportation, inflate operational costs and erode competitiveness. Regulatory burdens and multiple tax regimes further hinder growth, while market access and data gaps prevent MSMEs from scaling up and integrating into larger value chains. Due to these harsh conditions, the MSME start-up failure rate in Nigeria is alarmingly high, with estimates suggesting that around 80 per cent of these businesses fail within their first five years. The economic instability of recent years, marked by high inflation and currency volatility, has only exacerbated these difficulties, with 67 per cent of small businesses reporting a drop in sales in 2024. Despite these obstacles, Nigerian MSMEs have shown remarkable resilience and ingenuity. As Chinedu Nnabuihe of ProHealth observed at the event, “In spite of challenges such as limited access to finance, infrastructure, and economic constraints, Nigeria’s MSMEs have continued to show resilience, creativity, and determination.” This resilience is a testament to the entrepreneurial spirit that defines the Nigerian business landscape. Other countries support MSMEs in various ways to make them thrive. In Indonesia, MSMEs contribute 64 per cent of business value added, thanks to targeted digitalisation and export support. Italy and Portugal have fostered MSME growth through cluster development, tax relief, and innovation grants, with MSMEs accounting for over 60 per cent of value added in both countries in 2024, per McKinsey. To empower its MSME sector, Nigeria must first expand access to affordable finance. The implementation of a national credit guarantee scheme could de-risk lending and encourage banks to support MSMEs, particularly in high-impact sectors like agriculture, technology, and manufacturing. Investment in infrastructure, especially reliable electricity, efficient transportation, and robust digital networks, will lower operational costs and boost productivity. Regulatory reforms just enshrined in legislation to streamline tax compliance, reduce bureaucratic hurdles, and zero-VAT on essential items will encourage business formalisation and growth. However, robust policy implementation is crucial. The forthcoming 2025 MSME Census, as highlighted by stakeholders at the Abuja event, promises to provide the data needed for targeted, evidence-based policymaking. Fostering innovation, digital skills, and market access, especially under the African Continental Free Trade Area, with the support of financial institutions, NGOs, and other stakeholders, will help MSMEs integrate into regional and global value chains and boost success rates. Supporting MSMEs is an economic imperative to create a pathway to inclusive growth, poverty reduction, and national resilience. By prioritising MSMEs, Nigeria can turn opportunities into real results for its citizens.
Read more stories like this on punchng.com
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Healthwatch
How Is Metastatic Prostate Cancer Detected And Treated In Men Over 70?
~5.5 mins read
Questions and answers about the specifics of diagnosing and treating older men whose cancer has metastasized.
National guidelines on prostate cancer screening with the PSA test are set by the US Preventive Services Task Force (USPSTF). This independent panel of experts in preventive and primary care recommends against screening for prostate cancer in men older than 70.
Why? Prostate cancer tends to be slow-growing. Men in this age group are more likely to die with the disease rather than from it. And in the view of the USPSTF, survival benefits from treating PSA-detected prostate cancer in older men are unlikely to outweigh the harms of treatment.
Still, that leaves open the possibility that men could be screened for prostate cancer only after their disease has advanced to symptomatic stages. For a perspective on PSA screening and advanced prostate cancer treatment in older men, we spoke with Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.
Q. How often should men over the age of 70 be screened for prostate cancer?
Such testing is performed outside of guidelines, and generally following a discussion with the patient’s physician. It's not unusual for us to find advanced metastatic prostate cancer in older men flagged by a PSA test. The disease might spread asymptomatically, but some men get a PSA test only after they have advanced prostate cancer symptoms such as trouble urinating, fatigue, or bone pain.
The USPSTF's PSA screening guidelines are long overdue for an update — they were last published in 2018. And with life expectancy increasing overall for men over 70, we are all anxiously awaiting the new guidelines, which are generally updated every six years.
Q. What sort of other tests follow after a positive result with PSA screening?
Typically, a prostate needle biopsy. And I also recommend a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland. President Biden was having urinary symptoms at the time of his PSA test, and he was reported to have had a nodule noted on his DRE. We do not know what his PSA score was.
Recently, we've been moving toward magnetic resonance imaging scans of the prostate that provide more diagnostic information, and can serve as a guide to more precisely identify abnormalities in the prostate gland that we can sample with a biopsy.
Q. How do we know if the cancer is likely to spread aggressively?
The more aggressive tumors have cells with irregular shapes and sizes that can invade into adjoining tissues. A time-honored measure called the Gleason score grades the two most common cancer cell patterns that pathologists see on a biopsy sample.
That system has now undergone some labelling changes. To simplify matters, doctors developed a five-tier grading system that ranks tumors from Grade Group 1 — the least dangerous — to Grade Group 5, which is the most dangerous. These Grade Groups still correlate with Gleason scores. For instance, a Gleason score of 3+3=6 correlates with Grade Group 1 for low-risk prostate cancer, whereas a Gleason score of 4+5=9 for high-risk disease correlates with Grade Group 5.
We can also evaluate how fast cancer cells are dividing — this measure is called mitotic rate — or order genetic tests that provide additional information. We know that men who test positive for inherited BRCA1 and BRCA2 gene mutations are at risk for more aggressive disease, for instance. BRCA test results also have implications for family members, since the same mutations elevate risks for other inherited cancers including breast cancer and ovarian cancer.
Q. How do you know if the cancer is metastasizing?
Traditionally, patients would get a computed tomography scan of the abdomen and pelvis along with a bone scan. These tests look for metastases in the lymph nodes and bones, but they are increasingly outdated. These days, doctors are more likely to scan for a protein called prostate-specific membrane antigen (PSMA) that can be expressed at high levels on tumor cell surfaces.
A PSMA scan is much better at detecting prostate tumors in the body that are still too small to see with other imaging tests. If the scans show evidence of metastatic spread, we classify men as having either high- or low-volume disease depending on the extent. Men with no more than three to five metastases are described as having oligometastatic prostate cancer.
Q. What treatment options are available for metastatic prostate cancer?
We generally don't begin with a single drug. Men with low-volume metastatic prostate cancer typically get doublet therapy, which is a combination of two drugs that each starve tumors of testosterone, a hormone that prostate cancer needs to grow.
One of the drugs, called leoprolide (Lupron), blocks testosterone production. The other drugs are drawn from a class of medications that prevent testosterone from binding to its cell receptor. Those drugs are called androgen receptor pathway inhibitors (ARPIs). They include enzalutamide (Xtandi), daralutamide (Nubeqa), apaludamide (Erleada), or another drug with a slightly different mechanism called abiraterone (Zytiga).
If the cancer progresses on doublet therapy, then we can add chemotherapy to the mix. This is called triplet therapy (Lupron + ARPI + chemotherapy). We may also recommend immediate triplet therapy depending upon the extent of the cancer spread.
Some men are eligible for other treatments as well. For instance, men with PSMA-positive disease (meaning their cells express the protein in high amounts) can be treated with an intravenously-delivered therapy called Lutetium-177. Known as a radioligand, this type of therapy seeks out PSMA-expressing cells and kills them with tiny radioactive particles.
Some men are eligible for metastasis-directed therapy (MTD). In such cases, we treat metastatic deposits with highly focused beams of radiation delivered from outside the body. MTD is generally reserved for patients with oligometastatic prostate cancer.
Q. What happens if a patient is positive on a genetic test for prostate cancer?
That opens up options for so-called targeted therapy — which is a term we use to describe treatments that target specific cell changes that cause tumors to grow. Patients with BRCA1 or BRCA2 mutations, for instance, can start on doublet therapy plus a targeted therapy called a PARP inhibitor. Two PARP inhibitors are approved for prostate cancer in BRCA-positive men: olaparib (Lynparza) and rucaparib (Rubraca). Men with a different gene mutation called microsatellite instability are eligible for a targeted drug called pembrolizumab (Keytruda).
Q. How is the outlook for metastatic prostate cancer changing?
It's improving dramatically! Metastatic prostate cancer used to carry a very poor prognosis. Today, it's not unusual for men to live 10 years or longer with the disease. We're even starting to treat cancer in the prostate directly — something we didn't do in the past since the cancer had already spread beyond the prostate gland. More recent studies have shown improvements from delivering radiation to the prostate gland itself in patients with metastatic cancer. We're including these treatments more often now, which is something we wouldn't have considered before.
Q. Any final notes?
I would advise men to undergo a cardiac evaluation prior to starting on hormonal therapy. Hormonal therapies can exacerbate cardiovascular risk factors, so these should be addressed before and during treatment.
Thanks for your insights!
You're very welcome, glad to help.
profile/5683FB_IMG_16533107021641748.jpg
News_Naija
Tears, Prayers, Exultation: Diddy Radiates Relief After Partial Acquittal
~2.7 mins read
His gaze to the ceiling in exultation and hands miming prayer, Sean Combs appeared overjoyed as the jury foreman declared the music mogul not guilty of racketeering and sex trafficking charges, thus taking a life sentence in prison off the table. Combs, 55, was still convicted on two lesser counts related to prostitution and could serve time. But he and his lawyers hailed the day as a win. Defence attorney Teny Geragos’s eyes welled with tears before jurors had even finished reading the full verdict, clutching Combs’s hand before embracing her co-attorney Marc Agnifilo. Combs, who has been seen in court reading books including “The Power of Positive Thinking,” contained himself as the judge thanked jurors, but his relief was palpable. He was later captured by a sketch artist, having fallen to his knees, his face buried in the chair he sat in for two months listening to weeks of testimony that cast him as a serial predator and master manipulator with violent impulses. His lawyer and prosecutors then made competing arguments as to whether he should be released on bond pending his sentencing. When Judge Arun Subramanian rhetorically asked whether or not Combs wants to return to the notorious Brooklyn prison where he has been held since September 2024, he rapidly shook his head. Before retiring to a courthouse holding cell to await the judge’s decision, Combs voiced thanks and love to his family members, who have been a regular presence during the proceedings. He also softly pumped his fists in his lap and mouthed his thanks to the jury. – ‘Disturbing reality’ – It was a jubilant scene for a defence team that spent weeks picking apart harrowing testimony from women who said Combs abused and forced them into sexual marathons with male escorts. The details were often difficult to hear, as was photo and video evidence of brutal beatings the women said Combs had subjected them to. The defence never denied the violence, or the sex – encounters that prosecutors said met legal thresholds for crimes including sex trafficking, forced labour and drug distribution. Government attorneys argued that Combs led a criminal organisation of loyal employees who helped him carry out those crimes and many others with impunity. But the defence dismissed, and even mocked, those allegations. And jurors took their side. It was a major blow for federal prosecutors, who appeared somber as they left the room while the defence celebrations were ongoing. Outside the courthouse, crowds of Combs supporters, along with hordes of influencers and content creators – who have been a constant feature of the proceedings — created a circus of sorts, prompting police to barricade the plaza just outside the building. Many of those celebrated with an air of “told you so” — and eagerly crowded the courthouse, hoping to catch a glimpse of Combs. – Bail debate – Ahead of the bail hearing, the US Attorney’s Office that brought the charges released a serious statement that stood in stark contrast with the chaos outside. “Sex crimes deeply scar victims, and the disturbing reality is that sex crimes are all too present in many aspects of our society,” read the statement. “Victims endure gut-wrenching physical and mental abuse, leading to lasting trauma.” Combs ultimately was denied bail – in relative terms, a minor disappointment on one of the most pivotal days of his life. If slightly deflated, he sat stoically as the teams debated the decision into the evening. Agnifilo called him a “remarkable prisoner” who had “lived up to his obligations.” Prosecutor Maurene Comey countered that Combs is an “extremely violent man with an extraordinarily dangerous temper who has shown no remorse and no regret.” Combs waved at the judge as if he had something to say, but then huddled with his lawyers. He ultimately didn’t take the mic. His return to prison awaiting sentencing was not particularly unexpected. Outside, Agnifilo dubbed the day a “major step in the right direction,” vowing that Combs would one day walk free. AFP
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