Month: December 2021

In December, researchers reported findings from a study showing that the drug abiraterone halves the risk of prostate cancer death among a specific group of patients who previously would not have been treated with it. Currently, abiraterone is approved only for men with prostate cancer that is spreading (metastasizing) in the body. But men enrolled in the study were treated at earlier stages, before their tumors had a chance to spread. Based on the findings, the investigators concluded that abiraterone should considered for treating aggressive prostate cancer that has not yet begun to spread to other sites, but likely will in the future.

Abiraterone was first approved in 2011, specifically for metastatic prostate cancer that no longer responds to chemotherapy or drugs that block testosterone (a hormone that fuels prostate tumor growth). Treatments that block testosterone production in the testicles and other glands are called androgen deprivation therapies, or ADT. Some tumors get around ADT by making their own testosterone, however, and that’s where abiraterone comes into the picture: it prevents cancer cells from making the hormone. Doctors give abiraterone together with prednisolone, a steroid that lessens treatment side effects. More recently, abiraterone’s approval was extended to men who still respond to ADT or have not yet been treated with chemotherapy.

During the newly published study, which is called STAMPEDE, researchers in the UK and Switzerland enrolled 1,974 men with high-risk cancer that was still confined to the prostate and nearby lymph nodes. The STAMPEDE clinical trial is testing multiple treatments for advanced prostate cancer, and this particular study was one of several conducted as part of that broader effort. The men in this case were 68 years old on average, and each of them was assigned to one of three different groups:

• ADT by itself (the control group, which included 988 men) 
• ADT in combination with abiraterone and prednisolone (459 men)
• ADT in combination with abiraterone, prednisolone, and another drug called enzalutamide that is similar to abiraterone (527 men).

ADT in the control group lasted three years, while most of the men receiving combined therapies underwent two years of treatment.

The results

After six years of follow-up, 7% of the 986 men who received abiraterone as part of their treatment had died from prostate cancer. By contrast, 15% of the 988 men given ADT by itself had a prostate cancer death. Moreover, abiraterone significantly lengthened the time it took for metastases to appear.

Based on these findings, the investigators concluded that “patients treated with the combination therapy [that includes abiraterone] are more likely to live longer and die from another cause.” Side effects were more common among abiraterone-treated men, and included hypertension and increased liver enzymes. Adding enzalutamide had no added treatment benefits, making that drug’s use among nonmetastatic cancer patients “unjustified due to additional toxicity and cost,” the investigators wrote.

“This important study adds to the extraordinarily encouraging news regarding treatment advances in advanced and metastatic forms of prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Giving abiraterone together with prednisolone is now a mainstay in the management of men with prostate cancer that has spread beyond the confines of the prostate gland and lymph nodes. This new study shows that the addition of abiraterone plus prednisolone to traditional ADT can benefit men who have not yet developed metastatic disease but would be likely to do so in the future. The investigators of the STAMPEDE program continue to make practice-changing discoveries that are meaningful and improve survival in this population, and we welcome these results.”

Boutique or specialty fitness studios offer all sorts of ways to exercise, such as strength training, indoor cycling, and kickboxing. Other popular options, like yoga and Pilates, are less likely to leave you sweaty and breathless, emphasizing flexibility and measured movement. Now a new trend has emerged: studios that focus solely on stretching. What are these studios offering, and will you benefit from this focus?

What are stretch studios offering?

These studios, which include StretchLab, StretchMed, LYMBYR, and others, provide assisted stretching sessions, either one-on-one or in small groups. The promised benefits range from reasonable goals of increasing flexibility and range of motion to more questionable assertions, such as preventing injuries and eliminating chronic pain.

“If you participate in certain sports that require flexibility, like dance or gymnastics, stretching may be important to maintain range of motion,” says Dr. Adam Tenforde, associate professor of physical medicine and rehabilitation at Harvard Medical School, and sports medicine physician at Spaulding Rehabilitation and Mass General Brigham.

But if your focus is on improving your overall health, the evidence to support stretching is sorely lacking — especially compared with the wealth of evidence supporting the benefits of regular, moderate physical activity.

“Contrary to popular belief, there’s no consistent evidence that stretching helps prevent injuries,” says Dr. Tenforde. And if you have an existing injury, such as a muscle or joint sprain, aggressively stretching that tissue could actually make the injury worse, he adds.

The “stretch therapists” and “flexologists” at stretching studios may have certain certifications and training, but they’re probably not qualified to recognize and address health-related causes for pain or stiffness. If you have a previous or current musculoskeletal injury, you’re much better off going to a physical therapist who has the expertise and training to treat you correctly.

Feeling tight and stiff?

If you’re free from injuries but just feel tight and stiff, try a yoga class, which can provide added benefits like improving your balance and helping you relax and de-stress. Or consider tai chi, a gentle, meditative form of exercise that can help lower blood pressure and enhance balance. Another option is to get a massage.

If you decide to try assisted stretching offered at a studio, listen to your body, and make sure you communicate how you’re feeling with the therapist working on you, Dr. Tenforde advises.

But you’ll probably do more for your overall health by spending that time taking a brisk walk or some other type of exercise instead, he says. Most Americans don’t meet the federal recommended guidelines for physical activity, which call for 150 minutes per week of moderate-intensity exercise and muscle-strengthening activities twice weekly. “As doctors, we’re dealing more with diseases related to inactivity, not diseases of inflexibility, says Dr. Tenforde.

Want to do your stretching at home?

Three easy morning exercises — an A-B-C routine of arm sweeps, back bend, and chair pose — can help ease morning stiffness. This also works well during the day if you spend too much time sitting.

Stretching at home could save you money and time. These tips can help you get the most out of at-home morning stretches or other flexibility routines.

• Warm up muscles first. Much like taffy, muscles stretch more easily when warm.
• Feel no pain. Stretch only to the point of mild tension, never to the point of pain.
• Pay attention to posture and good form. Posture counts whether you’re sitting, standing, or moving. Photos of stretches tell only part of the story, so read instructions carefully to get form right.
• Focus on the muscle being stretched. One side of your body often is tighter than the other. Work on balancing this over time.
• Breathe. Breathe comfortably while stretching rather than holding your breath.
• Practice often. You’ll make the best flexibility gains if you stretch frequently — daily, or on as many days of the week as possible. At the very least, try to do stretches two or three times a week.