Eight out of ten patients with advanced prostate cancer - which kills 10,000 men a year - may see their tumours shrink and be relieved of pain simply by taking a daily pill even if their disease has spread around the body, the study suggests.

Some men taking abiraterone have survived for more than twice as long as expected when all other treatments failed, suggesting that the most common cancer in men may in future become a manageable chronic disease.

Scientists are also starting trials of the drug for sufferers of breast cancer to see if it has similar benefits.
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Survival rates for common cancers such as breast and colon cancer have more than doubled in 60 years, and experts predict that, with this new drug, prostate cancer has the potential to join this list.

About 35,000 Britons have prostate cancer diagnosed each year. Many of the cancers do not spread and can be managed by surgery or monitoring.

Nearly all fatal cases are aggressive forms that are resistant to current treatments and are fuelled by testoster-one, the “male” sex hormone. After chemotherapy and radiotherapy have failed, the typical survival period is just one year or 18 months.

Johann de Bono, who led the study at the Institute of Cancer Research and the Royal Marsden Hospital, London, said that 250 men worldwide with advanced cases had so far taken the new drug - some for as long as 32 months, indicating that it could even tually boost survival by many years. The study, published today in the Journal of Clinical Oncology, found benefits for 21 patients with advanced prostate cancer. Trials are continuing.

Dr de Bono said he hoped that the new drug could be licensed and available for treatment of advanced disease within three years. He suggested that it could eventually make chemotherapy obsolete. “This is potentially a major step forward,” he said. “These men have very aggressive prostate cancer, which is exceptionally difficult to treat and almost always fatal. We hope that abiraterone will eventually offer them real hope of an effective way of managing their condition and prolonging their lives.”

Karol Sikora, a leading cancer specialist, described the study as a “significant piece of work”. He said: “We now can make people live with cancer. It’s not curable but we can keep people alive to the extent that they will die of something else. Most people affected by cancer are over 60, so if we can give them an extra 10 to 15 years that is as good as can be. We have to take into account the variability of some forms of hormone-driven cancer - this is not 100 per cent effective - but to be able to treat some of the worst cases, and grant them extra years of life, is a very positive thing.”

Advanced prostate cancer is typically treated with a form of chemical or surgical castration to block production of the male hormones. Abiraterone blocks the generation of these hormones in the testes and elsewhere in the body, including the generation of hormones in the cancer itself.

The pill decreased the size of tumours in 70 to 80 per cent of men with advanced prostate cancer, the researchers said. Patients also recorded large falls in prostate specific antigen levels in the blood - a key indicator of prostate cancer.

“Current treatments can be horrible, and carry side-effects such as loss of libido, but in some cases the cancer seems immune to therapy and carries on accelerating,” Dr de Bono said. “We believe that the cancer cells can make their own hormone ‘fuel’ to grow and survive. We believe we now have a drug that can block the ability of the cancer to make that fuel.”

An international study aims to recruit 1,200 men with advanced prostate cancer. The drug is also being used to treat breast cancer in women through a preliminary trial funded by Cancer Research UK.

Dr de Bono said: “It was able to help patients whose cancer had spread to the bones, liver, even lung. A number of patients were able to stop taking morphine for the relief of bone pain, and they got their quality of life back. In the wider context we eventually aim to make chemotherapy obsolete.”

Malcolm Mason, Cancer Research’s prostate cancer expert, said that the results were exciting but the studies were small and it was too early to say what role the drug might have in treating those with earlier stages of cancer.

There was once a doctor who, when patients said they wished to lose weight, would say “read my book.” The book was nicely bound and, quite thick but, when opened all the pages were blank except for one upon which were written two words “Eat Less”.

There is a good deal of truth behind this simple statement for people put on weight when their food intake exceeds their energy output. Many patients have very little idea about their calorific input or output although this didn’t matter in the days when most people had a way of life which involved a significant amount of exercise.

Walking and cycling has now given way to the motorcar and public transport; manual work has been replaced by sedentary occupations; agricultural work – once the single most common manual occupation in the United Kingdom — has been largely replaced by technology; most food is processed to some extent before it meets the consumer whereas previously energy was spent by individuals in growing, harvesting, preparing, cooking and utilising foods in the kitchen. For example our parents can remember that oats were boiled for up to twelve hours before they were ready to become porridge. Quick porridge oats today take only minutes to prepare.

Central heating cuts down the amount of calories required to keep the body at an acceptable temperature and significant shivering, a potent means of using up calories, is now quite rare. Even the need to wear heavy warm clothing utilised energy but many people will live most of their lives in very lightweight clothing. Central heating and air conditioning is a reality for most.

Of course many patients deny overeating to which the doctor can say always that only plants can synthesize food out of air and water; human beings have to eat it. This brings us back to calories in and calories out. The calculation is simple. If the calories going out in exercise are more than the calories coming in as food the individual will loose weight.

If the calories coming in as food are greater than the calories going out as exercise then the individual will gradually put on weight no matter how small the difference.

If the individual indulges in very heavy exercise or manual labour then it is virtually impossible to eat too much. Labourers can have an intake of 4,000 to 5,000 calories a day and still lose weight. Computer operators, on the other hand, sitting virtually stationary throughout the working day can find 1,000 to 1,500 calories too much to allow them to keep a steady weight. Losing a lot of weight in a short time is rarely the way by which long term weight loss can be achieved. It does however, seem that a combination of a dietary restriction and exercise has a benefit greater than if only one of these procedures is carried out. This can be summed up into “one and one can make three.” Certainly dieting alone rarely seems to achieve the objective. A change in the way of life is what is required and a permanent balance achieved between food intake and exercise.