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Genitourinary Cancers

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The promise of using reverse transcriptase–polymerase chain reaction (RT-PCR) technology for the detection of circulating prostate cancer cells in peripheral blood, although technically feasible at the molecular level, has proven clinically impractical for routine implementation in patient management. Reverse transcriptase–polymerase chain reaction has been successfully applied to detect and quantify (relatively speaking) genes that are differentially expressed in cells and tissues obtained from patients during various stages of malignant growth. In addition, the method has been applied to the detection of circulating cancer cells in peripheral blood using highly specific primer sets for specific molecular targets. These include epithelial cell cytokeratins for breast cancer, as well as enzymes, such as tyrosinase for melanoma and prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) for prostate cancer, using either nonnested or nested methodologies.

The article by Drs. de la Taille, Olson, and Katz is an accurate and concise review of clinical studies for the detection of circulating prostate cancer cells using reverse transcriptase–polymerase chain reaction (RT-PCR) technology. These investigators from the Department of Urology at Columbia-Presbyterian Medical Center have as much experience as any group in the use of RT-PCR for this purpose. Initially very strong proponents of the efficacy of RT-PCR as a staging tool, they have become slightly more reserved in the current article. In this well-written review, the authors allude to a number of issues affecting RT-PCR results from prostate cancer patients that deserve further comment.

Dr. de la Taille and colleagues from Columbia University provide an overview of the concept of molecular staging” of prostate cancer using reverse transcriptase–polymerase chain reaction (RT-PCR). They do an admirable job of summarizing all of the currently available data on the results of this assay in the clinical staging of prostate cancer. As they note, only their group and one other have been able to demonstrate that a positive assay correlates with final pathologic stage. A limited number of other studies have suggested that the RT-PCR assay can predict prostate-specific antigen (PSA) recurrence.

ATHENS-In patients with advanced or inoperable prostate cancer, intermittent androgen suppression shows promise as an equally effective, less toxic, and cheaper alternative to continuous hormone blockade, Dr. Sergio Bracarda, of Perugia University (Italy), said at the 23rd Congress of the European Society for Medical Oncology (ESMO).

Superficial transitional cell carcinoma of the bladder comprises an extremely heterogeneous group of tumors, both in terms of morphology and, even more importantly, in terms of tumor biology and clinical behavior. Drs. deVere White and Stapp provide a succinct overview of the challenges encountered clinically because of tumor heterogeneity and the availability of different treatment options. The authors also outline the use of traditional prognostic factors (clinicopathologic characteristics) and the current state of development of biological markers that hold promise in providing significant clinically useful prognostic information.

BETHESDA, Md--Citing "an unprecedented opportunity to make substantial strides in the treatment of prostate cancer," an outside panel has urged the National Cancer Institute to increase funding and broaden efforts to understand and defeat the second leading cause of cancer deaths among US men.

AMELIA ISLAND, Fla--Is brachy-therapy for prostate cancer a ‘gimmick’ or a new treatment technique with numerous advantages over either radical prostatectomy or external beam radiotherapy? Very definitely the latter, Jay Friedland, MD, of the H. Lee Moffitt Cancer Center, Tampa, said at the Southern Association for Oncology (SAO) 11th annual meeting.

BETHESDA, Md--The Oncologic Drug Advisory Committee (ODAC) has voted not to recommend that the Food and Drug Administration approve Metaret (suramin hexasodium for injection, Parke-Davis) for the treatment of hormone-refractory prostate cancer.

STRATFORD, Connecticut--Several studies have shown the ability of the percent-free PSA blood test to help differentiate benign prostatic hyperplasia (BPH) from prostate cancer among men with elevated PSA levels and thus reduce the need for prostate biopsy. Now, two studies in the September issue of Urology have further defined the situations in which percent-free PSA may be used to improve the performance of total PSA level results.

PRINCETON, NJ--Cytogen Corporation is sponsoring a new website on prostate cancer that highlights its diagnostic imaging agent ProstaScint. The agent is used in newly diagnosed patients at high risk for metastases and in postprostatectomy patients with a high suspicion of recurrence or spread.

WILMINGTON, Delaware--Zeneca Pharmaceuticals has received FDA approval to market Zoladex (goserelin acetate implant) for use in combination with the antiandrogen flutamide (Eulexin) prior to and during radiation therapy for the management of early-stage prostate cancer (stages B2-C).

MIAMI--In terms of randomized trial results, the M-VAC (methotrexate, vinblastine, Adriamycin, cisplatin) regimen should probably be considered the standard of treatment for metastatic bladder cancer, but the overall outlook with this regimen is not optimal, and newer treatments are needed.