Genitourinary Cancers

The latest analysis of a large prevention trial conducted by the National Cancer Institute (NCI) and the National Public Health Institute of Finland showed that long-term use of a moderate-dose vitamin E supplement substantially reduced prostate cancer incidence and deaths in male smokers. The report was published in the March 18, 1998, issue of the Journal of the National Cancer Institute, and the lead author is Olli P. Heinonen, md, dsc, of the Department of Public Health, University of Helsinki, Finland.

HELSINKI, Finland--Supplemental vitamin E significantly decreased both the incidence and mortality of prostate cancer in a large randomized trial of male smokers in Finland, said Olli P. Heinonen, MD, DSc, and his colleagues from the University of Helsinki, the National Cancer Institute, and Montefiore Medical Center, New York.

The traditional definition of “advanced” prostate cancer includes only patients with widespread osteoblastic or soft-tissue metastases (clinical or pathologic stage T any N any M1; or stage D2). Current evidence indicates that

The traditional definition of “advanced” prostate cancer includes only patients with widespread osteoblastic or soft-tissue metastases (clinical or pathologic stage T any N any M1; or stage D2). Current evidence indicates that

The traditional definition of “advanced” prostate cancer includes only patients with widespread osteoblastic or soft-tissue metastases (clinical or pathologic stage T any N any M1; or stage D2). Current evidence indicates that

BOSTON--Investigators at McGill University, the Harvard School of Public Health, and Brigham and Women’s Hospital have identified insulinlike growth factor-1 (IGF-1) as a possible high-risk factor for prostate cancer.

WASHINGTON--Recognizing the devastating burden of prostate cancer, particularly among black men, the American Cancer Society (ACS) has released a plan of action aimed at addressing issues in research, education, patient and family support, and public policy. ACS president-elect Charles J. McDonald, MD, said that the Society will convene a conference shortly of "all key African-American national organizations" to determine how to implement the plan.

A two-drug combination regimen may provide a more tolerable therapy for patients suffering from advanced bladder cancer, many of whom are elderly.

A US multicenter study led by Dr. William J. Ellis of the University of Washington has found that the new, quantitative BTA TRAK Assay improves the detection of recurrent bladder cancer over cytology, the standard microscopic method. These results were reported in the December 1997 issue of Urology.

The American Cancer Society (ACS) has issued a “National Blueprint for Action,” describing a multifaceted set of proposals aimed at overcoming the disproportionate incidence of prostate cancer in African-American men.

New treatments announced at the 1997 Endocrine Society Annual Meeting could help slow the rate of prostate cancer growth and improve the quality of life of those who have the disease.

The value of screening for prostate cancer, the second most common cancer in men, has been fiercely debated in recent years, but Professor Bolla from the Department of Radiotherapy, Centre Hospitalier de Grenoble, France, has no doubt that early detection is of prime importance in the treatment of prostate cancer.

Researchers have found preliminary evidence suggesting that a man’s lifetime risk of prostate cancer may be linked to the amount of testosterone circulating in his body as early as puberty or even in utero, although direct evidence of this link

ORLANDO-Permanent trans-peritoneal ultrasound-guided radioactive implants (brachytherapy) get high marks for quality of life (QOL) in men with clinically localized prostate cancer, V. Elayne Arterbery, MD, reported in a poster session at the annual meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO).

HAMBURG-Although BCG is extremely effective in high-risk bladder cancer and carcinoma in situ, many physicians hesitate to use it because of the intense inflammation and systemic side effects it produces. Moreover, no consensus has yet been reached about whether BCG is actually superior to chemotherapy.

Professor Michel Bolla of the Department of Radiotherapy, Centre Hospitalier de Grenoble, France, commented on new

HAMBURG-Patients with poor-prognosis M1 prostate cancer who undergo orchidectomy have little to gain and much to lose from adjuvant mitomycin (Mutamycin) therapy, according to the findings of a phase III study from the EORTC’s Genitourinary Tract Cancer Cooperative Group.

Using a series of 421 patients with localized prostate cancer who were treated with radiation, six predictive models were analyzed to determine which model correlates most closely to actual clinical outcome data in regard to biochemical freedom from failure. Multivariate analysis was performed using the following covariates: prostate specific antigen; Gleason score; stage; dose; PSA density; and perineural invasion. Initially, the Pisansky model appeared to be the most predictive.

A Scandinavian study challenges the efficacy of endocrine treatment alone, compared to endocrine treatment plus radiotherapy for the treatment of locally advanced prostate cancer. All patients in the study receive neoadjuvant total androgen blockade for 3 months and then continue with antiandrogens alone. After 3 months, radiotherapy will be started in one arm of the study. The primary end point of the study is survival, with secondary end points of prostate-specific antigen (PSA) progression, clinical progression, and quality of life. [Oncol News Int 6(Suppl 3):18-19, 1997]

To investigate the potential use of adjuvant hormonal therapy, a randomized, prospective trial was conducted among patients with locally advanced prostate cancer, comparing irradiation alone, with irradiation plus hormonal treatment with goserelin, an agonist anologue of gonadotropin-releasing hormone that reduces testosterone secretion. A total of 415 men under 80 years old with locally advanced disease and no previous treatment for prostate cancer were initially recruited, with data available for analysis on 401 of these patients. Preliminary results at 33-months’ follow-up suggested that goserelin started at the onset of external irradiation improved both local control and 5-year survival. Updated results at 45 months confirm these data. The overall 5-year survival rate for those treated with goserelin in addition to radiotherapy was 79%, compared to 62% in the radiotherapy only group. The localized control rate was 97% in the combined treatment group compared to 77% in the radiotherapy only group. [Oncol News Int 6(Suppl 3):21-22, 1997]

Outcomes beyond tumor response and patient survival have increasingly gained in importance over the past two decades. Quality of life (QOL) and cost-effectiveness of therapy have emerged as additional end points of interest. Conflicting results can and have been reported, however, depending on the measures used to report QOL and cost-effectiveness. Examples of QOL and cost-effectiveness issues and measures related to androgen deprivation therapy (ADT) for prostate cancer follow. [Oncol News Int 6(Suppl 3):22-24, 1997]

As health-care costs escalate, health-care planners must determine how the allocation of health-care dollars should be prioritized. One approach is to assess the cost of achieving a quality-adjusted year of life and then allocating the dollars in descending order, from least to most expensive, until all available money has been expended. Of course, calculating the cost per life-year is the real challenge because it is usually determined from mathematical decision models, which include many assumptions that may be subject to criticism.

HAMBURG-The Federation of European Cancer Societies released information on prostate cancer in Europe at its biennial European Cancer Conference (ECCO 9).

Waselenko and Dawson provide a summary of the extensive experience in the management of metastatic prostate cancer. Their article follows a traditional descriptive format and is quite informative. The part that is missing is a general discussion of the various biological aspects involved in the complex process of prostate cancer progression, which has been the focus of major research over the past few years.[1] Undoubtedly, this emerging body of knowledge will provide the background for the design and development of new treatments. There are a few issues, however, that deserve more emphasis.

Drs. Benoit and Naslund venture into the complex arena of medical economics and cost-effectiveness analysis of prostate cancer screening-a task that is made all the more difficult because of the dual paucity of data on costs and effectiveness. Their underlying premises are that cost control is a dominant concern in the prostate cancer screening debate and that cost-effectiveness analyses have been used to “justify denial of prostate cancer screening.” Both of these assumptions bear scrutiny.