Genitourinary Cancers

Controversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.

Dr. DeAntoni provides a timely, critical review of the concept of age-specific prostate-specific antigen (PSA) ranges, as well as other frequently used attempts to improve the accuracy of serum PSA testing in the diagnosis of unsuspected prostate cancer. His review is complete, and his assessments of each of the modalities reflect not only the majority view but also realistic appraisals of the limitations of this less-than-perfect test.

CHICAGO--Because of its high cost and lack of universal availability, magnetic resonance imaging (MRI) has not been a prominent tool in the initial evaluation of prostate cancer. However, MRI is proving to be a highly accurate method of identifying local recurrence of prostate cancer after radical prostatec-tomy, Jeffrey M. Silverman, MD, said at the Radiological Society of North America (RSNA) annual meeting.

In a lively session featured at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Richie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

We read with interest the recent practice guidelines on prostate cancer published by the National Comprehensive Cancer Network (NCCN) in a supplement to the November 1996 issue of ONCOLOGY (pp 265-288). The establishment of such

Researchers at Columbia-Presbyterian Medical Center have identified a gene that may control the metastatic spread of prostate cancer and tumor growth. If confirmed, the preliminary findings may eventually help doctors identify patients whose

Improved diagnostic techniques for prostate cancer, the most common cancer among American men, have led to a threefold increase in the rate of diagnosis since 1988. But that presents physicians with a dilemma: Many of these early cancers are

WASHINGTON--An international team of researchers has mapped a major gene that predisposes men to prostate cancer to the long arm of chromosome 1, finally resolving the question of whether genes for this cancer actually exist. Dubbed HPC-1, for hereditary prostate cancer 1, the gene appears to account for about 3% of the 340,000 prostate cancers diagnosed annually in the United States.

ROCKVILLE, Md--TICE BCG vaccine (Organon Teknika Corp.) has won the backing of the Food and Drug Administration's Oncologic Drugs Advisory Committee (ODAC) as a prophylaxis against recurrent papillary carcinoma of the urinary bladder.

In a lively session at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Ritchie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

After increasing sharply from 1989 through 1992, US prostate cancer incidence rates dropped by 16% for white men and nearly stabilized for African-American men (2% increase) in the latest period available for analysis, 1992 to 1993. These findings, based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry information and US Census population estimates, are reported in the November 20th issue of the Journal of the National Cancer Institute.

ROCKVILLE, Md--The FDA has approved a new indication for Novan-trone (mitoxantrone), making it the first chemotherapy agent approved for the treatment of advanced hormone-refractory prostate cancer. Novantrone in combination with corticosteroids has been shown to reduce bone pain and stabilize or reduce reliance on analgesics in these patients without adversely affecting quality of life.

LOS ANGELES--"Prostate cancer is a disease of options," Douglas Keyser, MD, said at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting. And individual treatment decisions are difficult to make because of the lack of randomized studies and head-to-head comparisons between radiation therapy and surgery.

Superficial bladder cancer can be a frustrating disease for both the patient and physician. It has been referred to as a "nuisance disease" because of its propensity for recurrence, necessitating frequent cystoscopies and trips to the operating room for resection of recurrent disease. In addition, however, there looms for the patient and physician the 10% to 15% probability of disease progression, often requiring cystectomy to achieve local control and placing the patient at much greater risk for disease mortality. The challenge is to predict which patients will benefit from adjuvant therapy in order to avoid disease progression and, secondarily, disease recurrence.

Dr. Grossman's article provides a well-organized review of the literature on the treatment of superficial bladder cancer. At the time of diagnosis, approximately 80% of patients with bladder cancer have superficial tumors (limited to the urothelial lining of the bladder or the underlying lamina propria). In such patients, the risk of distant disease is low, and the natural history of bladder cancer is based on two separate, but related processes: tumor recurrence and progression to a higher stage of disease.

NEW YORK--Baseball-Hall-of-Famer Bob Watson remembered feeling "on top of the world" in October, 1993, after being named the first African-American general manager of a major league ball club (the Houston Astros), but the very next year, at the age of 47, he was feeling "angry and afraid" after learning he had prostate cancer.

NEW YORK--Michael Korda, best-selling author and editor-in-chief and vice president of Simon and Schuster, had never heard of PSA until a routine test showed that his was elevated; he had never thought about prostate cancer as something that could happen to him. After all, he was asymptomatic, a "fanatic exerciser," had given up smoking 20 years ago, and ate carefully.

GAITHERSBURG, Md--Members of the FDA's Oncology Drug Advisory Committee (ODAC) agreed that Immu-nex Corp.'s Novantrone (mitoxan-trone)--in combination with corticosteroids--offers a clinical benefit to patients with hormone-resistant prostate cancer.

NEW YORK--Pharmaceutical companies are currently investigating 25 new treatments for prostate cancer, including a potential vaccine, Alan Holmer, president of the Pharmaceutical Research and Manufacturers of America, said at a media briefing conducted by the American Cancer Society and the New York City-based Cancer Research Institute.

GAITHERSBURG, Md--Faced with significant differences between FDA staff and company-associated scientists in the analysis of data from two clinical studies, the FDA's Oncology Drugs Advisory Committee (ODAC) declined to vote either way on whether to recommend approval of Pharmacia & Upjohn's Remisar (bropirimine tablets) for the treatment of patients with BCG-refractory or BCG-intolerant urinary bladder carcinoma in situ (CIS).

NEW YORK--Marion Morra, associate director of the Yale Cancer Center, has collaborated with her sister Eve Potts, a medical writer for more than 30 years, to produce The Prostate Cancer Answer Book: An Unbiased Treatment Guide, published in September by Avon Books to coincide with Prostate Cancer Awareness Month.

Physicians screening African-American men for prostate cancer should use different cut-off points for a popular blood test because they will accurately detect 95% of cases in this high-risk group, according to a study published in the August 1 issue of The New England Journal of Medicine. The revised normal values for the prostate-specific antigen (PSA) test are based on a new diagnostic strategy and age-specific ranges for African-Americans, who have the world's highest prostate cancer rate.

BETHESDA, Md--Physicians have long hypothesized that natural variation in sex hormones may influence prostate cancer risk, said Meir Stampfer, MD, of the Harvard School of Public Health. Efforts to prove this, however, have yielded unclear results. Now, by examining the interrelationship of different sex hormones, Dr. Stampfer and his colleagues have achieved what he calls the first clear demonstration that circulating levels of sex hormones can predict a man's risk of developing prostate cancer.

Thomas Jefferson University in Philadelphia has received a patent for a molecular-based blood test that provides a novel approach to diagnosing prostate cancer. Jefferson has given exclusive licensing rights to the test to UroCor, Inc., for the United States and Canada, and to the Italian-based biotechnology firm Raggio-Italgene, for Europe and Japan.

The paper by Drs. Moul and Heidenreich provides a very nice review of prognostic factors for metastasis in patients with clinical stage I nonseminoma. Risk-adapted management--ie, the management of patients at low risk for metastasis by surveillance and patients at high risk for metastasis by retroperitoneal lymph node dissection (RPLND)--is very reasonable, and we are now at a point where a paradigm can be developed to accurately classify clinical stage I patients as either low or high risk and manage them accordingly.