Prostate Cancer

This article will present current information about alpha-pharmaceuticals, a new class of targeted cancer therapy for the treatment of patients with CRPC and bone metastases. It will review preclinical and clinical studies of the experimental radiopharmaceutical radium-223 chloride (Alpharadin).

Use of neoadjuvant metformin prior to radical prostatectomy helped to reduce metabolic effects and slow the growth rate of cancer in a single-center phase II study conducted among men with confirmed prostate cancer.

Rationale for prostate cancer screening continues to be debated as an update to a large European trial reconfirms a reduction in death rates from prostate cancer in men who are screened for the disease. The study, however, found no significant difference in overall mortality between the two arms of the trial.

The new drug, MDV3100, extended overall survival by 4.8 months (P < .001) and reduced the risk for death by 37% as compared to placebo in men with castration-resistant prostate cancer who had progressed after treatment with docetaxel.

Screening is always an issue that generates a great deal of emotion, as recently seen with the controversies surrounding mammography and prostate-specific antigen (PSA) testing.

Initial results of a multicenter trial show that 2 biomarkers, PCA3 and T2-ERG, are found at high levels in prostate cancer compared to noncancerous prostate cells and correlate well with 2 indicators of aggressive prostate cancer, tumor volume and Gleason score.

It is still difficult to gauge the probability that a low-risk prostate cancer patient may be upgraded to a higher prostate cancer stage. Researchers at Vanderbilt University Medical Center have now determined that smaller prostates were more likely to evolve into more serious, aggressive disease.

After several decades with only modest changes in the therapeutic paradigm, rapid progress in understanding the biology of advanced prostate cancer has been translated into more accurate terminology, such as “castration-resistant” (as opposed to “hormone-refractory” or “androgen-independent”) prostate cancer, as well as clinically meaningful therapeutic developments.

These are, indeed, exciting times for patients with metastatic prostate cancer and the clinicians who care for them.

We have entered a period of accelerated drug development and optimism in the care of advanced prostate cancer. The treatment paradigm for these patients is rapidly evolving, with future study needed to define the optimal sequencing and potential combinations of these new agents.

This review will examine agents with potential activity in the palliation and treatment of skeletal metastases of prostate cancer, and will weigh the clinical-outcomes evidence for and against their broad use.

In addition to endeavors to develop new therapeutics, we should anticipate and prioritize studies that will address questions regarding the efficacy of combination therapy, timing and sequencing strategies, and the development of predictive markers to individualize and optimize therapy.

We are seeing a new era in drug development with the identification of novel intra- and extracellular targets to which therapies are being directed. Perhaps more exciting is learning how to optimize standard therapies in combination with biologic agents and radiopharmaceuticals in order to target multiple pathways in prostate cancer growth. Stay tuned!

This is a very emotional issue. Any time a group claims less screening is good, I always take it with a grain of salt-yet the data certainly seem to support that generalized screening with PSA may not impact survival in the general population.

Flax, an annual plant believed to have originated in Egypt, is cultivated around internationally and is among the world’s oldest crops.

Vitamin E supplements, rather than reducing the risk of prostate cancer have been found to increase the risk of developing the disease. The findings are a 3-year follow-up to the Selenium and Vitamin E Cancer Prevention Trial (SELECT).

Based on a review of prostate cancer treatment and screening trials, the U.S. Preventive Services Task Force (USPSTF) has stated that prostate-specific antigen (PSA)–based screening may not be necessary, saying that the potential benefits of the screening do not outweigh the potential harm of complications from evaluations and treatments.

Radium-223, an alpha particle given intravenously, has been shown to improve overall survival in men with castrate-resistant prostate cancer (CRPC), with a 30% risk reduction of death (HR = 0.695, P = 0.00185).

The U.S. Food and Drug Administration (FDA) has approved two new indications for the osteoporosis drug denosumab, as a treatment for bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer and in women receiving adjuvant aromatase inhibitor therapy for breast cancer.

Cabozantinib (cabo), formerly known as XL184, has recently shown unprecedented activity against bone metastases in prostate cancer patients in a phase II trial.

Researchers have found that patients with early, localized prostate cancer benefit from short-term androgen-deprivation therapy (ADT) for 4 months prior to and during radiotherapy, and that the addition of ADT increases overall survival and decreases mortality.

Scientists at the Center for Translational Pathology and the department of urology at the University of Michigan Medical School have developed a new noninvasive urine test for prostate cancer that may be able to stratify patients by risk.

Hoppe et al present an excellent review of the physics relevant to an understanding of proton therapy-and of the available literature assessing the use of proton beams in the management of prostate cancer.

Fifteen years from now, graduate business school students seeking a PhD in medical economics will write dissertations on the topic of proton therapy and its place in the health care reform efforts of the 2010s

This review discusses the rationale, history, and current status of proton therapy for prostate cancer-and controversies regarding it.

At the session on Management of Prostate Cancer in Older Adults: To Treat or not to Treat, Anthony D’Amico, William Dale, and Shabbir Alibhai all lent their clinical expertise in treating prostate cancer to outline the latest recommendations for screening and treating men for prostate cancer.

Abiraterone acetate has been shown to significantly acetate prolonged overall survival among patients with metastatic castration-resistant prostate cancer (CRPC) who previously received chemotherapy. The results of the Phase III study were published in the May 26, 2011 edition of the New England Journal of Medicine.

Drs. Ruch and Hussain provide an excellent overview of the emerging therapeutic agents and targets for advanced prostate cancer.

The article by Ruch and Hussain provides a comprehensive overview of the progress that has been made in translating basic science findings in prostate cancer biology to clinical trials.

This article will present a detailed review of the body of evidence regarding the PSA assay, with reflections on the resulting future of prostate cancer screening.