Prostate Cancer

One of the largest clinical trials classifies which patients will benefit most from androgen deprivation therapy paired with radiotherapy.

Most men who have had radical prostatectomy can look forward to at least 15 years free from prostate cancer. But which patients are likely to see their PSA levels double within nine months, and therefore have high risk of recurrence? Oncologists are calling for new ways to predic, and researchers are on the case.

Prostate cancer patients administered high doses of proton-beam therapy appear to have a markedly reduced risk of disease recurrence when compared with other low-risk patients treated with conventional radiation therapy, according to two recent studies.

In order for a new treatment modality to be considered efficacious, it needs to be evaluated by acceptable criteria and demonstrate an improvement on the natural course of the disease.

Over 40 million men and women in the United States have osteoporosis and low bone mineral density (BMD), placing them at risk for adverse skeletal events such as fractures and their sequelae. There are over 12 million cancer survivors in this country. Of these, 22% were diagnosed with breast cancer and 17% with prostate cancer.[1,2] Because cancer therapies can adversely influence bone health, these survivors are at particular risk for skeletal complications. Cancer therapies associated with bone loss include hormone deprivation therapies such as aromatase inhibitors, ablative surgical procedures that induce hypogonadal states, and premature menopause induced by chemotherapy.[3,4]

The first major study to address the cardiovascular adverse effects of endocrine therapy for prostate cancer could change attitudes toward treatment options because testosterone deprivation may have more impact on the patient’s life than it does on the androgen receptor.

Findings of a study by researchers in Italy suggest C-11 choline PET/CT could diagnose prostate cancer recurrence sooner than transrectal ultrasound, CT, MRI, or bone scintigraphy in patients who have undergone radical prostatectomy.

Astellas has partnered with Medivation to co-develop and market the oral anti-androgen, MDV3100. In September, Medivation enrolled patients in the phase III AFFIRM trial, which is evaluating MDV3100 in 1,200 men with castration-resistant prostate cancer who were previously treated with docetaxel (Doxil) chemotherapy.

Dr. Otis W. Brawley took a courageous stand late last week, one he has taken many times before, but which had until then gone all but unnoticed. Responding to a Journal of the American Medical Association article detailing the scientific and medical limitations of breast and prostate screening, the chief medical officer of the American Cancer Society acknowledged that “in the case of some screening for some cancers, modern medicine has overpromised.”

The comparison of brachytherapy and surgery may be done on several levels. This review focuses the comparison on toxicity, the “soft” endpoints of biochemical relapse-free survival and clinical relapse-free survival, and the “hard” endpoint of prostate cancer–specific mortality.

Standard treatment options for prostate cancer patients include surveillance, surgery, external-beam radiotherapy, brachytherapy, the combination of external-beam and brachytherapy, and the combination of radiotheraputic modalities with hormonal therapy, for appropriately chosen patients.

In this review, we summarize contemporary data pertaining to active surveillance, a safe and appropriate strategy for select patients with low-risk cancer characteristics who undergo monitoring at regular intervals.

Active surveillance is becoming a very reasonable and appropriate “treatment” strategy for men with low-risk localized prostate cancer, as Large and Eggener eloquently describe in this review article. It is important to recognize that active surveillance is not what was once referred to as “watchful waiting,” which I believe many patients interpret as “watching and waiting to die.

The Association of Community Cancer Centers recently surveyed its members and found a universal request for assistance in developing prostate cancer care programs. The ACCC responded by setting up pilot programs in the U.S. that focus on the following areas:

Marcia Prenguber, ND, FABNO, director of integrative care at Goshen Center for Cancer Care in Indiana, said more than 75% of patients use complementary and alternative medicine, yet remain reluctant to tell their oncologists about it. Dr. Prenguber said she does not consider complementary medicine as an alternative to standard treatment, but as a way to tailor healing to the individual.

The risks associated with neoadjuvant hormonal therapy may outweigh the benefits of its use in conjunction with brachytherapy in some older men with prostate cancer, according to research from the radiation oncology program at Boston’s Harvard Medical School.

ORLANDO-Whom to treat vs whom not to treat remains a major dilemma in prostate cancer care, but distinguishing men who will benefit from treatment from those who will not is not a clear-cut prospect, according to a speaker at the 2009 ASCO Genitourinary Cancers Symposium.

More than a million additional cases of prostate cancer have been diagnosed and treated for prostate cancer over the last 20 years because of PSA screening, especially in younger men, according to the results of a SEER database analysis. The authors of this latest strike against screening claimed that most of this excess incidence represents overdiagnosis.

A phase III trial demonstrated that denosumab can reduce fracture risk in men with nonmetastatic prostate cancer undergoing androgen deprivation therapy, Amgen announced.

Patients who experience fatigue during radiotherapy for breast or prostate cancer may be reacting to activation of the proinflammatory cytokine network, a known inflammatory pathway, according to researchers from the University of California, Los Angeles.

Men with prostate cancer who consumed the active compounds in green tea demonstrated a significant reduction in serum markers predictive of prostate cancer progression, according to a study in Cancer Prevention Research (online June 19, 2009).

Young men with advanced forms of prostate cancer do not live as long as older men with similar forms of the disease, according to research conducted at the University of Washington in Seattle.

Prostate cancer remains the most common solid organ malignancy diagnosed among men in the United States, with the American Cancer Society estimating that 1 in 6 men will be diagnosed with prostate cancer, and 1 in 35 will die of the disease.[1]

So here we go again with one more round in the battle of treatment options for localized prostate cancer. While more than 3 decades of such sparring has gotten us no closer to evidence-based conclusions, one might say that these matches do serve the purpose of bringing out the best and the worst of the therapeutic contenders.

Ferring Pharmaceuticals announced that the US Food and Drug Administration (FDA) has approved the trade name Firmagon (degarelix for injection) for its prostate cancer treatment previously marketed under the generic name degarelix.

In 2008, approximately 186,000 American men were diagnosed with prostate cancer, resulting in about 28,600 deaths.[1] It is the most commonly diagnosed cancer, and second only to lung cancer as the leading cause of cancer death in men.

The optimal treatment for clinically localized prostate cancer is an ongoing subject of controversy.[1] As pointed out by Drs. Mirhadi and Sandler, no randomized trial has compared radical prostatectomy (RP) to radiation therapy (RT), and no study has definitively “proven” the superiority of one technique over the other. Therefore, we disagree with the author’s conclusion that RT “is the ‘only way to go’ when managing early-stage prostate cancer.”

For the September and October issues of ­ONCOLOGY, we have assembled a team of experts in the diagnosis and management of early-stage prostate cancer-ie, disease that has not clinically metastasized at first presentation, and which is theoretically curable-and have asked them to take a position on optimal patterns of care.

Prostate cancer experts agree on one issue: No single treatment can be considered universal for men diagnosed with prostate cancer. There are myriad choices and considerations to be reviewed with every diagnosis. In addition, there are conflicting data about when, or if, men require screening for prostate cancer as well as when to start therapy for confirmed disease.

Prostate cancer patients who undergo androgen deprivation therapy have an increased chance of developing bone- and heart-related side effects compared to patients who do not undergo ADT, according to an analysis in Cancer online (April 29, 2009).