Prostate Cancer

A new technique, ultrasonic tissue-type imaging, could revolutionize the detection and treatment of prostate cancer, according to Ernest J. Feleppa, PhD, research director of the Frederic L. Lizzi Center for Biomedical Engineering at the Riverside Research Institute in New York. “The method seems to be capable of distinguishing cancerous from noncancerous tissue in the prostate,” Dr. Feleppa said

Crawford and Hou[1] review the data on luteinizing hormone-releasing hormone (LHRH) antagonists in prostate cancer. They describe the results of a phase III trial comparing monthly degarelix to monthly leuprolide in men with advanced prostate cancer. Degarelix treatment was associated with a more rapid decline of serum testosterone, and was not associated with an initial surge of serum testosterone seen during the first few days of treatment with leuprolide. They discuss the role of this new form of medical gonadal suppression for the treatment of prostate cancer.

The recent US Food and Drug Administration (FDA) approval of degarelix, a luteinizing hormone-releasing hormone (LHRH) antagonist, has renewed interest in this class of drugs as a prostate cancer therapy. Approval was based on a prospective phase III trial of 610 patients randomized to one of two dosing schedules of degarelix, or standard-of-care monthly leuprolide acetate monotherapy, with initial antiandrogen therapy allowed at the treating physician’s discretion for prevention of clinical flare.[1]

Drs. Crawford and Hou provide an important clinical introduction to a novel class of hormonal agents that have been under development for several decades for the treatment of advanced and metastatic prostate cancer.

Physicians have known since 1941 that testosterone suppression benefits patients with symptomatic metastatic prostate cancer.[1] The pioneering study in this regard showed that estrogen therapy achieved comparable efficacy to castration by improving acid and alkaline phosphatase levels associated with relief of cancer-related symptoms. More than 6 decades later, however, many of the therapies subsequently developed for achieving androgen deprivation still suffer from serious limitations.

Ferring Pharmaceuticals announced the launch of a phase IIIB clinical trial of degarelix for injection, a new injectable gonadotropin-releasing hormone (GnRH) receptor antagonist approved by the US Food and Drug Administration (FDA) for the treatment of hormone-sensitive advanced prostate cancer.

Is the era of PSA screening coming to an end? Proponents say the test saves lives, but a growing number of critics contend that widespread screening does more harm than good. The ongoing controversy over the clinical value of PSA screening has long been perpetuated by a lack of persuasive data, leaving doctors and their patients with difficult conversations and a host of perplexing decisions.

PSA is the most important biomarker in a common malignancy. I will continue to test men starting at age 35 if there is a family history of prostate or breast cancer. Depending on the vitality of the individual, I will continue with PSA testing for the duration of the man’s health.

Like the vast majority of men, I was “stupid” where my healthcare was concerned. I never asked for a copy of my blood work or questioned the results of my tests. After all, we treat our doctors like gods.

Although significant questions remain, the recently released IMPACT study is a major victory for Dendreon's prostate cancer vaccine, Provenge. Two years ago, Provenge was denied FDA approval causing a wave of public outcry. Now, all eyes are on FDA as Dendreon gears up to once again tackle the approval process.

Aureon Laboratories has released Prostate Px, a test to predict prostate cancer regression and disease recurrence at the time of diagnosis. The technology combines molecular biomarkers, histological and clinical information with advanced mathematics, said Ricardo Mesa-Tejada, MD, vice president of pathology and medical director of Aureon Laboratories.

Ascenta Therapeutics announced positive preliminary results from its Phase II study of AT-101 in combination with docetaxel (Taxotere) and prednisone in men with docetaxel refractory, castrate resistant prostate cancer (CRPC). AT-101 is an oral, pan-Bcl-2 inhibitor.

VIENNA-Image-guided intensity-modulated radiotherapy, high-intensity focused ultrasound, and cryotherapy are increasing the curative treatment options for men with prostate cancer. The problem is how to determine which patients are most suitable for these therapies.

The value of a molecular marker in cancer depends on whether its use will improve clinical outcomes. Studies on tumor biomarkers are in preliminary stages, and there is a “near total” absence of any papers examining the clinical implications of using markers, according to a speaker at the 2009 Genitourinary Cancers Symposium.

Prostate-specific antigen testing, the most widely used screening tool in prostate cancer, has long had both critics and supporters. Two studies published in the New England Journal of Medicine continue to generate debate over the value of PSA screening. The papers have two major points in common: They are large-scale studies, and they leave more questions than answers.

DENVER—Designer T cells that attack tumors with a vengeance could be the future of prostate cancer treatment. Although the results are very preliminary, the incorporation of designer T cells into prostate cancer treatment led to a significant reduction in PSA levels, according to researchers from Boston University School of Medicine in Providence, R.I.

SAN FRANCISCO-Studies show improved outcomes when androgen deprivation therapy (ADT) is part of the care for men with intermediate-risk prostate cancer, said Mack Roach III, MD, taking the “pro” side of a debate on the issue. But “con” speaker Arul Mahadevan, MD, argued that the studies in question included mostly high-risk patients, and that monotherapy is effective in intermediate-risk patients.

Osteoporosis, the most common late effect of cancer treatment in the US, occurs with greater frequency among cancer survivors than the general population. Survivors of breast cancer, prostate cancer, and childhood leukemia are at particularly high risk for changes in bone mineral density (BMD) / osteoporosis that can lead to fractures.[1] In breast and prostate cancer patients, bone effects are often the result of endocrine therapy–induced alterations in bone microarchitecture. They also can be caused by other types of cancer therapy, vitamin D deficiency, and other physiological changes that may or may not be related to cancer or its treatment. In childhood leukemia patients, bone effects can be caused by a variety of factors, including corticosteroid therapy, radiation therapy to the brain, and the disease itself.

Ferring Pharmaceuticals received approval from the US Food and Drug Administration (FDA) for degarelix, a new injectable gonadotropin-releasing hormone (GnRH) receptor antagonist indicated for patients with advanced prostate cancer.

CHICAGO-Prostate-specific antigen measurements are considered a useful organ-specific marker, but they are not necessarily an adequate tumor marker. PET/CT in combination with PSA levels can play a significant role in detecting and staging prostate cancer, according to two presentations at RSNA 2008 (abstracts SSA18-02 and SSA18-09).

Omer Kucuk, MD, has joined Emory University’s Winship Cancer Institute in Atlanta as professor of hematology and medical oncology. Dr. Kucuk conducted the earliest clinical trials on soy and lycopene supplements in prostate cancer treatment. He was previously at the Karmanos Cancer Center at Wayne State University in Detroit.

When the U.S. Preventive Services Task Force reported that routine prostate cancer screening for older men appears to result in little benefit, the announcement raised more than a few eyebrows in the urologic medical community.

For men with locally advanced prostate cancer, the addition of radiation treatment to antiandrogen hormone therapy reduces the risk of dying of prostate cancer by 50% compared to those who have antiandrogen hormone treatment alone, according to a randomized study presented September 22, 2008, during the plenary session of the American Society for Therapeutic Radiology and Oncology’s 50th Annual Meeting in Boston.

Men over 70 years of age with early-stage prostate cancer have a 20% higher mortality if they are treated first with hormone therapy before being treated with radiation seed implants (brachytherapy), compared to men who are treated with brachytherapy alone, according to the largest cohort study of its kind presented September 23, 2008, at the 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Boston.

During this election year, approximately 1.4 million U.S. residents will be diagnosed with cancer. For U.S. presidential hopefuls Sen. Barack Obama and Sen. John McCain, cancer has hit close to home. Sen. McCain, 72, has been treated several times for squamous cell carcinoma and malignant melanoma. Sen. Obama lost his grandfather to prostate cancer and his mother to ovarian cancer.

SOUTH SAN FRANCISCO-Cell Genesys terminated VITAL-2, the second of two phase III clinical trials of Gvax immunotherapy for prostate cancer.

In the article entitled "Interstitial Brachytherapy Should Be Standard of Care for Treatment of High-Risk Prostate Cancer," Merrick, Wallner, and Butler once again make the case for interstitial brachytherapy as a primary treatment for prostate cancer (see their earlier article, "Permanent Prostate Brachytherapy: Is Supplemental External-Beam Radiation Therapy Necessary?" in ONCOLOGY, April 2006).[1] This time Nathan Bittner has joined as the lead author.

In this issue of ONCOLOGY, Bittner et al provide a thoughtful review of the literature to advocate for the viewpoint that interstitial brachytherapy should be standard of care for the treatment of high-risk prostate cancer.

In the realm of general oncology, patients who present with aggressive, poorly differentiated malignancies are usually at high risk for disseminated disease, and systemic therapy often supersedes local therapy in importance. It is not surprising, then, that a similar systemic approach to therapy is often considered for patients who present with high-risk prostate cancer. This recommendation is often supported by much of the surgical literature that cites discouraging outcomes in these patients when treated by radical prostatectomy alone.

The magnitude of the role surgical exploration and extirpation play in the contemporary management of patients with advanced ovarian cancer is hard to overstate. Beyond diagnostic confirmation, the aggressive posture taken to remove bulk disease provides-among other benefits-symptomatic relief, theoretically enhanced immunologic integrity, chemosensitivity, and improved survival characteristics.