Prostate Cancer

Dendreon Corporation recently announced that it received a Complete Response Letter, commonly referred to as an "approvable" letter, on May 8, 2007 from the US Food and Drug Administration (FDA) regarding its Biologics License Application (BLA) for sipuleucel-T (Provenge) for the treatment of asymptomatic, metastatic, androgen-independent prostate cancer.

Androgen deprivation therapy (ADT) for prostate cancer may be associated with increased risk of death from cardiac disease in men aged 65 and older

The advent of prostate-specific antigen (PSA) screening has increased early detection and treatment of prostate cancer. Most patients respond well to prostatectomy or localized radiation therapy if the cancer is diagnosed before it metastasizes. As a result, the mortality rate from prostate cancer has fallen significantly since the late 1980s.

Irreversible electroporation (IRE), a new nonthermal ablative modality that destroys parenchymal tissue while leaving vasculature and nerves intact, appears to be promising for application in the prostate

The American Society of Clinical Oncology (ASCO) has updated its 2004 clinical practice guideline on the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer

An FDA advisory panel has supported the requested approval of the cancer vaccine Provenge (sipuleucel-T, Dendreon) for the treatment of asymptomatic, metastatic, hormone-refractory prostate cancer.

Spectrum Pharmaceuticals, Inc, recently announced that the New Drug Application (NDA) for satraplatin has been accepted for priority review by the US Food and Drug Administration (FDA). A Prescription Drug User Fee Act date of August 15, 2007, has been established by the FDA for a decision regarding the approval of the satraplatin application. Satraplatin is an investigational drug for the treatment of hormone-refractory prostate cancer in patients who have failed prior chemotherapy.

The advent of prostate-specific antigen (PSA) screening has increased early detection and treatment of prostate cancer. Most patients respond well to prostatectomy or localized radiation therapy if the cancer is diagnosed before it metastasizes. As a result, the mortality rate from prostate cancer has fallen significantly since the late 1980s.

patient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.

Focal cryoablation for prostate cancer—the so-called male lumpectomy—appears to be an effective alternative to treatments that involve the whole gland, with lower rates of adverse effects

Dutasteride, a 5-alpha-reductase (SRD5A) inhibitor currently used to treat benign prostatic hyperplasia (BPH), produces genetic changes in normal prostate tissue that may be protective against the development of prostate cancer

A new multicenter, randomized, phase III trial of Therion Biologics' Prostvac-VF prostate cancer vaccine is currently underway. The vaccine consists of a virus modified to carry the gene sequence for prostate-specific antigen (PSA) and the transgenes for three T-cell co-stimulatory molecules (TRICOM). It is designed to help the immune system kill prostate cancer cells.

Men with indolent, very-low-risk prostate cancer who are eligible to be managed with active surveillance or "watchful waiting" appear to be reluctant to choose this strategy, researchers said at ASCO's 2007 Prostate Cancer Symposium

Men with low- and intermediate-risk early-stage prostate cancer who received external-beam radiation therapy (RT) did not live as long as those who were treated with brachy-therapy or radical prostatectomy, researchers said at ASCO's 2007 Prostate Cancer Symposium

In a phase III study, toremifene (Acapodene), a selective estrogen receptor modulator, increased bone mineral density (BMD) and improved lipid profiles in men receiving androgen deprivation therapy (ADT) for advanced prostate cancer, and may prove to be a useful adjunct to protect against the multiple serious adverse effects of ADT

The number of early stage prostate cancers being detected by PSA screening appears to have leveled off; similarly, the gains in cure rates due to early detection may have reached their limit.

The Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center is teaming up with New York City's taxi drivers to remind New Yorkers and visitors to the city to get screened for colon cancer.

Satraplatin, an investigational oral platinum agent, given in combination with prednisone, slows the progression of hormone-refractory prostate cancer, according to the phase III Satraplatin and Prednisone Against Refractory Cancer (SPARC) trial presented at the 2007 Prostate Cancer Symposium (abstract 145).

There has been a resurgence of interest in developing noncytotoxic immune therapies for patients with either hormone-naive biochemically relapsed post-primary therapy or castrate metastatic prostate cancer. The rationale for developing an immunotherapeutic approach has been based on the overexpression and underglycosylation of a wide variety of altered "self" molecules including prostate-specific antigen (PSA), acid phosphatase (ACP), prostate stem cell antigen (PSCA), and prostate-specific membrane antigen (PSMA), which can serve as targets for immune recognition and attack. In addition, such a strategy could theoretically make use of the patient's immune system to fight the tumor particularly if their disease is of reasonably low volume. A variety of immunotherapeutic approaches have been explored through phase I, II, and now phase III trials demonstrating that immunologic tolerance could be broken, as evidenced by the development of high-titer antibodies and T-cell responses specific for the tumor. What appears to be revolutionizing the immunotherapy field is the combination of vaccines with cytokines or immune modulators, which not only potentiate immune reactivity in vivo but foster dramatic antitumor responses. This review explores the challenges now faced in establishing a role for immune therapies for prostate cancer treatment.

There has been a resurgence of interest in developing noncytotoxic immune therapies for patients with either hormone-naive biochemically relapsed post-primary therapy or castrate metastatic prostate cancer. The rationale for developing an immunotherapeutic approach has been based on the overexpression and underglycosylation of a wide variety of altered "self" molecules including prostate-specific antigen (PSA), acid phosphatase (ACP), prostate stem cell antigen (PSCA), and prostate-specific membrane antigen (PSMA), which can serve as targets for immune recognition and attack. In addition, such a strategy could theoretically make use of the patient's immune system to fight the tumor particularly if their disease is of reasonably low volume. A variety of immunotherapeutic approaches have been explored through phase I, II, and now phase III trials demonstrating that immunologic tolerance could be broken, as evidenced by the development of high-titer antibodies and T-cell responses specific for the tumor. What appears to be revolutionizing the immunotherapy field is the combination of vaccines with cytokines or immune modulators, which not only potentiate immune reactivity in vivo but foster dramatic antitumor responses. This review explores the challenges now faced in establishing a role for immune therapies for prostate cancer treatment.

There has been a resurgence of interest in developing noncytotoxic immune therapies for patients with either hormone-naive biochemically relapsed post-primary therapy or castrate metastatic prostate cancer. The rationale for developing an immunotherapeutic approach has been based on the overexpression and underglycosylation of a wide variety of altered "self" molecules including prostate-specific antigen (PSA), acid phosphatase (ACP), prostate stem cell antigen (PSCA), and prostate-specific membrane antigen (PSMA), which can serve as targets for immune recognition and attack. In addition, such a strategy could theoretically make use of the patient's immune system to fight the tumor particularly if their disease is of reasonably low volume. A variety of immunotherapeutic approaches have been explored through phase I, II, and now phase III trials demonstrating that immunologic tolerance could be broken, as evidenced by the development of high-titer antibodies and T-cell responses specific for the tumor. What appears to be revolutionizing the immunotherapy field is the combination of vaccines with cytokines or immune modulators, which not only potentiate immune reactivity in vivo but foster dramatic antitumor responses. This review explores the challenges now faced in establishing a role for immune therapies for prostate cancer treatment.

More than 90% of prostate cancer patients who receive appropriate radiation dose levels with permanent radiation seed implants are cured 8 years after diagnosis

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Tositumomab/iodine-131 tositumomab (Bexxar) and ibritumomab tiuxetan (Zevalin) are radioimmunoconjugates targeting the CD20 antigen. Both agents are approved in the United States for use in relapsed or refractory, indolent or transformed, B-cell lymphoma. These agents are well tolerated and have the highest levels of single-agent activity observed in these histologies. This review will summarize the key trials that led to approval of both I-131 tositumomab and ibritumomab tiuxetan, and then focus on four novel therapeutic concepts in radioimmunotherapy: retreatment, therapy of de novo indolent lymphoma, therapy of aggressive histologies, and incorporation in high-dose therapy programs utilizing autologous stem cell support.

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Bisphosphonates are an important part of managing bony metastasis of prostate, breast, lung, and other cancers but can cause osteonecrosis of the jaw (ONJ) in some patients.

Unfounded fears may influence a prostate cancer patient's decision to forgo external-beam radiation therapy

The morbidities associated with prostate cancer treatments have improved over the years. However, potential overtreatment and the risks of adverse events associated with radical treatment still pose a considerable challenge. Targeted focal therapy (TFT) of prostate cancer appears to be part of a logical continuum in the quest to improve upon the management of early organ-confined disease. TFT is a procedure in which only the cancer in the gland is ablated. The normal gland, sphincter, and in most cases the neurovascular bundles are preserved. Therefore, this approach averts some of the common complications of more radical therapy. Initial experience has been encouraging; however, long-term data and full implementation of emerging advances in imaging are urgently needed before the widespread adoption of this approach. In this review, we present the current status of our knowledge about this procedure and the most important challenges that need to be addressed. We also present the initial results with this approach at our center.

The morbidities associated with prostate cancer treatments have improved over the years. However, potential overtreatment and the risks of adverse events associated with radical treatment still pose a considerable challenge. Targeted focal therapy (TFT) of prostate cancer appears to be part of a logical continuum in the quest to improve upon the management of early organ-confined disease. TFT is a procedure in which only the cancer in the gland is ablated. The normal gland, sphincter, and in most cases the neurovascular bundles are preserved. Therefore, this approach averts some of the common complications of more radical therapy. Initial experience has been encouraging; however, long-term data and full implementation of emerging advances in imaging are urgently needed before the widespread adoption of this approach. In this review, we present the current status of our knowledge about this procedure and the most important challenges that need to be addressed. We also present the initial results with this approach at our center.