Prostate Cancer

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).

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.