Prostate Cancer

SAN ANTONIO-In a retrospective study of prostate cancer patients with a rising PSA after external beam radiation therapy, pretreatment factors appeared to have little independent influence on the development of metastatic disease. However, two post-treatment factors, PSA doubling time and time to onset of a rising PSA, were found to be major determinants of metastatic relapse, Lewis G. Smith III, MD, reported at the 41st Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

WASHINGTON-Medicare now provides coverage for prostate cancer screening. As of Jan. 1, all men, age 50 and older with Medicare benefits, are eligible for one digital rectal exam and one prostate-specific antigen (PSA) test each year. Congress directed the Health Care Financing Administration to cover prostate cancer screening for beneficiaries, beginning this year, in the Balanced Budget Act of 1997.

Prostate cancer is the most common form of noncutaneous cancer in men in the United States. Despite its prevalence, the natural history of this disease is remarkably heterogeneous. In many patients, the cancer

Researchers announced recently that they have developed a new system to deliver the p53 tumor suppressor gene directly into the tumor through the bloodstream. The system, when used in combination with radiotherapy and chemotherapy, may significantly improve treatment outcomes for prostate cancer patients. The findings were presented at the International Conference on Molecular Cancer Therapeutics sponsored by the American Association of Cancer Research (AACR), National Cancer Institute (NCI), and European Organization for Research and Treatment of Cancer (EORTC).

ROCHESTER, NY-Starting anti-androgen therapy immediately after radical prostatectomy, rather than delaying such treatment until disease progression, improves outcomes in prostate cancer patients found to be node positive after radical prostatectomy and pelvic lymphadenopathy, according to results of an ECOG trial.

SAN ANTONIO-Increasing the radiation dose from 70 Gy to 78 Gy favorably affects outcome in some patients with locally confined prostate cancer, according to preliminary results of a randomized dose escalation study reported at the 41st Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

Testing further for a form of prostate-specific antigen (PSA) can help urologists find, stage, and classify prostate cancer in men whose PSA tests are ambiguous, according to a multicenter study that included The Johns Hopkins Hospital. The additional test, which is routinely available for all men taking the PSA test, can also help patients and their doctors determine the best course of treatment. The test measures free PSA, the form of PSA not bound to proteins in the blood. According to the study, the higher the percentage of free PSA compared to the bound form, the smaller the tumor is likely to be, the less chance there is that it has spread from the prostate, and the less likely it is that the disease is the most aggressive form.

SAN ANTONIO -The Southwest Oncology Group (SWOG) has announced the start of the first major phase III trial to compare the chemotherapy combination of docetaxel (Taxotere) and estramustine phosphate (Emcyt) with the commonly used combination of mitoxantrone (Novantrone) and prednisone for the treatment of advanced, hormone-refractory prostate cancer.

The Southwest Oncology Group (SWOG) announced the beginning of the first major phase III clinical trial comparing the combination of docetaxel (Taxotere) and estramustine (Emcyt) to the commonly used combination of mitoxantrone (Novantrone) and prednisone in the treatment of advanced, hormone-refractory prostate cancer. Patient enrollment is currently underway, with approximately 660 men being recruited. This trial is being conducted by SWOG and is funded by the National Cancer Institute (NCI) in collaboration with the Cancer and Leukemia Group B (CALGB) and North Central Cancer Treatment Group (NCCTG).

VIENNA, Austria-Proof that starting adjuvant goserelin (Zoladex) treatment simultaneously with radiotherapy improves local control and survival in men with locally advanced prostate cancer emerged 2 years ago from a study conducted jointly by the Radiotherapy and Genitourinary groups of the European Organization for Research and Treatment of Cancer (EORTC).

CHICAGO-Despite recent excitement about therapy involving ifosfamide (Ifex) and other new chemotherapy drug combinations, MVAC-methotrexate, vinblastine, Adriamycin (doxorubicin), and cisplatin-remains the standard of care for advanced bladder cancer, Derek Raghavan, MD, said at the Chicago Prostate Cancer Shootout III Plus Bladder Conference, sponsored by the Chicago Urological Society, Chicago Radiological Society, and Chicago Medical Society

WILMINGTON, Delaware-Astra-Zeneca has launched CHOICES, a comprehensive resource program for men with prostate cancer and their families. The program contains expert advice to help patients make informed treatment choices and real life messages from survivors, the company said in a news release.

The article by Olson and Pienta is a thorough review of the important issues facing men with metastatic prostate cancer and their caregivers. Many recent reports have documented physicians’ lack of awareness about cancer pain, which underscores the significance of proper evaluation and management. As the authors note, any evaluation of current and future therapies must focus not only on the efficacy of pain control but also on how a particular treatment affects a patient’s overall quality of life.

In a recent poll of the American people, cancer was cited as the disease that most Americans (53%) feared would end their lives. Even though heart disease is 50% more likely than cancer to cause an American to die, it is the concern of only 37% of Americans. Among the African-American community, 78% believe that cancer is a major problem, and 17% believe it is a minor problem. Of American women, 40% are very worried that they may develop breast cancer.

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management of these cancers is slowly evolving. In the past, surgery, often extensive, was the treatment of choice. Recently, however, radiation and chemotherapy have begun to play larger roles as initial therapies, with surgery being reserved for salvage. With these modalities in their treatment armamentarium, oncologists may now be able to spare patients some of the physical and psychological sequelae that often follow surgical intervention without compromising local control and survival. Part 1 of this two-part article, published in last month’s issue, dealt with cancer of the penis. This second part focuses on cancer of the urethra in both females and males. [ONCOLOGY 13(11):1511-1520, 1999]

Prostate cancer is the most commonly diagnosed cancer among American men. The majority of patients with advanced disease have metastatic bone lesions, which are frequently very painful. These lesions tend to respond well to treatment with both nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, although careful dose titration and individualized treatment plans may be needed to achieve maximal analgesia. Opioid side effects are often transient or well controlled with additional medication. Patients with intolerable side effects may experience fewer adverse reactions with a different opioid. Palliative radiation provides pain relief in up to 80% of prostate cancer patients with single or at most a few sites of localized bone pain. Bisphosphonates, powerful inhibitors of osteoclast-mediated bone resorption, are promising new agents for the treatment of painful bone lesions in prostate cancer patients. Radioisotopes, which deliver high-dose radiation to bone lesions without significantly affecting normal bone, are highly effective in providing some degree of pain relief in up to 80% of patients with diffuse, painful bone metastases. Also, chemotherapy shows promise in alleviating pain and possibly extending survival in patients with advanced prostate cancer.[ONCOLOGY 13(11):1537-1549, 1999]

WASHINGTON-The US Postal Service has issued a 33 cent postage stamp designed to encourage the early detection and treatment of prostate cancer. The stamp features a drawing of the male gender symbol against a red background. The words “Prostate Cancer Awareness-Annual Checkups and Tests” appear on the stamp, which was designed by Michael Cronan of San Francisco.

Large Study Confirms Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

PHILADELPHIA-Black men have reduced levels of insulin-like growth factor binding protein 3 (IGF-BP3), compared to white men, and this may be a factor in the higher prostate cancer rates seen in this population, researchers reported at the 90th annual meeting of the American Association for Cancer Research (AACR) in Philadelphia.

BUFFALO, NY-Prostate cancer screening protocols and treatment for localized prostate cancer are less standardized than for other cancers such as breast cancer, and treatment choices remain difficult for many men and their physicians, Jerome P. Richie, MD, said at the Surgical Oncology Symposium, hosted by Roswell Park Cancer Institute.

NEW YORK-Advances in nuclear medicine may meet the need for more accurate detection and higher-resolution imaging in breast and prostate cancer management, especially in the assessment of bone metastases, speakers said at a symposium on nuclear oncology co-sponsored by Memorial Sloan-Kettering Cancer Center and Johns Hopkins University.

In 1991, the United States Congress expressed a growing concern over the incidence of prostate cancer and the controversy over the optimal treatment of the various stages of the disease. Congress also supported the need for both basic

BETHESDA, Md-The National Institutes of Health has unveiled a 5-year plan that, if fully funded, will nearly quadruple its total budget for prostate cancer research, from the $113.6 million spent in fiscal year 1998 to $420.1 million in FY 2003. NIH anticipates spending $180.3 million on researching the disease this fiscal year, the first year of the 5-year program, an increase of 58.7% over FY 1998.

Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

BETHESDA, Md -The National Cancer Institute plans to spend $13.6 million over the next 4 years to fund industry/academic collaborations aimed at developing noninvasive imaging technologies for diagnosing and treating prostate cancer. The Institute hopes the new initiative will bring academic institutions and companies together to pursue image-guided therapy techniques. Image-guided therapy couples images obtained either before or during surgery with computers, sensors, and other devices to help guide more accurate treatments.