Prostate Cancer

Adenocarcinoma of the prostate the most common solid tumor in American men, is responsible for tremendous morbidity and mortality in this country, and yet controversy governs most discussions of screening, diagnosis, and treatment. Central to any

Quality of life (QOL) and health status data obtained from the Veterans Administration Cancer of the Prostate Outcomes Study (VA CaPOS) have the potential to add substantially to information available from other observational databases and

The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate

DALLAS-Of 1,371 men with early-stage prostate cancer (T1c) detected by PSA screening and treated via radical prostatectomy between 1987 and 1996, only three have died of their cancer, Angelo J. Iocca, MD, of the Mayo Clinic, Rochester, Minnesota, said at the American Urological Society annual meeting.

BETHESDA, Md-Up to 40% to 50% of prostate cancer patients who undergo radical prostatectomy for localized prostate carcinomas will relapse. Traditional prognostic markers, such as clinical stage or pretreatment levels of prostate-specific antigen (PSA), are of limited value in predicting which individuals will have relapsed disease.

Like pretreatment prostate-specific antigen (PSA), post-treatment PSA nadirs may have prognostic significance in patients with prostate carcinoma, according to data presented by Timothy S. Boyd, MD, Robert C. Orth, BS, Wolfgang A. Tomé,

New Orleans-The advisability of neoadjuvant hormonal therapy in the management of prostate cancer is a hotly debated issue. At the American Society of Therapeutic Radiology and Oncology (ASTRO) spring refresher course, two opinion leaders in radiation oncology squared off on opposite sides of this issue.

BETHESDA, Md-The National Cancer Institute is funding a wide range of prostate cancer research, including genetic epidemiology, molecular diagnostics, diet and nutrition, animal models, surveillance, diagnostic imaging, clinical trials, prevention and early detection, and the Cancer Genome Anatomy Project .

WASHINGTON-The Health Care Financing Administration (HCFA) has announced a national decision that Medicare will cover cryosurgery for patients with localized prostate cancer. The decision rescinds an October 1996 ruling against such coverage, which HCFA said reflected a lack of conclusive scientific evidence at that time in favor of the procedure. Additional evidence supporting its effectiveness led HCFA to reverse itself and grant coverage.

Dr. Vicini and colleagues provide an excellent review of the experience to date utilizing interstitial brachytherapy in the treatment of locally advanced prostate cancer. As the authors mention, ample evidence suggests the existence of a dose-

Vicini and colleagues present an informative, compelling review of both past and recent clinical investigations of the use of brachytherapy in patients with prostate cancer, particularly those with locally advanced disease. The tables presented at the

Brachytherapy boosts in combination with external-beam radiation therapy allow a highly conformal dose of radiation to be delivered to the prostate in a safe, efficient manner. Several types of brachytherapy boost

BUFFALO, NY-Roswell Park Cancer Institute is offering a new blood test to detect early prostate cancer. The complexed prostate-specific antigen (cPSA) test appears to be more accurate than standard PSA at differentiating between prostate cancer and benign conditions, and thus may eliminate the need for unnecessary biopsies when PSA tests are ambiguous

ROCKVILLE, Md-Patients with advanced prostate cancer treated with luteinizing hormone-releasing hormone (LHRH) agonists have essentially the same survival rate and experience roughly the same side effects regardless of which drug they receive, according to a technology assessment report prepared for the Department of Health and Human Services’ Agency for Health Care Policy and Research (AHCPR).

CHICAGO-A Canadian study has shown that men with hormone-resistant prostate cancer have improved global and social function, fewer symptoms, and a greater improvement in quality of life (QOL) measures over time when mitoxantrone (Novantrone) is added to prednisone. A subset of patients who crossed over to mitoxantrone after prednisone therapy had failed also experienced significantly greater improvement in quality of life measures.

Prostate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and

Ms. Bruner and colleagues from Fox Chase Cancer Center are to be congratulated for their comprehensive, well-designed program to maximize our understanding of prostate cancer in young men who are at high risk for developing the disease. I

Bruner et al describe a model for risk assessment and genetic counseling of individuals and families at increased risk for prostate cancer. This model includes the establishment of a prostate cancer risk registry and screening clinic for unaffected

Bruner and colleagues describe a comprehensive, long-term research program designed to understand, model, and modify prostate cancer risk. According to the investigators, the main problem with early prostate cancer risk screening is the

CHICAGO-According to 1994 patterns of practice, only about 20% of cancer centers in the United States provide 3D conformal radiotherapy to men with prostate cancer, and only 2% of these centers give more than conventional doses of radiation, Gerald Hanks, MD, said at a quality of life and outcomes symposium, sponsored by Northwestern University and Evanston Northwestern Healthcare.

CHICAGO-In 1994, the National Cancer Institute began a large-scale, longitudinal investigation of health-related quality of life outcomes in men diagnosed with prostate cancer. Arnold Potosky, PhD, updated the trial’s progress at a quality of life and outcomes symposium sponsored by Northwestern University and Evanston Northwestern Healthcare.

Androgen suppression, primarily castration, has been the key objective of treatment of metastatic prostate cancer. Surgical castration, achieved by the use of bilateral orchiectomy, produces a short-term symptomatic and objective tumor response in 70% to 80% of patients.[1] Medical castration, by the use of leuteinizing hormone-releasing hormone (LHRH) agonists, produces an almost equivalent effect. However, use of medical or surgical castration eliminates only 90% to 95% of the daily testosterone production. The remainder is produced in the adrenal glands.

The promise of using reverse transcriptase–polymerase chain reaction (RT-PCR) technology for the detection of circulating prostate cancer cells in peripheral blood, although technically feasible at the molecular level, has proven clinically impractical for routine implementation in patient management. Reverse transcriptase–polymerase chain reaction has been successfully applied to detect and quantify (relatively speaking) genes that are differentially expressed in cells and tissues obtained from patients during various stages of malignant growth. In addition, the method has been applied to the detection of circulating cancer cells in peripheral blood using highly specific primer sets for specific molecular targets. These include epithelial cell cytokeratins for breast cancer, as well as enzymes, such as tyrosinase for melanoma and prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) for prostate cancer, using either nonnested or nested methodologies.

The article by Drs. de la Taille, Olson, and Katz is an accurate and concise review of clinical studies for the detection of circulating prostate cancer cells using reverse transcriptase–polymerase chain reaction (RT-PCR) technology. These investigators from the Department of Urology at Columbia-Presbyterian Medical Center have as much experience as any group in the use of RT-PCR for this purpose. Initially very strong proponents of the efficacy of RT-PCR as a staging tool, they have become slightly more reserved in the current article. In this well-written review, the authors allude to a number of issues affecting RT-PCR results from prostate cancer patients that deserve further comment.

Dr. de la Taille and colleagues from Columbia University provide an overview of the concept of molecular staging” of prostate cancer using reverse transcriptase–polymerase chain reaction (RT-PCR). They do an admirable job of summarizing all of the currently available data on the results of this assay in the clinical staging of prostate cancer. As they note, only their group and one other have been able to demonstrate that a positive assay correlates with final pathologic stage. A limited number of other studies have suggested that the RT-PCR assay can predict prostate-specific antigen (PSA) recurrence.