Prostate Cancer

A Scandinavian study challenges the efficacy of endocrine treatment alone, compared to endocrine treatment plus radiotherapy for the treatment of locally advanced prostate cancer. All patients in the study receive neoadjuvant total androgen blockade for 3 months and then continue with antiandrogens alone. After 3 months, radiotherapy will be started in one arm of the study. The primary end point of the study is survival, with secondary end points of prostate-specific antigen (PSA) progression, clinical progression, and quality of life. [Oncol News Int 6(Suppl 3):18-19, 1997]

To investigate the potential use of adjuvant hormonal therapy, a randomized, prospective trial was conducted among patients with locally advanced prostate cancer, comparing irradiation alone, with irradiation plus hormonal treatment with goserelin, an agonist anologue of gonadotropin-releasing hormone that reduces testosterone secretion. A total of 415 men under 80 years old with locally advanced disease and no previous treatment for prostate cancer were initially recruited, with data available for analysis on 401 of these patients. Preliminary results at 33-months’ follow-up suggested that goserelin started at the onset of external irradiation improved both local control and 5-year survival. Updated results at 45 months confirm these data. The overall 5-year survival rate for those treated with goserelin in addition to radiotherapy was 79%, compared to 62% in the radiotherapy only group. The localized control rate was 97% in the combined treatment group compared to 77% in the radiotherapy only group. [Oncol News Int 6(Suppl 3):21-22, 1997]

The outcome of 500 patients treated solely with irradiation for clinical stages T1-T4, N0, M0 prostatic carcinoma was used to develop an enhanced prognostic system for patients with clinically localized prostatic cancer. Clinical tumor stage, Gleason score, and pretherapy prostate-specific antigen (PSA) were independently associated with clinical or biochemical relapse and included in a risk score equation that defined patient groups with distinctly different outcomes. [Oncol News Int 6(Suppl 3):8-9, 1997]

Outcomes beyond tumor response and patient survival have increasingly gained in importance over the past two decades. Quality of life (QOL) and cost-effectiveness of therapy have emerged as additional end points of interest. Conflicting results can and have been reported, however, depending on the measures used to report QOL and cost-effectiveness. Examples of QOL and cost-effectiveness issues and measures related to androgen deprivation therapy (ADT) for prostate cancer follow. [Oncol News Int 6(Suppl 3):22-24, 1997]

The single most significant predictor of the inability of radiotherapy to prevent biochemical failure is the pretreatment PSA level. Palpable stage and Gleason score are also important pretreatment prognostic factors and have been combined with PSA to construct a model to predict treatment outcome.

Three equations have been formulated to estimate the risk that men treated for clinically localized prostate cancer have extracapsular extension, lymph node involvement, and non-organ confined disease. The equation for extracapsular extension risk is based on pretreatment prostate-specific antigen (PSA) and Gleason scores.

Reverse-transcriptase polymerase chain reaction (PCR) technology can detect small numbers of cells expressing prostate-specific antigen (PSA), even when these cells are extensively diluted in a population of non-PSA expressing cells. The assay was applied to a cohort of more than 200 patients who were candidates for radical prostatectomy based on diagnostic tests that predicted that the prostate cancer was localized to the prostate gland. In this group, a positive RT-PCR test correlated significantly with early metastatic spread of prostate cancer. [Oncol News Int 6(Suppl 3):11-12, 1997]

A total of 186 randomly selected needle biopsies were evaluated and radical prostatectomy samples were matched with preoperative PSA concentration and patient demographics. Gleason score and optimized microvessel density were determined from the needle biopsy samples; pathologic stage was verified by independent review of the prostatectomy samples. An automated digital image analysis system measured microvessel morphology and calculated the optimized microvessel density in biopsies. Using this system in combination with the Gleason score and serum PSA significantly increases the ability to predict extraprostatic extension of cancer preoperatively. [Oncol News Int 6(Suppl 3):13-14, 1997]

Information from pathologic stage and pretreatment clinical parameters-prostate-specific antigen (PSA), Gleason score, and clinical stage-can be incorporated into a single construct-calculated prostate cancer volume. It is represented by the quotient of the cancer-specific PSA and the PSA measured in serum per cm3 of prostate cancer of a given Gleason score, where cancer-specific PSA is defined as PSA corrected for the PSA contributed by benign prostatic epithelial cells.

Data from three academic institutions were used to develop a model to predict pathologic stage in a group of men with clinically localized prostate cancer. The model combined serum prostate-specific antigen (PSA) level, clinical stage, and Gleason score. The data were used to generate nomograms that present the probability of a patient having organ-confined cancer, isolated capsular penetration, seminal vesicle involvement, or pelvic lymph node involvement. [Oncol News Int 6(Suppl 3):14-15, 1997]

As health-care costs escalate, health-care planners must determine how the allocation of health-care dollars should be prioritized. One approach is to assess the cost of achieving a quality-adjusted year of life and then allocating the dollars in descending order, from least to most expensive, until all available money has been expended. Of course, calculating the cost per life-year is the real challenge because it is usually determined from mathematical decision models, which include many assumptions that may be subject to criticism.

BOSTON-Between 1984 and 1990, the age-adjusted rate of radical prostatectomy to treat early prostate cancer increased almost sixfold. One reason may be that physicians and patients believed, based on published reports, that newer nerve-sparing procedures gave patients a much greater chance of retaining sexual potency after surgery.

HAMBURG-The Federation of European Cancer Societies released information on prostate cancer in Europe at its biennial European Cancer Conference (ECCO 9).

In October 1996, the FDA approved ProstaScint (capromab pendetide), a new diagnostic imaging agent for prostate cancer, manufactured by Cytogen Corporation, Princeton, NJ.[1-5]

Waselenko and Dawson provide a summary of the extensive experience in the management of metastatic prostate cancer. Their article follows a traditional descriptive format and is quite informative. The part that is missing is a general discussion of the various biological aspects involved in the complex process of prostate cancer progression, which has been the focus of major research over the past few years.[1] Undoubtedly, this emerging body of knowledge will provide the background for the design and development of new treatments. There are a few issues, however, that deserve more emphasis.

Drs. Benoit and Naslund venture into the complex arena of medical economics and cost-effectiveness analysis of prostate cancer screening-a task that is made all the more difficult because of the dual paucity of data on costs and effectiveness. Their underlying premises are that cost control is a dominant concern in the prostate cancer screening debate and that cost-effectiveness analyses have been used to “justify denial of prostate cancer screening.” Both of these assumptions bear scrutiny.

Metastatic prostate cancer is a growing health problem and is the second leading cause of cancer death in men. While the response of patients with metastatic prostate cancer to initial hormonal manipulation is excellent, the

The introduction of prostate-specific antigen (PSA) testing for use in the early detection of prostate cancer has led to controversy regarding the appropriateness of prostate cancer screening and any subsequent treatment. Much

This review succinctly summarizes a relatively large body of literature surrounding the treatment of advanced, stage D2 (M+) prostate cancer. However, the patient with classic stage D2 prostate cancer, presenting de novo with multiple sites of bony metastasis, pain, and other systemic symptoms, is becoming less common in clinical practice. In 1997, prostate cancer is most commonly diagnosed in a locally advanced form, either clinically or pathologically stage C (T3), and accounts for approximately 60% of all newly diagnosed cases in the United States.[1] The reasons for this “stage migration” undoubtedly lie in the widespread use of prostate-specific antigen (PSA) for the detection of prostate cancer while still organ-confined, and in the use of PSA to monitor patients who have undergone definitive local treatment.

NEW YORK-Researchers at Memorial Sloan-Kettering Cancer Center have developed a method of quantifying bone involvement in patients with androgen-independent prostate cancer and have found that the resulting bone scan index (BSI) correlates with patient survival. In contrast, simply counting the number of bone lesions present did not provide useful prognostic information.

BALTIMORE, Md-The American Foundation for Urologic Disease (AFUD) has developed and published a comprehensive resource guide for prostate cancer patients, their families and friends, and health care professionals. The publication contains detailed information about prostate cancer, as well as compilations of organizations, publications, and other resources related to the disease.

As a tumor grows, so does its need for nutrients, with a new vascular supply necessary for a tumor to grow to a diameter

NEW ORLEANS-Emerging strategies for treatment of advanced prostate cancer rest on precise classification of the hormone status of the disease and a range of developing techniques and agents aimed at increasing survival, according to experts at the 92nd Annual Meeting of the American Urological Association.

In this article, the authors have done an excellent job in reviewing recent findings regarding prostate-specific antigen (PSA) and other methods for the early detection of prostate cancer. This is a fast-moving field, with new results being reported on a weekly basis. Indeed, it is an exciting time to be conducting research in prostate cancer. At the same time, however, it is far too easy to lose sight of some of the basic principles by which we should judge evidence to make research or clinical decisions. Specifically, there are hard-learned epidemiologic lessons about which we need to constantly remind ourselves.

Men who show no suspicious signs of prostate cancer on rectal examinationsand who also have a prostate specific antigen (PSA) level below 2.0 apparently

MENLO PARK, Calif-In preclin-ical studies, an attenuated adenovirus engineered to incorporate the regulatory region of the PSA gene has been shown to selectively infect and destroy human prostate cancer cells expressing PSA. The engineered virus, named CN706, was developed by scientists from Calydon, Inc., a California-based biopharmaceutical firm, and the Brady Urological Institute at The Johns Hopkins Oncology Center.

When used alone, prostate-specific antigen (PSA) is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity,

CHICAGO-Radical prostatectomy as treatment for men with localized prostate cancer came under attack by Kent E. Wallner, MD, at the Prostate Cancer Shootout II conference.

CHICAGO-Radiation oncologists have been trying to improve the delivery of external beam irradiation in a variety of ways in an attempt to increase local control of prostate cancer and thereby improve long-term survival, Jeffrey D. Forman, MD, professor of radiation oncology, Wayne State University, Detroit, said at the Prostate Cancer Shootout II conference.

As described by Wilt et al in their review, the Prostate Cancer Intervention Versus Observation Trial (PIVOT) is asking very important questions about the effect of surgical treatment vs observation, with delayed androgen deprivation available to both groups, in patients with localized prostate cancer. Clinicians who have suffered with the old Uro-Oncology Trial comparison of prostatectomy vs radiation hope that PIVOT provides answers rather than confusion.