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Prostate Cancer

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HELSINKI, Finland--Supplemental vitamin E significantly decreased both the incidence and mortality of prostate cancer in a large randomized trial of male smokers in Finland, said Olli P. Heinonen, MD, DSc, and his colleagues from the University of Helsinki, the National Cancer Institute, and Montefiore Medical Center, New York.

WASHINGTON--Recognizing the devastating burden of prostate cancer, particularly among black men, the American Cancer Society (ACS) has released a plan of action aimed at addressing issues in research, education, patient and family support, and public policy. ACS president-elect Charles J. McDonald, MD, said that the Society will convene a conference shortly of "all key African-American national organizations" to determine how to implement the plan.

ORLANDO-Researchers at the Seattle Prostate Institute, University of Washington, and Northwest Hospital have shown excellent progression-free survival in favorable prostate cancer patients with the use of transperitoneal ultrasound-guided brachytherapy as sole treatment. Peter Grimm, DO, presented eight-year follow-up data on more than 400 patients in a poster presentation at the American Society for Therapeutic Radiology and Oncology meeting.

Drs. Forman and Velasco provide a timely and thorough review of the maturing concept of applying radiation therapy to the prostatic fossa after radical prostatectomy. The guidelines for therapy continue to evolve because of the increasing reliance on blood prostate-specific antigen (PSA) level for both detecting a recurrence of disease and evaluating response to radiotherapy.

I agree with Drs. Forman and Velasco that the optimal management of patients with an elevated prostate-specific antigen (PSA) level after prostatectomy remains to be determined. The broader issue, however, is optimizing the management of post-prostatectomy patients who are at risk for recurrence. Hence, the dilemma: Should we wait for a chemically apparent recurrence before instituting treatment? Or, should we, on the basis of available information, quantify the risk of recurrence and the possible side effects of therapy and determine whether or not adjuvant radiotherapy is warranted based on the risk/benefit ratio?

New treatments announced at the 1997 Endocrine Society Annual Meeting could help slow the rate of prostate cancer growth and improve the quality of life of those who have the disease.

The value of screening for prostate cancer, the second most common cancer in men, has been fiercely debated in recent years, but Professor Bolla from the Department of Radiotherapy, Centre Hospitalier de Grenoble, France, has no doubt that early detection is of prime importance in the treatment of prostate cancer.

ORLANDO-Permanent trans-peritoneal ultrasound-guided radioactive implants (brachytherapy) get high marks for quality of life (QOL) in men with clinically localized prostate cancer, V. Elayne Arterbery, MD, reported in a poster session at the annual meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO).

NEEDHAM, Mass-UroMed Corporation has received FDA clearance for marketing of its nerve-locating product, the CaverMap Surgical Aid. The device is intended to guide surgeons during radical prostatectomy in mapping and ultimately sparing the cavernous nerves responsible for potency.

HAMBURG-Patients with poor-prognosis M1 prostate cancer who undergo orchidectomy have little to gain and much to lose from adjuvant mitomycin (Mutamycin) therapy, according to the findings of a phase III study from the EORTC’s Genitourinary Tract Cancer Cooperative Group.

In Session I of the First Sonoma Conference on Prostate Cancer, a critical concern in prostate cancer management was addressed: improving the pretreatment prediction of patients’ outcomes in localized prostate cancer.

Using a series of 421 patients with localized prostate cancer who were treated with radiation, six predictive models were analyzed to determine which model correlates most closely to actual clinical outcome data in regard to biochemical freedom from failure. Multivariate analysis was performed using the following covariates: prostate specific antigen; Gleason score; stage; dose; PSA density; and perineural invasion. Initially, the Pisansky model appeared to be the most predictive.

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]