Prostate Cancer

MARINA DEL REY, Calif--Preliminary studies show that cryosurgical ablation of the prostate can be used to treat localized prostate cancer, resulting in negative post-treatment biopsies and undetectable serum PSA levels, reported Peter R. Carroll, MD, associate professor of urology and director, Urologic Oncology Program, University of California, San Francisco (UCSF).

Adenocarcinoma of the prostate is now the most common tumor in males. The use of the digital rectal examination, prostate-specific antigen (PSA), and transrectal ultrasound of the prostate with biopsies has improved the detection of prostate cancer and has increased the percentage of patients with organ-confined disease who are treated with radical prostatectomy. It is critical for the practicing urologic and medical oncologist to have accurate and precise pathologic information in order to counsel patients for appropriate therapy. Ideal biopsy and clinical predictive criteria for tumor volume in prostates are not readily available in the literature.

Dr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.

The pathologist plays an integral role in the evaluation and treatment of many urologic cancers. Prostate cancer may be the best example of the importance of the pathologist in providing accurate clinical staging. Dr. Epstein has written an excellent review of the critical pathologic information available from prostate needle biopsy and radical prostatectomy specimens. The article highlights how to utilize this information in day-to-day clinical practice. Although the article is complete, some areas deserve special attention.

During the last few years, pathologists have assumed several important roles in the assessment of adenocarcinomas of the prostate. The establishment of postoperative serum prostate-specific antigen (PSA)

PALM SPRINGS, Calif--Early diagnosis of prostate cancer can be a mixed blessing, bringing with it not only the chance of cure but also the psychological distress of choosing between watchful waiting and treatment, and if treatment is chosen, which treatment, Andrew Roth, MD, said at the Academy of Psychosomatic Medicine meeting.

WILMINGTON, Del--Zeneca Pharmaceuticals has received clearance from the FDA to market a new formulation of Zoladex (goserelin acetate implant) for the palliative treatment of advanced prostate cancer.

MIAMI BEACH--Potency status in prostate cancer patients before radiation therapy, not the radiation dose, is the main determinant of potency status afterwards, Adam P. Dicker, MD, said at the 37th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

MIAMI BEACH--Cancer patients treated with strontium-89 (Metastron) for palliation of their metastatic bone pain may also benefit therapeutically, said Michael J. Katin, MD, a radiation oncologist in Fort Myers, Florida, whose practice includes a significant number of patients with painful bone metastases resulting primarily from prostate cancer.

MIAMI BEACH--Early-stage prostate cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT) at the University of Michigan Medical Center had excellent survival rates with few complications, Howard Sandler, MD, reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.

WASHINGTON--In 1990, General H. Norman Schwarzkopf commanded the imagination of the American people during his service as Commander of Operations Desert Shield and Desert Storm. At the First National Congress on Cancer Survivorship, he stormed the stage of the Washington Court Hotel to describe his role as a prostate cancer survivor and patient advocate. The message was simple and personal. "I am here," the general said, "because I won a battle."

JERUSALEM--Tumor cells that are not eradicated by chemotherapy or radiotherapy can enter a prolonged dormant state and thus pose a continuous threat of tumor relapse in patients who are seemingly "cured," Eitan Yefenof, PhD, said in an interview with Oncology News International.

WILMINGTON, Del--Zeneca Pharmaceutical's Casodex (bicaluta-mide), a new nonsteroidal antiandrogen, has received FDA approval for the hormonal treatment of advanced prostate cancer in combination with a luteinizing-hormone-releasing hormone analog (LHRH-A). The agent acts by binding to cytosol androgen receptors.

NEW YORK-Citing the dispro-portionally high incidence and mortality of prostate cancer among African-American men, Marc B. Garnick, MD, associate clinical professor of medicine, Harvard Medical School, singled out this segment of the population as the target for intensive efforts to raise awareness.

In recent years, clinicians and researchers have noted that bloodtests made by different companies for the prostate-specific antigen

NEW YORK-A new study by Louis Harris and Associates points to serious gaps between what doctors treating prostate cancer say they tell their patients and what prostate cancer patients report they have heard. A panel of experts at a press conference called to present the findings agreed that these communication gaps must be repaired if further progress is to be made in fighting what they called this "male epidemic."

The American Urological Association, representing 10,000 urologists worldwide, is encouraged that the Office of Technology

The value of prostate cancer screening remains controversial because of the high prevalence of the disease and the fact that many tumors detected through screening are not destined to lead to morbidity or mortality, rendering

SEATTLE-Current screening techniques allow the early detection of prostate cancer in large numbers of men every year. The problem is that prostate cancer appears to be an almost ubiquitous malignancy in men over the age of 50. The question, then, is which patients require intervention to prevent their cancer from becoming life threatening?

SEATTLE-Improvements in standard imaging techniques may lead toenhanced prostate cancer detection and local staging accuracyin the near future, Gary Sudakoff, MD, said at the Pacific NorthwestCancer Foundation Meeting on Transperi-neal Brachytherapy forEarly Stage Prostate Cancer. Such methods may include combiningcolor Doppler imaging with endorectal ultrasound (see image )and using new types of coils with magnetic resonance imaging (MRI),said Dr. Sudakoff, of the University of Chicago.

RTOG 94-13 is a phase III study designed to determine the appropriatetreatment volume and the optimal way to combine radiation and

SEATTLE--A mixture of neutron radiation with conventional photon radiation, using a custom tailored pelvic template for each patient, appears to provide more effective therapy for prostate cancer than photon radiation alone (eg, external beam or I-125), while reducing the complications caused by neutron radiation alone, said Jeffrey Forman, MD, of Wayne State University, Detroit.

NEW YORK--The identification of prostate-specific antigen immunoreactivity (IR-PSA) in some cases of breast cancer has raised the possibility that PSA could be used as a biochemical marker for prognosis of breast cancer.

NEW YORK--A new testing kit that measures free PSA (F-PSA), developed by a French pharmaceutical firm, may improve the positive predictive value (PPV) of PSA testing.

SEATTLE--A study of 1,695 cancer-free men found that PSA density provides a far more accurate screening assay for detection of prostate cancer than PSA serum concentration, Robert Kane, MD, of Harvard Medical School, said at the Pacific Northwest Cancer Foundation Meeting on Transperineal Brachytherapy for Early Stage Prostate Cancer.

Widespread use of prostate-specific antigen (PSA) as a screening tool has led to an increased incidence of biopsy-proven prostate cancer, as well as a shift toward more cases with clinically confined disease (stage T1 to T2). The two traditional therapeutic modalities, radical prostatectomy and external-beam radiation therapy, have undergone technical refinements. Other modalities, such as brachytherapy and cryosurgery, are also being used to treat early-stage disease. Comparisons between treatment results are difficult. Biochemical failure, based on PSA findings, is currently used to measure treatment efficacy, but the precise definition and clinical relevance of biochemical failure have yet to be established. The author presents current analyses of biochemical failure, cause-specific survival, distant metastasis, and morbidity rates following various treatment modalities. [ONCOLOGY 9(9):803-816, 1995]

Dr. Stock provides a thorough summary of recent data on the principal modes of treatment for early-stage prostate cancer. Prostatectomy, external radiation, and brachytherapy have all improved substantially over the last 15 years. Despite these improvements, however, it is still unclear how these modalities compare in terms of efficacy and morbidity. To provide some balance to his evenhanded approach, I will add a few remarks.

The article by Stock provides a comparison of outcomes following radiation therapy and radical prostatectomy in men with clinically localized prostate cancer. The reliability of this comparison is complicated by the lack of randomized trials and the obvious selection biases inherent in uncontrolled studies. Ultimately, however, the value of either therapy depends critically on the difference between radiation or surgery and watchful waiting--an issue that is not addressed in this article.

CHICAGO--Until recently, physicians would have offered watchful waiting only to a select group of older men with localized prostate cancer. Now, because of concerns about the quality as well as the length of life, physicians are vigorously debating whether watchful waiting may be an option for men as young as the early 50s.

LAS VEGAS--A new, longer duration formulation of an LHRH (luteinizing hormone releasing hormone) analogue for advanced prostate cancer offers more convenient dosing and appears to be safe and effective.