Prostate Cancer

Dr. Powell is to be congratulated for an outstanding review article on prostate cancer in African-American men. As he points out, the age-adjusted incidence of prostate cancer in African-American (black) males is 50% higher than that in Caucasian (white) men, and black men have the highest incidence of prostate cancer in the world.[1] Differences between blacks and whites in the probability of being diagnosed with prostate cancer (9.6% vs 5.2%), lifetime prostate cancer-specific mortality (3% vs 1.4%), and 5-year survival (65% vs 78%) are all indicative of a major public health problem in the black male population.[2]

The article by Powell highlights uncertainties about the relative contributions of diagnostic delay and tumor biology to racial disparities in stage at diagnosis among American men with prostate cancer, and explores a variety of factors that may discourage early cancer detection in African-American men. Observations derived from our ongoing prospective studies of prostate cancer diagnosis and treatment outcomes in black and white American veterans and from our experience with prostate cancer screening at the University of Mississippi Hospital and Clinics afford additional insights into these issues and provide a framework for this commentary.

Mortality from prostate cancer is two to three times greater among African-American men between the ages of 50 and 70 than among American Caucasian men of similar ages. Also, African-Americans tend to present with more advanced tumors than their American Caucasian counterparts. This article explores differences between the two races that may account for the disproportionately high mortality among African-Americans and their more advanced disease stage at presentation. These include epidemiologic and histologic features of prostate cancer; clinical, biologic, and environmental factors; and barriers to health care. Various important issues that warrant further investigation are also highlighted. [ONCOLOGY 11(5):599-605, 1997]

FARMINGTON, Conn--Men with advanced prostate cancer who are in remission while on treatment with an LHRH agonist and flutamide (Eulexin) have a quality of life (QOL) that is similar to an equivalent norm for a matched population of US men without prostate cancer, say Peter C. Albertsen, MD, and his colleagues from Connecticut, Am-sterdam, and Boston.

In a lively session featured at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Richie, md, Brigham and Women's Hospital, Boston, and Steven H. Woolf, md, mph, Medical College of Virginia,

Dr. DeAntoni has carefully reviewed the literature on age-specific reference ranges for prostate-specific antigen (PSA) in the diagnosis of prostate cancer and the controversy surrounding their use. Key to understanding of this debate are two fundamental concepts: (1) the definition of "clinically significant prostate cancer" and (2) the use of sensitivity and specificity, which is frequently obscured by the surrounding rhetoric. The assumption that all readers uniformly interpret the meaning of clinically significant prostate cancer and wish to achieve the same results by manipulating sensitivity and specificity is probably incorrect.

As the number of cases of newly diagnosed prostate cancer has risen dramatically in the United States during the past decade, the management of a rising prostate-specific antigen (PSA) level following definitive therapy has become an increasingly common dilemma. Waxman and associates provide a concise, focused review of many of the key issues and controversies surrounding this dilemma. Several of these issues warrant particular attention.

PSA is the best tumor marker yet discovered. Age-specific reference ranges could improve the sensitivity of PSA by detecting curable, organ-confined tumors.

Controversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.

This article addresses an increasingly common dilemma: the finding of a rising prostate-specific antigen (PSA) level in an asymptomatic patient following radical surgery or radiation therapy for prostate cancer. The incidence of prostate cancer has skyrocketed, and the number of men being treated with radiation or radical prosta-tectomy has similarly increased. The most common basis for the initial diagnosis of prostate cancer is an elevated PSA. For the patient who is already sensitized to PSA as a diagnostic marker, it is extremely distressing to learn that his PSA is rising following radical treatment. This is particularly true for the patient who has experienced a treatment-related adverse effect on quality of life. For the treating physician, this all-too common scenario is disappointing and even guilt-laden.

WASHINGTON--The American Urological Association (AUA) has urged Congress to pass the Medicare Preventive Benefit Improvement Act of 1997, which would provide coverage for annual prostate cancer screening for Medicare-eligible men over the age of 50. The screening procedures covered would include prostate-specific antigen (PSA) blood tests and digital rectal exams.

Dr. DeAntoni provides a timely, critical review of the concept of age-specific prostate-specific antigen (PSA) ranges, as well as other frequently used attempts to improve the accuracy of serum PSA testing in the diagnosis of unsuspected prostate cancer. His review is complete, and his assessments of each of the modalities reflect not only the majority view but also realistic appraisals of the limitations of this less-than-perfect test.

CHICAGO--Because of its high cost and lack of universal availability, magnetic resonance imaging (MRI) has not been a prominent tool in the initial evaluation of prostate cancer. However, MRI is proving to be a highly accurate method of identifying local recurrence of prostate cancer after radical prostatec-tomy, Jeffrey M. Silverman, MD, said at the Radiological Society of North America (RSNA) annual meeting.

BETHESDA, Md--It's called "Know Your Options: The National Prostate Cancer Education Program," and it's a joint effort by the National Cancer Institute and US TOO International, the world's largest men's cancer group.

NEW YORK--Medical leaders and prostate cancer patient advocacy groups have joined with Immunex Corporation to launch Empowered Patients in Control (EPIC), an education program designed to help men with late-stage prostate cancer confront the physical and emotional issues related to their disease.

In a lively session featured at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Richie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

We read with interest the recent practice guidelines on prostate cancer published by the National Comprehensive Cancer Network (NCCN) in a supplement to the November 1996 issue of ONCOLOGY (pp 265-288). The establishment of such

Researchers at Columbia-Presbyterian Medical Center have identified a gene that may control the metastatic spread of prostate cancer and tumor growth. If confirmed, the preliminary findings may eventually help doctors identify patients whose

Improved diagnostic techniques for prostate cancer, the most common cancer among American men, have led to a threefold increase in the rate of diagnosis since 1988. But that presents physicians with a dilemma: Many of these early cancers are

In the United States, racial variations have been documented in the incidence, mortality, and clinical management of cancers of the breast, colon, lung, and prostate.[1-4] In conjunction with similar findings from nonmalignant diseases, such as cardiovascular and cerebrovascular disease, these data suggest that racial variations in medical care are widespread.[5-8] However, few empirical studies explain why these racial variations exist at all.

WASHINGTON--An international team of researchers has mapped a major gene that predisposes men to prostate cancer to the long arm of chromosome 1, finally resolving the question of whether genes for this cancer actually exist. Dubbed HPC-1, for hereditary prostate cancer 1, the gene appears to account for about 3% of the 340,000 prostate cancers diagnosed annually in the United States.

In a lively session at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Ritchie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

LOS ANGELES--By using hyper-fractionation, radiation oncologists at Wayne State University were able to deliver an isocenter dose of 85 Gy to the prostate in men with locally advanced prostate cancer, producing a 95% negative biopsy rate.

The excellent article by Monaco and Goldschmidt summarizes potential pitfalls that must be confronted and avoided as we balance the cost and allocation of health-care resources with the state-of-the-art cancer care that we as a society have come to expect. As a clinician and researcher who is devoting most of my professional efforts to prostate cancer, I would like to put Monaco and Goldschmidt's article in the context of the most common cancer now affecting American men.[1] Although these are my personal opinions, they are based on a number of recent practice guidelines, as will be noted.

After increasing sharply from 1989 through 1992, US prostate cancer incidence rates dropped by 16% for white men and nearly stabilized for African-American men (2% increase) in the latest period available for analysis, 1992 to 1993. These findings, based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry information and US Census population estimates, are reported in the November 20th issue of the Journal of the National Cancer Institute.