Prostate Cancer

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.

ROCKVILLE, Md--The FDA has approved a new indication for Novan-trone (mitoxantrone), making it the first chemotherapy agent approved for the treatment of advanced hormone-refractory prostate cancer. Novantrone in combination with corticosteroids has been shown to reduce bone pain and stabilize or reduce reliance on analgesics in these patients without adversely affecting quality of life.

LOS ANGELES--"Prostate cancer is a disease of options," Douglas Keyser, MD, said at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting. And individual treatment decisions are difficult to make because of the lack of randomized studies and head-to-head comparisons between radiation therapy and surgery.

In a surprising finding that suggests radical changes in the way prostate cancer is managed, researchers at the University of Chicago Medical Center have shown in laboratory experiments that the male hormone testosterone, which fuels prostate cancers early in their growth, can in later stages cause tumors to stop growing or even shrink.

NEW YORK--Baseball-Hall-of-Famer Bob Watson remembered feeling "on top of the world" in October, 1993, after being named the first African-American general manager of a major league ball club (the Houston Astros), but the very next year, at the age of 47, he was feeling "angry and afraid" after learning he had prostate cancer.

NEW YORK--Michael Korda, best-selling author and editor-in-chief and vice president of Simon and Schuster, had never heard of PSA until a routine test showed that his was elevated; he had never thought about prostate cancer as something that could happen to him. After all, he was asymptomatic, a "fanatic exerciser," had given up smoking 20 years ago, and ate carefully.