Your AI-Trained Oncology Knowledge Connection!
Physicians screening African-American men for prostate cancer should use different cut-off points for a popular blood test because they will accurately detect 95% of cases in this high-risk group, according to a study published in the August 1 issue of The New England Journal of Medicine. The revised normal values for the prostate-specific antigen (PSA) test are based on a new diagnostic strategy and age-specific ranges for African-Americans, who have the world's highest prostate cancer rate.
BETHESDA, Md--Physicians have long hypothesized that natural variation in sex hormones may influence prostate cancer risk, said Meir Stampfer, MD, of the Harvard School of Public Health. Efforts to prove this, however, have yielded unclear results. Now, by examining the interrelationship of different sex hormones, Dr. Stampfer and his colleagues have achieved what he calls the first clear demonstration that circulating levels of sex hormones can predict a man's risk of developing prostate cancer.
Thomas Jefferson University in Philadelphia has received a patent for a molecular-based blood test that provides a novel approach to diagnosing prostate cancer. Jefferson has given exclusive licensing rights to the test to UroCor, Inc., for the United States and Canada, and to the Italian-based biotechnology firm Raggio-Italgene, for Europe and Japan.
The treatment of advanced prostate cancer continues to be an enigma. Every few years, it seems, a new variation in treatment is espoused and offered to the public. To date, two trends seem to have emerged: For men under 70 years of age, there seems to be a consensus that definitive treatment should be pursued for low-grade, low-stage, localized tumors. Prostatectomy or radiation therapy may cure or at least increase survival; for men over age 70, less vigorous treatment is often the preferred choice [1,2]. Nevertheless, outside of these two points of agreement, many other controversial questions remain and will persist for some time.
Over the last 10 years, we have learned more about not only the natural history of untreated locally advanced prostate cancer but also the ways in which we can effectively modify radiation therapy to treat this disease. There are now sufficient data to suggest that patients with prostate cancer that is considered locally advanced (stages T2b to T4) have a propensity for the development of lymph node metastasis and occult distant spread. In these patients, there also is a recognized difficulty in controlling the disease locally with radiation, due to the bulk of tumor present and the surrounding dose-limiting, late-reacting normal tissues.
The staging and treatment of prostate cancer are complex, particularly in patients with clinical disease that has advanced locally beyond the confines of the gland. Management choices are made more difficult by a paucity of
BETHESDA, Md--Physicians who screen for prostate cancer using prostate-specific antigen (PSA) need to use a different set of normal age-adjusted values for their African-American patients, say Judd W. Moul, MD, LTC, MC, USA, and colleagues from the Walter Reed Army Medical Center, Mayo Clinic, and Uniformed Services University of the Health Sciences funded by the Department of Defense (DOD) Center for Prostate Disease Research.
PHILADELPHIA--Although the addition of chemotherapy to supportive care with a corticosteroid provides no survival advantage for patients with hormone-refractory prostate cancer, the combination appears to achieve better pain control, compared with corticosteroid therapy alone.
ORLANDO--Treatment of recurrent prostate cancer, whether by prostatectomy or chemotherapy, has not yielded very effective or long lasting results. Many patients now ask about cryotherapy, in the hopes of better effectiveness and/or improved quality of life (less incontinence and less chance of impotence). However, urologists have been reluctant to use salvage cryosurgery for prostate cancer patients after radiation or hormonal therapy, because the outcome and quality of life data were simply not there, Louis L. Pisters, MD, said at the American Urological Association meeting earlier this year.
ROCKVILLE, Md--In recent actions, the FDA approved two new diagnostic tests--for bladder cancer and colorectal cancer--and extended the indications for an antiandrogen agent in the treatment of prostate cancer.
For decades, the fear of becoming impotent and incontinent as a result of surgery for prostate cancer kept many men from undergoing screening and treatment, leading to many deaths that might have been prevented. This situation has changed
Until recently, newly diagnosed patients with prostate cancer were faced with one of four basic management options: observation, radiation therapy, radical prostatectomy, or hormonal manipulation. The exact option chosen by an individual
Dr. Roach initiates his discussion with the relevant statement that how we detect, stage, and treat carcinoma of the prostate, as well as subsequently evaluate treatment efficacy, has forever been dramatically altered by the availability of prostate specific antigen (PSA), which has been labeled "the most useful tumor marker available" [1]. However, as Dr. Roach also notes, new information and insights generate new questions and uncertainties about the best applications of this valuable tumor marker.
Pretreatment prostate-specific antigen (PSA) level is the single most important prognostic factor for patients undergoing radiotherapy for clinically localized prostate cancer. When combined with Gleason score and T-stage, pretreatment PSA enhances our ability to accurately predict pathologic stage. Patients with pretreatment PSA levels more than 10 ng/mL are at high risk for biochemical failure when treated with conventional radiation alone. A PSA nadir of more than 1 ng/mL and a post-treatment PSA more than 1.5 ng/mL are associated with a high risk of biochemical failure. Postoperative radiotherapy delivered while the tumor burden is low (eg, PSA less than 1 ng/mL) predicts a favorable outcome. Many of these conclusions about the usefulness of pretreatment PSA are based on the assumption that PSA can be used as a surrogate end point for disease-free and overall survival from prostate cancer. However, this assumption still remains to be validated by phase III trials. [ONCOLOGY 10(8):1143-1153, 1996]
Radical radiation therapy and radical prostatectomy are the two most commonly employed therapeutic alternatives for clinically localized (T1-T2,NX,M0) prostate cancer. A vigorous debate is ongoing about the relative efficacy of each modality. This debate centers around the percentage of patients who cannot be cured by one method or the other, suggesting that some patients may be better served by one treatment, or by some form of combined-modality therapy employing radiation after surgery or neoadjuvant androgen suppression before radiation.
ORLANDO--An assay that measures the proportion of free and bound prostate-specific antigen (PSA) has been found to discriminate between prostate cancer and benign conditions that elevate PSA, thus reducing the rate of unnecessary biopsies, several research groups reported at the American Urological Association annual meeting.
ORLANDO--Today, after more than 10 years of research, PSA-related testing can daunt even the most experienced urologists, said a panel of experts at the American Urological Association meeting. Three panelists advised urologists on how to interpret a rising PSA after prostate cancer treatment and what further actions to take when this occurs.
ASCO--In an EORTC study, the combination of radiotherapy and adjuvant hormonal therapy with an LHRH analog has been shown to significantly increase survival in patients with locally advanced prostate cancer, compared with radiotherapy alone.
ASCO--Many men diagnosed with prostate cancer will not die of their disease if left untreated, but clinicians have no way of telling which early cancers require more aggressive treatment and which are likely to be indolent. A new genetic test, developed by researchers at Dana-Farber Cancer Institute, may shed some light on this important dilemma.
FORT LAUDERDALE, Fla--The duration of anticipated survival after a prostate cancer diagnosis, and therefore the period of time at risk in the disease, is unique to prostate cancer in the influence it exerts on selection of therapy.
ABBOTT PARK, Ill--Abbott Laboratories and the Finnish-based company Wallac Oy, a subsidiary of EG&G Inc. (Wellesley, Mass), have received a US patent for two methods of assaying free PSA (prostate-specific antigen).
Researchers at two major medical centers have found that radiation therapy is just as successful as surgery in treating younger men with early-stage prostate cancer. Currently, men 60 years old or under with prostate cancer are far more likely to be treated with surgery than with radiation therapy.
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.
