Prostate Cancer

Prostate-specific antigen (PSA) testing has changed the face of prostate cancer, leading to earlier diagnosis and improved outcome, says David F. Paulson, md, professor and chairman, Division of Urology, Duke University Medical School.

A phase II study intended to provide histological evidence of clinical response to a new injectable gel product for prostate cancer patients was recently announced by Matrix Pharmaceuticals, Inc. IntraDose-CDDP injectable gel is designed to

LOS ANGELES--A survey of men with and without prostate cancer used four different instruments (see below) to get a clear picture of how treatment decisions affect quality of life, and found some surprising results, Mark S. Litwin, MD, MPH, told Oncology News International.

This article compares the results of radical retropubic prostatic surgery done by a group of urologists at the Mayo Clinic during a recent 3-year period with results obtained in a similar group of patients operated on prior to 1987. The authors show that when a surgical procedure is done often, with modern techniques and attention paid to surgical and anatomic detail, very good results can be achieved.

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent. [ONCOLOGY 9(5):379-389, 1995]

Radical prostatectomy is not only the most common operation performed by most urologic oncologists, but also probably now represents the most common open operative procedure performed by all urologists in the United States. Much of this dramatic increase is due to the use of prostate-specific antigen (PSA) as a method for early diagnosis. My own experience is not unusual, in that approximately 50% of my male patients who underwent a radical prostatectomy last year had clinical stage T1c prostate cancer, meaning that the digital rectal exam was normal. The diagnostic biopsy was performed because of an elevated PSA.

During the past decade, there has been an increase of over 300% in the incidence of prostate cancer and a 150% increase in the death rate from this dreaded cancer. It is estimated that more than 244,000 men will be diagnosed with this neoplasm during 1995, and at least 42,000 will die as a direct result of the disease [1]. Challenged by this dramatically rising incidence and mortality, three strategies can be implemented: (1) attempt to prevent the disease; (2) find the disease early, treat it, and cure it; and (3) discover a cure for the disease once it has escaped the bounds of the prostate.

NEW YORK--Zeneca Pharmaceuticals' Casodex, an oral antiandrogen agent, has received approval for marketing in the United Kingdom for the treatment of advanced prostate cancer. Zeneca has also filed for approval of Casodex in the United States and several other countries, Zeneca president Robert C. Black said at a media briefing.

NEW YORK--The vinca alkaloid vinorelbine tartrate (Navelbine) has demonstrated clinical efficacy in hormone refractory prostate cancer as measured by time to disease progression, performance status, and pain indices, as well as bone scans and

Radiation Therapy Oncology Group Trial 92-02, which was recently reopened, is accruing about 50 patients a month, and will likely meet its goal of accruing more African Americans within a few

NEW YORK--The benefits of prostate cancer screening are greatest among men whose overall life expectancy is more than 10 years. In a talk at Lenox Hill Hospital, John A. Fracchia, MD, said that the increased incidence and mortality of prostate

ROCKVILLE, Md--In a nearly unanimous vote, the FDA's Oncologic Drugs Advisory Committee (ODAC) recommended that the agency approve a new indication for goserelin acetate implant (Zoladex), currently marketed as a prostate cancer therapy.

PHILADELPHIA--The burgeoning support group movement has much to offer patients with prostate cancer. Professionals who wish to refer patients to a support group, or to start their own group, should be aware of the several types of groups that

PHILADELPHIA--Ongoing trials of a protocol that provides prolonged exposure to estramustine phosphate (Emcyt) and paclitaxel (Taxol) have produced promising results in men with hormone-refractory prostate cancer, Gary Hudes, MD, told Oncology News International.

CHICAGO--Proponents of the prostate-specific antigen (PSA) test have new ammunition to support the view that the controversial screening method accurately predicts the progression of prostate cancer and the long-term survival of patients,

NEW YORK--Finasteride (Pros-car), currently FDA approved for use in patients with symptomatic benign prostatic hyperplasia (BPH), is also being investigated as a prostate cancer treatment and is showing promise as an agent to prevent prostate cancer by reducing levels of dihydrotestosterone (DHT), Glenn J. Gormley, MD, PhD, said at the first International Conference on Cancer Prevention.

PHILADELPHIA--Pain from skeletal metastasis has a major impact on quality of life in patients with prostate cancer, Mary Layman-Goldstein, RN, OCN, said at the American Cancer Society's National Conference on Prostate Cancer. Ms. Layman-Goldstein, a clinical nurse specialist at Memorial Sloan-Kettering Cancer Center, served on a panel discussion on how to manage complications of prostate cancer.

NEW YORK--Transrectal ultrasound is a valuable tool in the diagnosis of prostate cancer, but much can be done to optimize the procedure. W. Holt Sanders, MD, assistant professor of urology, Emory University School of Medicine, says that the basic principle is to "make sure the area of interest is within the focal range."

PHILADELPHIA--Urinary incontinence probably occurs as a complication of radical prostatectomy more often than series reported in the literature suggest, said Jerry G. Blaivas, MD, in a panel discussion of complications of prostate cancer held at the American Cancer Society's National Conference on Prostate Cancer.

CHICAGO--DNA ploidy in needle biopsy specimens is proving to be a highly accurate method of predicting local and distant spread of prostate cancer, as well as the probability of recurrence, Matthew Rifkin, MD, reported at the annual meeting of the Radiological Society of North America.

NEW YORK--Although it has revolutionized the early detection of prostate cancer, PSA testing can, and must, be improved to become the powerful tool needed in the fight against this disease, H. Ballentine Carter, MD, said at a conference on prostate cancer at Lenox Hill Hospital.

NEW YORK--Initial enthusiasm accompanying the introduction of laparoscopy in the diagnosis and treatment of prostate cancer has given way to a more realistic assessment of its value, R. Ernest Sosa, MD, said at a conference on prostate cancer at Lenox Hill Hospital. It continues to have value, but its role is limited and is unlikely to broaden.

The pharmacoeconomics of patient managementis important in the case of the critically ill. Pain palliationand improvements to quality of life are treatment goals for patientswith metastatic prostate cancer and can actually

Neuroendocrine differentiation has been foundin 50% to 100% of prostate neoplasms of all stages. Furthermore,10% of prostatic tumors are extensively or fully differentiated.Thus, neuroendocrine-specific

Hormonal therapy for prostate cancer designedto reduce testosterone levels has been employed for decades andprovides objective remission rates of 40% to 60% and subjectiveresponse rates of 60% to 85%. Orchiectomy, as