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ONCOLOGY Vol 11 No 8

Why we like--and eat--fatty foods was the focus of an address by Dr. Adam Drewnowski, PhD, University of Michigan School of Public Health, at a symposium, "Reducing Dietary Fat: Putting Theory Into Practice," held last December in New

As described by Wilt et al in their review, the Prostate Cancer Intervention Versus Observation Trial (PIVOT) is asking very important questions about the effect of surgical treatment vs observation, with delayed androgen deprivation available to both groups, in patients with localized prostate cancer. Clinicians who have suffered with the old Uro-Oncology Trial comparison of prostatectomy vs radiation hope that PIVOT provides answers rather than confusion.

A nurse practitioner who has been caring for HIV/AIDS patients for over 15 years has some practical tips for dealing with the common symptoms associated with the disease. Dr. Gayle Newshan, PhD, NP, offered her advice during a recent

Recent studies delineate the effect of exercise on specific cancers but much more research on the role exercise plays in the prevention and treatment of cancer is needed, according to Susan Oliveria, ScD, MPH, director of epidemiology at the

Outlined in the article by Thompson and Seay are a series of questions relevant to the spectrum of stages of prostate cancer ranging from prevention to the treatment of advanced disease. Given the prevalence of prostate cancer, the morbidity of the disease, and the death rate from prostate cancer of more than 40,000 men in the United States each year, these questions warrant answers as soon as possible.

Thompson and Seay have attempted to provide a concise overview of the treatment of both localized and metastatic prostate cancer. Also, they have listed most of the current clinical trials focusing on these issues, along with two current trials addressing the prevention of the disease. There is certainly no getting away from the fact that, even with the plethora of publications dealing with prostate cancer (1,643 in 1994 alone, as the authors point out), there are major gaps in our fund of knowledge about this disease entity.

Pap Smear Refined

The high proportion of false negatives associated with Pap smears spurred the development of more effective collection and diagnostic techniques for cervical cells. The Pap smear, a universal standard in the detection of cervical cancer, has recently

The Genitourinary (GU) Cancer Committee of the Southwestern Oncology Group (SWOG) has achieved repeated successes in conducting prospective studies of prostate cancer. This article is a summary of recently completed and current trials in prostate cancer and, as such, represents an intriguing snapshot of priorities in prostate cancer clinical trials in 1997.

In 1941, Charles Huggins, Clarence Hodges, and R. E. Stevens reported on the beneficial effects of orchiectomy in 21 men with advanced prostate cancer.[1] Fifty-five years later, Southwest Oncology Group (SWOG) investigators were able to confirm, in a 1,387-patient intergroup comparative trial of bilateral orchiectomy with or without flutamide (Eulexin), that we still have nothing better to offer these men. This fact alone should underscore the critical need for well-planned, well-executed clinical trials in prostate cancer. The incidence and death rates continue to rise, and even today too few men are being enrolled in studies designed to alter these statistics.

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) should prove interesting in that the study design will permit observation of the natural history of a potentially lethal malignant disease, influenced only by palliative treatments. My comments will focus on the concerns raised by this study design. I will not address possible biases of the trial introduced by: (1) enrollment of less than 20% of the eligible population; (2) an enrollment rate per participating center of less than 3 patients per year; (3) a 7-year enrollment period; and (4) a 12-year follow-up (for a total trial duration of 19 years).

Spiegel and Moore draw an important distinction between the use of psychological techniques to promote quality of life and their use to promote quantity of life. On the one hand, a considerable body of research documents that hypnosis and other psychological techniques improve the quality of life of cancer patients. On the other hand, only limited empiric evidence supports the view that imagery and other psychological techniques increase the quantity of life of cancer patients.

Despite a heightened focus of the medical and research community on prostate cancer, many important questions about this disease remain unanswered. These include questions about the possible prevention of prostate cancer, as well as the optimal treatment approaches for localized, locally advanced, metastatic, and hormone-refractory disease. A whole host of prospective, well-designed clinical trials are currently in progress that should answer many of these questions. This review briefly explores some of these unresolved issues and describes ongoing trials designed to address them. [ONCOLOGY 11(8):1-11, 1997]

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]