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BALTIMORE, Md-The American Foundation for Urologic Disease (AFUD) has developed and published a comprehensive resource guide for prostate cancer patients, their families and friends, and health care professionals. The publication contains detailed information about prostate cancer, as well as compilations of organizations, publications, and other resources related to the disease.
As a tumor grows, so does its need for nutrients, with a new vascular supply necessary for a tumor to grow to a diameter
NEW ORLEANS-Emerging strategies for treatment of advanced prostate cancer rest on precise classification of the hormone status of the disease and a range of developing techniques and agents aimed at increasing survival, according to experts at the 92nd Annual Meeting of the American Urological Association.
In this article, the authors have done an excellent job in reviewing recent findings regarding prostate-specific antigen (PSA) and other methods for the early detection of prostate cancer. This is a fast-moving field, with new results being reported on a weekly basis. Indeed, it is an exciting time to be conducting research in prostate cancer. At the same time, however, it is far too easy to lose sight of some of the basic principles by which we should judge evidence to make research or clinical decisions. Specifically, there are hard-learned epidemiologic lessons about which we need to constantly remind ourselves.
Men who show no suspicious signs of prostate cancer on rectal examinationsand who also have a prostate specific antigen (PSA) level below 2.0 apparently
MENLO PARK, Calif-In preclin-ical studies, an attenuated adenovirus engineered to incorporate the regulatory region of the PSA gene has been shown to selectively infect and destroy human prostate cancer cells expressing PSA. The engineered virus, named CN706, was developed by scientists from Calydon, Inc., a California-based biopharmaceutical firm, and the Brady Urological Institute at The Johns Hopkins Oncology Center.
When used alone, prostate-specific antigen (PSA) is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity,
CHICAGO-Radical prostatectomy as treatment for men with localized prostate cancer came under attack by Kent E. Wallner, MD, at the Prostate Cancer Shootout II conference.
CHICAGO-Radiation oncologists have been trying to improve the delivery of external beam irradiation in a variety of ways in an attempt to increase local control of prostate cancer and thereby improve long-term survival, Jeffrey D. Forman, MD, professor of radiation oncology, Wayne State University, Detroit, said at the Prostate Cancer Shootout II conference.
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.
CHICAGO--Prostate cancer experts continue to seek other forms of therapy because the two major treatments--radiotherapy and radical pros-tatectomy--do not always reliably eradicate malignant cells.
CHICAGO--Despite strong evidence of the effectiveness of watchful waiting for men with localized prostate cancer in a Swedish study, participants at the Prostate Cancer Shootout II conference remained unconvinced.
Long recognized as standard treatment of gynecologic cancer and some other malignancies, brachytherapy may also play a role in the treatment of prostate cancer, said Dr. John C. Blasko of the University of Washington in Seattle.
PALM BEACH, Fla--A urologist believes his unique viewpoint can be helpful to radiation oncologists doing brachy-therapy and to his fellow urologists. "By 2005," said Nelson Stone, MD, of Mt. Sinai Medical Center, NY, "projections indicate that two thirds of prostate cancer cases will be treated with brachyther-apy or external beam irradiation. If urologists don't get on board, they'll be treating half of the cases they are now."
NEW ORLEANS--The inheritance pattern for prostate cancer is becoming better understood by linkage analysis, and it appears that the inherited form may be more aggressive than sporadic cancer, according to reports at the American Urological Association meeting.
PALM BEACH, Fla--The increased use of prostate brachytherapy has prompted the American Brachytherapy Society to establish a group to formulate standards and treatment guidelines, Peter D. Grimm, DO, said at the Society's 19th annual meeting.
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.
NEW ORLEANS--Progression-free survival rates after surgery for locally advanced prostate cancer were significantly improved by adjuvant therapy with the antiandrogen flutamide (Eulexin) in a randomized European trial.
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.
CHICAGO--When physicians squared off on the issue of brachytherapy (interstitial radioactive seed placement) for prostate cancer at the Prostate Cancer Shootout II conference, the lines could not have been drawn more clearly.
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).
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]
