Genitourinary Cancers

Physicians have long known that male hormones fuel prostate cancer growth. That’s why therapies that block the production of androgen-or testosterone-provide some of the most effective therapies for advanced prostate cancer. Certain drugs, for

FT. LAUDERDALE, Fla-Slight changes in the administration of salvage therapy after radical prostatectomy are among several revisions to the National Comprehensive Cancer Network (NCCN) Practice Guidelines for Prostate Cancer. The revised guidelines recommend radiotherapy for men with positive margins whose prostate-specific antigen (PSA) levels fail to fall to 0 ng/mL after surgery.

The results of an exploratory analysis published in the March 2000 issue of Urology suggest that prolonged combined androgen blockade (CAB) significantly increases survival in patients with advanced prostate cancer.

An estimated 180,400 new prostate cancer cases will be diagnosed in the United States this year, and many of these patients will be diagnosed and treated at community cancer centers.

Despite being one of the more common genitourinary neo plasms, superficial transitional cell carcinoma involving the urinary bladder can be a confusing entity for the treating physician. This confusion stems, in large part, from the binary classification

Baselli and Greenberg have presented a comprehensive overview of intravesical strategies for the management of superficial urothelial malignancies of the bladder, both past and present. A number of points made in the article deserve further

Approximately 54,400 new cases of transitional cell carcinoma of the bladder were reported in the United States in 1999, with an estimated 12,500 deaths attributable to this cancer. Close to 75% of all bladder tumors are confined

The intravesical instillation of therapeutic agents for the treatment of localized bladder cancer began in 1903 when Herring[1] summarized his experience with silver nitrate. Since then, intravesical chemotherapy and immunotherapy have emerged as

CLEVELAND-A program at Travis Air Force Base in California is educating men about the purpose of prostate cancer screening by mailing brochures to the women who use medical services on the base. “This is a novel approach to going after the top men’s cancer,” said Maj. (Dr.) Darryl C. Hunter, medical director of the General Huyser Regional Cancer Center at Travis Air Force Base. He spoke at the 33rd annual meeting of the American Association for Cancer Education.

Hormonal therapy with the goserelin acetate implant (Zoladex) significantly increases overall survival rates in patients with locally advanced prostate cancer when administered at the onset of conventional external irradiation and continued for 3 years.

CHICAGO-A preliminary study of interstitial gene therapy for recurrent prostate cancer shows that transrectal ultrasound can be used effectively for planning delivery of the agent and assessing its initial effects.

Mood disorders may play a role in erectile dysfunction (ED) in prostate cancer patients, according to a report at the Pan American Congress of Psychosocial & Behavioral Oncology. Of 10 prostate cancer patients referred for erectile dysfunction and/or a suspected mood disorder, 7 were diagnosed as having depression and 3 were found to have preexisting relationship problems.

NEW YORK-Erectile dysfunction is a significant factor in decreasing the quality of life (QOL) of prostate cancer patients, according to a report at the Pan American Congress of Psychosocial & Behavioral Oncology.

Immediate antiandrogen therapy after radical prostatectomy and pelvic lymphadenectomy improves survival and reduces the risk of recurrence in patients with node-positive prostate cancer, according to a study published in the December 9, 1999,

WASHINGTON-Medicare now provides coverage for prostate cancer screening. As of Jan. 1, all men, age 50 and older with Medicare benefits, are eligible for one digital rectal exam and one prostate-specific antigen (PSA) test each year. Congress directed the Health Care Financing Administration to cover prostate cancer screening for beneficiaries, beginning this year, in the Balanced Budget Act of 1997.

Researchers announced recently that they have developed a new system to deliver the p53 tumor suppressor gene directly into the tumor through the bloodstream. The system, when used in combination with radiotherapy and chemotherapy, may significantly improve treatment outcomes for prostate cancer patients. The findings were presented at the International Conference on Molecular Cancer Therapeutics sponsored by the American Association of Cancer Research (AACR), National Cancer Institute (NCI), and European Organization for Research and Treatment of Cancer (EORTC).

SAN ANTONIO-Increasing the radiation dose from 70 Gy to 78 Gy favorably affects outcome in some patients with locally confined prostate cancer, according to preliminary results of a randomized dose escalation study reported at the 41st Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

Testing further for a form of prostate-specific antigen (PSA) can help urologists find, stage, and classify prostate cancer in men whose PSA tests are ambiguous, according to a multicenter study that included The Johns Hopkins Hospital. The additional test, which is routinely available for all men taking the PSA test, can also help patients and their doctors determine the best course of treatment. The test measures free PSA, the form of PSA not bound to proteins in the blood. According to the study, the higher the percentage of free PSA compared to the bound form, the smaller the tumor is likely to be, the less chance there is that it has spread from the prostate, and the less likely it is that the disease is the most aggressive form.

SAN ANTONIO -The Southwest Oncology Group (SWOG) has announced the start of the first major phase III trial to compare the chemotherapy combination of docetaxel (Taxotere) and estramustine phosphate (Emcyt) with the commonly used combination of mitoxantrone (Novantrone) and prednisone for the treatment of advanced, hormone-refractory prostate cancer.

The Southwest Oncology Group (SWOG) announced the beginning of the first major phase III clinical trial comparing the combination of docetaxel (Taxotere) and estramustine (Emcyt) to the commonly used combination of mitoxantrone (Novantrone) and prednisone in the treatment of advanced, hormone-refractory prostate cancer. Patient enrollment is currently underway, with approximately 660 men being recruited. This trial is being conducted by SWOG and is funded by the National Cancer Institute (NCI) in collaboration with the Cancer and Leukemia Group B (CALGB) and North Central Cancer Treatment Group (NCCTG).

BALTIMORE-Physicians should consider using intravesical chemotherapy or immunotherapy as adjuvant therapy following surgery for non-muscle-invasive bladder cancer, according to new treatment guidelines released by the American Urological Association (AUA). “The fact that the peer-reviewed published data show that the use of intravesical agents after surgery lowers the probability of recurrence but not progression is the most important finding that we made,” panel chair Joseph A. Smith, Jr., MD, of the Vanderbilt University Medical Center, said in a news release.

The management of patients with clinical stage I nonseminomatous germ-cell tumors is still highly controversial. In a recent survey, urologists and oncologists were asked to state their choice of treatment for patients with clinical stage I nonseminomas who were at high risk for recurrence after orchiectomy. Not surprisingly, urologists chose retroperitoneal lymph node dissection over chemotherapy, while oncologists indicated a preference for adjuvant chemotherapy.[1]

Improvements in the clinical staging of testicular cancer may permit the identification of clinical stage I patients at low risk of harboring metastatic disease, who could be spared treatment and observed only. Both retrospective, single-institution studies and studies of unselected, consecutive patients have confirmed that vascular invasion, lymphatic invasion, and percentage of embryonal carcinoma are predictive of metastasis in patients with low-stage nonseminoma. Whether patients with these risk factors have a worse outcome if managed with surveillance, rather than with aggressive therapy, is unclear. Low MIB-1 staining (which identifies the Ki-67 antigen) in conjunction with a low percentage of embryonal carcinoma in the testicular specimen appears to be predictive of a low probability of metastasis. Computed tomography (CT) is a useful staging tool. A new prognostic classification system for seminomas and nonseminomas was recently developed by an international consensus conference. Laparoscopic retroperitoneal lymphadenectomy appears to be a feasible staging tool with acceptable short-term morbidity. Whether laparoscopic lymph node dissection is equivalent to the open procedure when used as a therapeutic modality is not yet known. At present, laparoscopy should be used only in selected patients in a study setting. Primary chemotherapy is not recommended currently because it has not yet been proven to be superior in patients with high-risk clinical stage I nonseminoma and can cause significant long-term sequelae.[ONCOLOGY 13(12):1689-1694, 1999]

Drs. Foster and Nichols, both recognized experts on testicular cancer, are to be congratulated for their concise overview of continuing controversies and challenges in the care of young men with this disease.

Experienced authors Richard Foster and Craig Nichols providea thoughtful, state-of-the-art discussion of current controversies in the management of testicular cancer. Present cure rates illustrate that significant diagnostic, chemotherapeutic, and surgical advances made over the past century have transformed testicular cancer from a once uniformly fatal disease into a tremendous oncologic success story.

BETHESDA, Md-Some kidney cancer patients in an ongoing phase II trial of an experimental antiangiogenesis monoclonal antibody have shown improvement. The randomized, three-arm study by National Cancer Institute researchers compares two different doses of the drug against a placebo.

CHICAGO-Despite recent excitement about therapy involving ifosfamide (Ifex) and other new chemotherapy drug combinations, MVAC-methotrexate, vinblastine, Adriamycin (doxorubicin), and cisplatin-remains the standard of care for advanced bladder cancer, Derek Raghavan, MD, said at the Chicago Prostate Cancer Shootout III Plus Bladder Conference, sponsored by the Chicago Urological Society, Chicago Radiological Society, and Chicago Medical Society

The article by Olson and Pienta is a thorough review of the important issues facing men with metastatic prostate cancer and their caregivers. Many recent reports have documented physicians’ lack of awareness about cancer pain, which underscores the significance of proper evaluation and management. As the authors note, any evaluation of current and future therapies must focus not only on the efficacy of pain control but also on how a particular treatment affects a patient’s overall quality of life.

This two-part article by Krieg and Hoffman, published last month and concluded in this issue, explores the current management of penile cancer (part 1) and urethral cancer in both men and women (part 2). My remarks will focus on female and male urethral cancer.

In this two-part article, Krieg and Hoffman review the management of patients with cancer of the penis and those with cancer of the urethra, respectively. Both of these cancers are uncommon, and, when they present as small, early, circumscribed lesions, both can be cured (with organ preservation) by radiation therapy. Also following organ preservation by radiation therapy, these patients must continue to be followed closely because 25% to 35% will develop a local recurrence and can be cured by prompt salvage surgery.