Genitourinary Cancers

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management of these cancers is slowly evolving. In the past, surgery, often extensive, was the treatment of choice. Recently, however, radiation and chemotherapy have begun to play larger roles as initial therapies, with surgery being reserved for salvage. With these modalities in their treatment armamentarium, oncologists may now be able to spare patients some of the physical and psychological sequelae that often follow surgical intervention without compromising local control and survival. Part 1 of this two-part article, published in last month’s issue, dealt with cancer of the penis. This second part focuses on cancer of the urethra in both females and males. [ONCOLOGY 13(11):1511-1520, 1999]

Prostate cancer is the most commonly diagnosed cancer among American men. The majority of patients with advanced disease have metastatic bone lesions, which are frequently very painful. These lesions tend to respond well to treatment with both nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, although careful dose titration and individualized treatment plans may be needed to achieve maximal analgesia. Opioid side effects are often transient or well controlled with additional medication. Patients with intolerable side effects may experience fewer adverse reactions with a different opioid. Palliative radiation provides pain relief in up to 80% of prostate cancer patients with single or at most a few sites of localized bone pain. Bisphosphonates, powerful inhibitors of osteoclast-mediated bone resorption, are promising new agents for the treatment of painful bone lesions in prostate cancer patients. Radioisotopes, which deliver high-dose radiation to bone lesions without significantly affecting normal bone, are highly effective in providing some degree of pain relief in up to 80% of patients with diffuse, painful bone metastases. Also, chemotherapy shows promise in alleviating pain and possibly extending survival in patients with advanced prostate cancer.[ONCOLOGY 13(11):1537-1549, 1999]

WASHINGTON-The US Postal Service has issued a 33 cent postage stamp designed to encourage the early detection and treatment of prostate cancer. The stamp features a drawing of the male gender symbol against a red background. The words “Prostate Cancer Awareness-Annual Checkups and Tests” appear on the stamp, which was designed by Michael Cronan of San Francisco.

Large Study Confirms Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

BUFFALO, NY-Prostate cancer screening protocols and treatment for localized prostate cancer are less standardized than for other cancers such as breast cancer, and treatment choices remain difficult for many men and their physicians, Jerome P. Richie, MD, said at the Surgical Oncology Symposium, hosted by Roswell Park Cancer Institute.

Many patients with kidney cancer who had been exposed to high levels of trichloroethylene have a unique pattern of genetic mutations within their cancerous cells. These findings were reported by Hiltrud Brauch, PhD, of the University of Hamburg,

CHICAGO-Systemic chemotherapy would seem to be a reasonable option to reduce the number of deaths from metastatic transitional cell bladder carcinoma. To date, however, systemic neoadjuvant chemotherapy has failed to show an effect on survival, and the jury is still out on the issue of chemotherapy following definitive therapy, said Derek Raghavan, MD, chief of medical oncology, University of Southern California Norris Cancer Center.

Patients with poor-prognosis testicular cancer have a better chance of surviving if they are treated at an institution that cares for five or more such patients during an approximate 4-year period than if treated at an institution that sees fewer than five

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management

WASHINGTON-“The possibility of spontaneous regression suggests that immunotherapy is a valid route to pursue in kidney cancer research,” said Ronald M. Bukowski, MD, director of the experimental therapeutics program at the Cleveland Clinic Cancer Center.

BETHESDA, Md-The National Institutes of Health has unveiled a 5-year plan that, if fully funded, will nearly quadruple its total budget for prostate cancer research, from the $113.6 million spent in fiscal year 1998 to $420.1 million in FY 2003. NIH anticipates spending $180.3 million on researching the disease this fiscal year, the first year of the 5-year program, an increase of 58.7% over FY 1998.

WASHINGTON-“Enough evidence has accumulated to suggest that interleukin-12 [IL-12] deserves continued study in kidney cancer and other malignancies, even though it has had a difficult track record so far,” Janice P. Dutcher, MD, said at the 1999 Kidney Cancer Association Annual Convention. Dr. Dutcher is associate director for clinical affairs, Our Lady of Mercy Cancer Center/New York Medical College.

Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

BETHESDA, Md -The National Cancer Institute plans to spend $13.6 million over the next 4 years to fund industry/academic collaborations aimed at developing noninvasive imaging technologies for diagnosing and treating prostate cancer. The Institute hopes the new initiative will bring academic institutions and companies together to pursue image-guided therapy techniques. Image-guided therapy couples images obtained either before or during surgery with computers, sensors, and other devices to help guide more accurate treatments.

WASHINGTON-Monoclonal antibodies are the basis of many diagnostic tests, but now are catching on as therapy as well, said Neil Bander, MD, surgical director, Urologic Oncology Program, Cornell University and New York Presbyterian Hospital, New York. “This particular type of approach has now been validated clinically and is being used to treat patients with various types of cancer,” Dr. Bander said at the Kidney Cancer Association Annual Convention.

The NCI will face some of the difficulties related to insurance coverage that discourage clinical trial participants as the institute ratchets up its prostate cancer research program. NCI director Richard Klausner, MD, told Congress in June that the NCI

Doctors have suspected that radiation therapy helps prevent patients from dying of prostate cancer, but they had little scientific evidence to support that theory. Now, Richard Valicenti, MD, assistant professor of radiation oncology at Jefferson

NEW YORK-When cancer patients go to the Internet for information on their disease, they are often overwhelmed by the thousands of sources available. The new Prostate Cancer Treatment Guidelines for Patients, issued jointly by the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN), “is an attempt to give patients a structure for processing information,” said Rodger Winn, MD, of M.D. Anderson Cancer Center and a key player in the NCCN guidelines development. The NCCN is an alliance of 17 of the nation’s leading cancer centers.

Docetaxel (Taxotere) combined with estramustine phosphate (Emcyt) and low-dose hydrocortisone appears to be a promising treatment for men with hormone-refractory prostate cancer, according to the results of a phase II trial conducted

PHILADELPHIA-Lycopene, the phytonutrient that produces the red color in tomatoes, showed beneficial effects on the prostate cancers of a group of men scheduled for prostatectomy, researchers reported at the American Association for Cancer Research annual meeting.

Discontinuing the practice of drawing blood every week from patients undergoing radiation therapy for prostate cancer can save time and money without jeopardizing the patient’s care, a new study has found.

ASCO-Docetaxel (Taxotere) plus estramustine phosphate (Emcyt) and low-dose hydrocortisone proved effective and well tolerated in a phase II study of men with hormone-refractory prostate cancer. The study was conducted by the Cancer and Leukemia Group B (CALGB) and presented at the ASCO annual meeting.

NEW YORK--The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) have collaborated to translate the NCCN prostate cancer guidelines into a patient-friendly resource for appropriate treatment, the two organizations announced at a press briefing.

UFT, a compound containing uracil and tegafur (a prodrug of 5-fluorouracil) in a 4:1 molar ratio, has been used in Japan for the treatment of and as adjuvant chemotherapy for bladder cancer. In phase II studies, 300 to 600

A prospective, randomized clinical trial was conducted to evaluate the efficacy of endocrine chemotherapy with uracil and tegafur (in a molar ratio of 4:1 [UFT]) in patients with prostate cancer. The study included two

The side effect profiles of various therapeutic modalities used in the definitive management of prostate cancer differ significantly, reported Tamara LaCouture, MD, and colleagues at the American Society for Therapeutic Radiology and

DALLAS-An analysis of SEER data shows small but steady decreases in prostate cancer mortality since 1991, Robert A. Stephenson, MD, said at the American Urological Association annual meeting. He attributed the decline to a combination of factors, including earlier detection and better treatment of advanced disease. Yet overall, he said, the data show that prostate cancer remains a major cause of death in men and may be undertreated in the elderly.

New research shows that a low-calorie diet slows the progress of prostate cancer in animals. Tumor progression was inhibited irrespective of how the calories were reduced; ie, by cutting fat or carbohydrates or by changing the overall diet. The research

The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate

New Orleans-The advisability of neoadjuvant hormonal therapy in the management of prostate cancer is a hotly debated issue. At the American Society of Therapeutic Radiology and Oncology (ASTRO) spring refresher course, two opinion leaders in radiation oncology squared off on opposite sides of this issue.