Genitourinary Cancers

MARINA DEL REY, Calif--Preliminary studies show that cryosurgical ablation of the prostate can be used to treat localized prostate cancer, resulting in negative post-treatment biopsies and undetectable serum PSA levels, reported Peter R. Carroll, MD, associate professor of urology and director, Urologic Oncology Program, University of California, San Francisco (UCSF).

PALM SPRINGS, Calif--Early diagnosis of prostate cancer can be a mixed blessing, bringing with it not only the chance of cure but also the psychological distress of choosing between watchful waiting and treatment, and if treatment is chosen, which treatment, Andrew Roth, MD, said at the Academy of Psychosomatic Medicine meeting.

MIAMI BEACH--Early-stage prostate cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT) at the University of Michigan Medical Center had excellent survival rates with few complications, Howard Sandler, MD, reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.

WILMINGTON, Del--Zeneca Pharmaceutical's Casodex (bicaluta-mide), a new nonsteroidal antiandrogen, has received FDA approval for the hormonal treatment of advanced prostate cancer in combination with a luteinizing-hormone-releasing hormone analog (LHRH-A). The agent acts by binding to cytosol androgen receptors.

The safety and efficacy of a new chemoradiation approach to treating bladder cancer, which is designed to effect a cure while

The value of prostate cancer screening remains controversial because of the high prevalence of the disease and the fact that many tumors detected through screening are not destined to lead to morbidity or mortality, rendering

Widespread use of prostate-specific antigen (PSA) as a screening tool has led to an increased incidence of biopsy-proven prostate cancer, as well as a shift toward more cases with clinically confined disease (stage T1 to T2). The two traditional therapeutic modalities, radical prostatectomy and external-beam radiation therapy, have undergone technical refinements. Other modalities, such as brachytherapy and cryosurgery, are also being used to treat early-stage disease. Comparisons between treatment results are difficult. Biochemical failure, based on PSA findings, is currently used to measure treatment efficacy, but the precise definition and clinical relevance of biochemical failure have yet to be established. The author presents current analyses of biochemical failure, cause-specific survival, distant metastasis, and morbidity rates following various treatment modalities. [ONCOLOGY 9(9):803-816, 1995]

Dr. Stock provides a thorough summary of recent data on the principal modes of treatment for early-stage prostate cancer. Prostatectomy, external radiation, and brachytherapy have all improved substantially over the last 15 years. Despite these improvements, however, it is still unclear how these modalities compare in terms of efficacy and morbidity. To provide some balance to his evenhanded approach, I will add a few remarks.

The article by Stock provides a comparison of outcomes following radiation therapy and radical prostatectomy in men with clinically localized prostate cancer. The reliability of this comparison is complicated by the lack of randomized trials and the obvious selection biases inherent in uncontrolled studies. Ultimately, however, the value of either therapy depends critically on the difference between radiation or surgery and watchful waiting--an issue that is not addressed in this article.

CHICAGO--Until recently, physicians would have offered watchful waiting only to a select group of older men with localized prostate cancer. Now, because of concerns about the quality as well as the length of life, physicians are vigorously debating whether watchful waiting may be an option for men as young as the early 50s.

WASHINGTON--A report released by the Congressional Office of Technology Assessment (OTA) says that screening for prostate cancer has not yet been proven to save lives. The report concluded: "Because scientific knowledge is limited, but the consequences of prostate cancer and its treatment are serious, an informed and reasonable patient could equally well decide to have screening or forego it." Nevertheless, OTA said that it would be reasonable for Medicare to consider reimbursement for such screening.

By literally freezing prostate cancer cells to death, radiologists can effectively treat prostate cancer in some patients while reducing complication rates, preliminary results of a study show. The new procedure, trans- rectal ultrasound-guided

African-American men with prostate cancer live as long as their white counterparts if they receive the same treatment, two cancer research studies show. African-American men, however, are not receiving comparable treatment, says Dr. Mack

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.

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.

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,

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.

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--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