Prostate Cancer

NEW YORK-A new study by Louis Harris and Associates points to serious gaps between what doctors treating prostate cancer say they tell their patients and what prostate cancer patients report they have heard. A panel of experts at a press conference called to present the findings agreed that these communication gaps must be repaired if further progress is to be made in fighting what they called this "male epidemic."

The American Urological Association, representing 10,000 urologists worldwide, is encouraged that the Office of Technology

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

SEATTLE-Current screening techniques allow the early detection of prostate cancer in large numbers of men every year. The problem is that prostate cancer appears to be an almost ubiquitous malignancy in men over the age of 50. The question, then, is which patients require intervention to prevent their cancer from becoming life threatening?

SEATTLE-Improvements in standard imaging techniques may lead toenhanced prostate cancer detection and local staging accuracyin the near future, Gary Sudakoff, MD, said at the Pacific NorthwestCancer Foundation Meeting on Transperi-neal Brachytherapy forEarly Stage Prostate Cancer. Such methods may include combiningcolor Doppler imaging with endorectal ultrasound (see image )and using new types of coils with magnetic resonance imaging (MRI),said Dr. Sudakoff, of the University of Chicago.

RTOG 94-13 is a phase III study designed to determine the appropriatetreatment volume and the optimal way to combine radiation and

SEATTLE--A mixture of neutron radiation with conventional photon radiation, using a custom tailored pelvic template for each patient, appears to provide more effective therapy for prostate cancer than photon radiation alone (eg, external beam or I-125), while reducing the complications caused by neutron radiation alone, said Jeffrey Forman, MD, of Wayne State University, Detroit.

NEW YORK--The identification of prostate-specific antigen immunoreactivity (IR-PSA) in some cases of breast cancer has raised the possibility that PSA could be used as a biochemical marker for prognosis of breast cancer.

NEW YORK--A new testing kit that measures free PSA (F-PSA), developed by a French pharmaceutical firm, may improve the positive predictive value (PPV) of PSA testing.

SEATTLE--A study of 1,695 cancer-free men found that PSA density provides a far more accurate screening assay for detection of prostate cancer than PSA serum concentration, Robert Kane, MD, of Harvard Medical School, said at the Pacific Northwest Cancer Foundation Meeting on Transperineal Brachytherapy for Early Stage Prostate Cancer.

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.

LAS VEGAS--A new, longer duration formulation of an LHRH (luteinizing hormone releasing hormone) analogue for advanced prostate cancer offers more convenient dosing and appears to be safe and effective.

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.

Prostate cancer patients who have an elevated prostate-specific antigen (PSA) blood test after surgery need radiation therapy

LAS VEGAS--Use of aggressive therapy in elderly prostate cancer patients has increased despite a lack of clear evidence of benefit, Michigan investigators reported at the American Urological Association meeting.

BETHESDA, Md--Judd W. Moul, MD, director of the Center for Prostate Disease Research (CPDR), established by Congress in 1991, has been awarded the American Medical Association's Young Physicians Section Community Service Award for his role in helping to establish prostate cancer patient support groups within the military health-care system.

FORT LAUDERDALE, Fla--Imagine a country where a cancer diagnosis is never revealed to a patient, where few have ever heard of screening mammography or breast self-examination, and where most men do not live long enough to get clinically evident prostate cancer.

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

FORT LAUDERDALE, Fla--Although prostate cancer screening remains controversial because of lack of a proven effect on disease-specific mortality, Judd Moul, MD, believes that new data regarding prostate-specific antigen (PSA) screening, as well as statistics from the armed forces, strongly support the benefits of screening.

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.

This article compares the results of radical retropubic prostatic surgery done by a group of urologists at the Mayo Clinic during a recent 3-year period with results obtained in a similar group of patients operated on prior to 1987. The authors show that when a surgical procedure is done often, with modern techniques and attention paid to surgical and anatomic detail, very good results can be achieved.

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.