Prostate Cancer

Dr. Roach initiates his discussion with the relevant statement that how we detect, stage, and treat carcinoma of the prostate, as well as subsequently evaluate treatment efficacy, has forever been dramatically altered by the availability of prostate specific antigen (PSA), which has been labeled "the most useful tumor marker available" [1]. However, as Dr. Roach also notes, new information and insights generate new questions and uncertainties about the best applications of this valuable tumor marker.

Pretreatment prostate-specific antigen (PSA) level is the single most important prognostic factor for patients undergoing radiotherapy for clinically localized prostate cancer. When combined with Gleason score and T-stage, pretreatment PSA enhances our ability to accurately predict pathologic stage. Patients with pretreatment PSA levels more than 10 ng/mL are at high risk for biochemical failure when treated with conventional radiation alone. A PSA nadir of more than 1 ng/mL and a post-treatment PSA more than 1.5 ng/mL are associated with a high risk of biochemical failure. Postoperative radiotherapy delivered while the tumor burden is low (eg, PSA less than 1 ng/mL) predicts a favorable outcome. Many of these conclusions about the usefulness of pretreatment PSA are based on the assumption that PSA can be used as a surrogate end point for disease-free and overall survival from prostate cancer. However, this assumption still remains to be validated by phase III trials. [ONCOLOGY 10(8):1143-1153, 1996]

Radical radiation therapy and radical prostatectomy are the two most commonly employed therapeutic alternatives for clinically localized (T1-T2,NX,M0) prostate cancer. A vigorous debate is ongoing about the relative efficacy of each modality. This debate centers around the percentage of patients who cannot be cured by one method or the other, suggesting that some patients may be better served by one treatment, or by some form of combined-modality therapy employing radiation after surgery or neoadjuvant androgen suppression before radiation.

ORLANDO--An assay that measures the proportion of free and bound prostate-specific antigen (PSA) has been found to discriminate between prostate cancer and benign conditions that elevate PSA, thus reducing the rate of unnecessary biopsies, several research groups reported at the American Urological Association annual meeting.

ORLANDO--Today, after more than 10 years of research, PSA-related testing can daunt even the most experienced urologists, said a panel of experts at the American Urological Association meeting. Three panelists advised urologists on how to interpret a rising PSA after prostate cancer treatment and what further actions to take when this occurs.

ASCO--In an EORTC study, the combination of radiotherapy and adjuvant hormonal therapy with an LHRH analog has been shown to significantly increase survival in patients with locally advanced prostate cancer, compared with radiotherapy alone.

ASCO--Many men diagnosed with prostate cancer will not die of their disease if left untreated, but clinicians have no way of telling which early cancers require more aggressive treatment and which are likely to be indolent. A new genetic test, developed by researchers at Dana-Farber Cancer Institute, may shed some light on this important dilemma.

FORT LAUDERDALE, Fla--The duration of anticipated survival after a prostate cancer diagnosis, and therefore the period of time at risk in the disease, is unique to prostate cancer in the influence it exerts on selection of therapy.

ABBOTT PARK, Ill--Abbott Laboratories and the Finnish-based company Wallac Oy, a subsidiary of EG&G Inc. (Wellesley, Mass), have received a US patent for two methods of assaying free PSA (prostate-specific antigen).

Researchers at two major medical centers have found that radiation therapy is just as successful as surgery in treating younger men with early-stage prostate cancer. Currently, men 60 years old or under with prostate cancer are far more likely to be treated with surgery than with radiation therapy.

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).

Adenocarcinoma of the prostate is now the most common tumor in males. The use of the digital rectal examination, prostate-specific antigen (PSA), and transrectal ultrasound of the prostate with biopsies has improved the detection of prostate cancer and has increased the percentage of patients with organ-confined disease who are treated with radical prostatectomy. It is critical for the practicing urologic and medical oncologist to have accurate and precise pathologic information in order to counsel patients for appropriate therapy. Ideal biopsy and clinical predictive criteria for tumor volume in prostates are not readily available in the literature.

Dr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.

The pathologist plays an integral role in the evaluation and treatment of many urologic cancers. Prostate cancer may be the best example of the importance of the pathologist in providing accurate clinical staging. Dr. Epstein has written an excellent review of the critical pathologic information available from prostate needle biopsy and radical prostatectomy specimens. The article highlights how to utilize this information in day-to-day clinical practice. Although the article is complete, some areas deserve special attention.

During the last few years, pathologists have assumed several important roles in the assessment of adenocarcinomas of the prostate. The establishment of postoperative serum prostate-specific antigen (PSA)

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.

WILMINGTON, Del--Zeneca Pharmaceuticals has received clearance from the FDA to market a new formulation of Zoladex (goserelin acetate implant) for the palliative treatment of advanced prostate cancer.

MIAMI BEACH--Potency status in prostate cancer patients before radiation therapy, not the radiation dose, is the main determinant of potency status afterwards, Adam P. Dicker, MD, said at the 37th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

MIAMI BEACH--Cancer patients treated with strontium-89 (Metastron) for palliation of their metastatic bone pain may also benefit therapeutically, said Michael J. Katin, MD, a radiation oncologist in Fort Myers, Florida, whose practice includes a significant number of patients with painful bone metastases resulting primarily from prostate cancer.

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.

WASHINGTON--In 1990, General H. Norman Schwarzkopf commanded the imagination of the American people during his service as Commander of Operations Desert Shield and Desert Storm. At the First National Congress on Cancer Survivorship, he stormed the stage of the Washington Court Hotel to describe his role as a prostate cancer survivor and patient advocate. The message was simple and personal. "I am here," the general said, "because I won a battle."

JERUSALEM--Tumor cells that are not eradicated by chemotherapy or radiotherapy can enter a prolonged dormant state and thus pose a continuous threat of tumor relapse in patients who are seemingly "cured," Eitan Yefenof, PhD, said in an interview with Oncology News International.

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.

NEW YORK-Citing the dispro-portionally high incidence and mortality of prostate cancer among African-American men, Marc B. Garnick, MD, associate clinical professor of medicine, Harvard Medical School, singled out this segment of the population as the target for intensive efforts to raise awareness.

In recent years, clinicians and researchers have noted that bloodtests made by different companies for the prostate-specific antigen