Hot Topics Debated at Upcoming Society of Urologic Oncology (SUO) Meeting

ONCOLOGY board member Judd Moul, MD, told the CancerNetwork blog that there will be several controversial pro-con debates featured at this year’s Society of Urologic Oncology (SUO) meeting, May 29th in San Francisco. Dr. Moul will moderate a pro-con debate about the effectiveness of PSA screening during a session titled, Prostate Cancer I – Screening: Lessons from the PLCO and ESRPC Randomized Trials. Stand by for exclusive interviews and podcasts…

In another session, Gerald L. Andriole, MD, and Patrick Walsh, MD, will debate the chemo-preventive effectiveness and value of finasteride and dutasterisde in prostate cancer during a session titled, Prostate Cancer III – Chemoprevention: Ready for Primetime?

With the Evidence Available, What is the State of Chemoprevention for Prostate Cancer? Andriole and Walsh should make for an interesting clash of clinical opinions…

PRO: Dr. Andriole was lead author in a study published in the April 1st edition of the New England Journal of Medicine looking at whether dutasteride reduces the risk of incident prostate cancer, as detected on biopsy, among men who are at increased risk for the disease.  Andriole, et al, concluded: “Among men at increased risk for prostate cancer and for benign prostatic hyperplasia, dutasteride reduced the risk of prostate cancers and precursor lesions and improved many outcomes related to benign prostatic hyperplasia. Dutasteride may be considered as a treatment option for men who are at increased risk for prostate cancer.”

CON: In a recent New England Journal of Medicine editorial, [Vol. 362; 1237-1238, No. 13, 2010] Dr. Walsh opened by asking the question, “Are we making progress in the chemoprevention of prostate cancer?”   Dr. Walsh examined studies that pointed to the benefits of finasteride in preventing prostate cancer. He concluded the editorial with another question: “What advice should we be giving our patients?”

His answer: “Dutasteride and finasteride do not prevent prostate cancer but merely temporarily shrink tumors that have a low potential for being lethal, and they do not reduce the risk of a positive biopsy in patients who have an elevated PSA level (corrected for the effect of the drug) or an abnormal digital rectal examination. Furthermore, the use of these drugs for prevention may be somewhat risky. Because PSA levels are suppressed, men may have a false sense of security, and if prostate cancer ever develops, the diagnosis may be delayed until they have high-grade disease that may be difficult to cure.”

These doctors are raising important clinical questions in the field of prostate cancer prevention and treatment. This disease, which kills about 27,360 American men per year, is still without an agreed-upon strategic plan for its diagnosis and treatment.  To that end, we need more solid debate and better designed clinical trials in order to develop universally accepted patient-specific screening and treatment guidelines.