For those who like to be able to keep up to date with many areas of prostate cancer management, several reviews have been published in the past few days, addressing key issues. The following is a brief summary with links to the abstracts or full articles (where available).
Four reviews have examined issues related to the management of advanced disease:
- Drake has reviewed the current status of the development of immunotherapeutic agents (often called “cancer vaccines”) for the treatment of prostate cancer. He emphasizes the point that these agents are unlikely to offer the most useful benefits when they are used as single agents, and states that it is probable that they will have their greatest value if used in combination with each other, with hormone therapy, and/or with chemotherapy.
- Dreicer has reviewed the current status of cytotoxic chemotherapy in the management of metastatic prostate cancer. He emphasizes that “chemotherapy for advanced prostate cancer has evolved from a frightful, toxic experience to one that frequently provides clinically meaningful palliation and a modest, but real survival benefit.” He goes on to note that efforts are under way to evaluate the role of second-line therapy options following the now-standard use of docetaxel as first-line chemotherapy.
- As a useful adjunct to Dreicer’s commentary, Armstrong and George have reviewed the current status of new drugs in development for treatment of metastatic and hormone-refractory prostate cancer. They correctly point out that, for many reasons, this is a very difficult area and that it comes with many challenges to clear demonstration of disease-specific clinical benefit and survival.
- Finally, in the area of treatment of advanced disease, Beekman and Hussain have summarized current knowledge regarding the application of hormonal therapy in management of contemporary prostate cancer patients. They observe that there is significant controversy as to the optimal approach for patients. The routine use of PSA testing and the subsequent stage migration that has occurred in men presenting with prostate cancer has profoundly impacted issues around the appropriate timing and use of hormone therapy. The majority of contemporary patients are diagnosed with very low PSA levels (in contrast to the patients in whom hormone therapy was traditionally applied, even as recently as the 1980s and 1990s, when many of the available hormonal therapies underwent clinical trials).
Other reviews have considered the mangement of localized and early stage disease:
- Smith has considered the role of surgery in treatment of localized, low risk disease. He acknowledges that, “Some patients with low risk disease who undergo radical prostatectomy are over treated and cured of a cancer which may not have been a significant threat to life or health.” However, he also points out that “the uncertainty of active surveillance leads many patients to pursue curative therapy.” He concludes that, in such patients, radical prostatectomy provides a way to minimize risk of death from prostate cancer. Side effects such as erectile dysfunction and long-term incontinence are problematic for some patients but, in Smith’s view, “the overwhelming majority return to their preoperative status within a short time with minimal risk for quality of life compromise.”
- Adolfsson has offered perspetive on the status of active surveillance and watchful waiting as strategies for the management of men, with an emphasis on our understanding of the current natural histroy of the disease. He also provides a very careful distinction between “watchful waiting” and “active surveillance” as management strategies.
Filed under: Drugs in development, Living with Prostate Cancer, Management, Treatment
