THE "NEW" PROSTATE CANCER INFOLINK

The news update for this weekend is largely of a “theoretical” as opposed to a “practical” nature. We have therefore kept the discussion brief and referred readers to the source material for more information.

Isharwahl et al. from Johns Hopkins have published data suggesting that the expression of the Her2/neu oncogene (a gene that is associated with poor prognosis in breast and ovarian cancers) and the DNA index (the percentage of abnormal DNA content) may have prognostic value in the management of prostate cancer. Their early data appear to show that these two markers can predict risk for progression, for metastatic disease, and for cancer-specific death. The abstract of their paper implies that the markers may have value either on their own or in combination with more tradiational markers of risk (Gleason sum, PSA leve at diagnosis, clinical stage, etc.).

A report by Song et al. from Samsung Medical College appears to show that risk for prostate cancer is a great deal higher than previously estimated in the Korean population. The data available from the GLOBOCAN 2002 database suggests that the age-standardized incidence of prostate cancer in South Korea was of the order of 7.6/100,000. However, various publications have suggested that the incidence has been increasing in recent years. The data provided by Song and colleagues, based on screening of > 3,900 men in three regions of South Korea, now suggest an actual incidence of 3.6 percent in males of 55 years and older, with minimal variation in incidence rates between the three regions. Why are we seeing this type of increase? Probably because of changes in diet and lifestyle over the past 40 years.

Loeb et al. have published additional data on the problems resulting from the lack of full standardization of PSA assay data. PSA assays are normally standardized either to the WHO 90:10 standard or in alignment with the original Hybritech assay. However, there are major differences between the results of assays carried out on the same blood sample using different tests. If doctors and their patients are not aware of exactly which test and standard are being used for each assay, apparent variations in PSA result have the potential to lead to inappropriate clinical decisions. The lesson for the patient is: make sure you know which assay system has been used for each PSA assay carried out!

Last, but by no means least, Mishail et al. report that, based on a survey of medical students and faculty involved in primary care at their own academic institution, primary care physicians are insuffiently educated about a variety of issues in urology, with significant implications for patient care. [It should, of course, be noted that (a) one might expect this to be the case and (b) this is a conclusion one would expect from specialists in urology!]