THE “NEW” PROSTATE CANCER INFOLINK

And hot off today’s news:

• A report on salvage prostatectomy in low risk patients
• More on the potential of active sruveillance
• Two “new” proteins that may affect risk and progression
• And some follow-up on yesterday morning’s news report

A report from Germany suggests a high level of effectiveness with low levels of adverse effect (at least on continence) for salvage radical prostatectomy after failure of prior radiotherapy in men with low-risk localized disease. It should be noted that the patients initially treated under this protocol might now be considered as exemplary candidates for active surveillance, which does therefore raise the question of why they got radiotherapy in the first place.

And talking of active surveillance (AS) in Europe, a report by van den Bergh et al. discusses the retrospective analysis of potential eligibility for AS of 616 men who were diagnosed with prostate cancer between 1994 and 2007. The authors’ goal was to retrospectively validate a set of specific criteria for eligibility for AS. All 616 patients met the following criteria for AS: PSA ≤ 10.0 ng/ml; PSA density < 0.2 ng/ml per ml; clinical stage T1c/T2; biopsy Gleason score ≤ 3+3=6; and ≤ 2 positive biopsy cores. They were initially managed expectantly, with a median follow-up of just under 4 years. The authors report that the calculated 10-year prostate cancer-specific survival (in 21 patients at risk) was 100 percent, which contrasted with the actual 77 percent overall survival. Men still alive showed favorable PSA characteristics. Although the calculated 10-yearr treatment-free survival was only 43 percent, objective signs of progression often did not indicate the shift to radical treatment. The cohort consisted of men on AS and those on watchful waiting (WW). Information on comorbidity or psychological distress was not available. They conclude that AS seems justified in selected men with screen-detected PCa. Prospective protocol-based AS programs are necessary to optimize selection criteria and to find the appropriate trigger points for switching to active therapy. Possible negative psychological reactions with AS against improved quality of life by withholding side-effects from radical treatment should be considered. (Note: It is worth comparing the data reported in this study to the data reported by Suardi et al., on which we have commented previously.)

There is new information about expression of two “new” proteins that may impact the risk for prostate cancer. Fernando et al. comment on expression of the WAVE1 protein, which affects cell motility and therefore may impact the potential for metastasis. Peehl et al. comment on the over-expression of monoamine oxidase-A in Gleason grade 4/5 cancers compared to Gleason grade 3 cancers.

Finally, Evans offers addditional editorial comment on the paper by Ankerst et al. suggesting a possible role of PCA3 in predicting risk for progressive prostate cancer, and mentioned on this column yesterday.