There are three reports in our first daily report for 2009, dealing with issues as varied as genetic profiling for prostate cancer risk, the relative merits of LRP and RALP, and the management of geriatric prostate cancer patients who are on long-term hormone therapy.
It has previously been reported that a combination of five single-nucleotide polymorphisms (SNPs) at 8q24, 17q12, 17q24.3 and a family history of the disease may predict risk of prostate cancer. Salinas et al. have tested this hypothesis using data from 1,308 patients with prostate cancer, aged 35-74, in King County, Washington and 1,266 age-matched controls. They showed that genotypes for the five SNPs plus a family history of the prostate cancer are associated with a significant elevation in risk for the disease, and may explain up to 45 percent of prostate cancer in the King County population. However, they do not improve prediction models for assessing who is at risk of getting or dying from the disease, once currently known risk or prognostic factors are taken into account. They conclude, correctly, that this SNP panel is likely to have limited clinical utility. The “New” Prostate Cancer InfoLink is concerned that this may be the case for a significant number of SNP panels that will be tested over the next few years.
A review by McCullough et al. suggests that one of the original developers of the modern technique of laparoscopic radical prostatectomy has become a convert to the robot-assisted procedure. Guy Vallancien is the senior author of this review, which states that, “Improvements in technique during robotic-assisted laparoscopic prostatectomy have improved the early return of continence postoperatively. Mean positive surgical margin rates were lowest for robotic-assisted laparoscopic prostatectomy as compared to pure laparoscopic or open radical prostatectomy series. Sexual potency rates were similar among all surgical treatments of prostate cancer. … The role of robotics in prostate cancer treatment is established, and continued technical advancements will ultimately improve patient outcomes.”
Last November we commented briefly on an article by Mohile et al. that reveiwed issues related to the management of the complications of hormone therapy in older prostate cancer patients. In a “Beyond the Abstract” commentary on this paper on the UroToday web site, Dr. Mohile has added additional perspective. She now points out that many studies have shown that older prostate cancer patients have high levels of impairment on comprehensive geriatric assessment (CGA) within activities of daily living (ADLs), instrumental activities of daily living (IADLs), comorbidity, physical disability, cognitive disorders, and depressive symptoms, and that such deficits are particularly evident in asymptomatic prostate cancer patients aged 70 or over on androgen deprivation therapy (ADT) . Major concerns include the high prevalence of physical disability in older patients receiving ADT that places them at higher risk for falling. Mohile argues that screening and evaluation for physical disability is imperative given the high prevalence of osteoporosis and risk for fractures with falling in this vulnerable population. The Vulnerable Elder’s Survey has demonstrated utility as a screening tool to detect impairments in this population. In addition, specialists who care for older patients with prostate cancer should work with geriatricians, internists, and others who can provide multidisciplinary comprehensive care to the patient to reduce risk of complications.
In a separate post we have addressed a report on a survey of patient advocates associated with the National Cancer Institute’s Prostate Cancer SPORE Program.
Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment Tagged: | gene, geriatric, hormone, LRP, RALP, risk, SNPs
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I wish to comment on Dr. Mohile’s additional perspectives concerning older prostate cancer patients, age 70 plus, who have shown high levels of impairment while on androgen deprivation therapy. I am a prostate cancer patient, diagnosed 04/08, age 75, who has been on ADT3 (Vantas Implant, Casodex and Avodart, T < 20) for 7 months. I have noticed numerous physical disabilities such as at least 3.5 seconds cut from my 40-yard dash times; I am well under my previous 200 lb bench press, am down to 350 lbs on leg presses, and I have fallen numerous times while walking my three dogs for 2 miles. As for cognitive impairment, I have lost my ability to multi-task and can no longer text on my phone while driving. I think somebody should charge my doctor for putting me on these “devil drugs” (sex life gone) with elder abuse. I hope there is somebody out there who can hear me as my hearing aid batteries have gone dead.
Glad to see that your sense of humor is still working George … However, I suspect that Dr. Mohile is referring to men who are more like 80-85 years old and who may have been on hormone therapy for a decade or more. She does use the term “geriatric.” Some men become “geriatric” in their late 60s, some never reach that state, and then there are the ones like Benjamin Button who start out in that condition (but don’t seem to improve with age!)
Its all true Michael, except I don’t know how to text message. The guy who beats me in the 40 passed on and I might have a chance to win in the senior games except for ADT. As for the curious case of Benjamin Button (Brad Pitt), I think I started out as Pediatric and stayed that way. Growing old is mandatory, growing up is optional. From now on though, its going to be “Serious George.” Do you think that is possible??
To utterly misquote Willet Whitmore, “Is seriousness possible in those for whom it is necessary, and is it necessary for those in whom it is possible?” I have no problem with “Curious George!”
Did you know that Willet F. Whitmore, Jr was a Rutgers grad like myself? He also said, “The current state of prostate cancer may not be good medicine but it is sure good business.” But what I like best is, “Tell me what you want to hear and I’ll refer you to someone who will recommend it.”
I have no problem with “Curious George.” By the way, Mike, do you know who Robert E. Hastings is? He is one of the most important men in modern urologic oncology as was Whitmore, Dean of Modern Urologic Oncology. Hummmm, who was he? You have 60 seconds.
Patrick Walsh’s first “nerve-sparing” patient.
Very, very good Mr. Scott. At JHU on April 26, 1982. Had an E 4 days later during a dream. You are the only PCa advocate, doctor, etc., that answered that question. Go to the head of the CLASS. A+++++.
One more try to stump you Mr. Scott. Who, when, and where pointed out to Dr. Patrick Walsh the macroscopic NVB which contained the cavernous erectile nerves. If you get this one Mr. Scott, I shall kiss ___ ___ on front steps of the _____ _____ .
Hmmmm … After wracking my brains for all of 3 minutes (and double-checking in Peter Scardino’s book), that has to have been Pieter Donker in Leiden in 1981! :O)
George … It’s not what you know … It’s what you know how to find out! I don’t even own a copy of Dr. Peter Scardino’s Prostate Book! :O)
I AM FLABBERGASTED!!!! That’s where it is found!!!
No more questions. Fill in the blanks for your reward.
I G I V E U P You are the Braineack. “Beam Me Up Scotty” — George