THE "NEW" PROSTATE CANCER INFOLINK

There are four reports in today’s news of any real interest to the patient community. They deal with:

• The progress of the Prostate Cancer Clinical Trials Consortium
• Antiandrogens in prevention of prostate cancer (maybe)
• Disseminated tumor cells and prostate cancer progression
• Oral fenretinide in treatment of biochemical relapse after first-line therapy

Morris et al. have published a first annual report on the activities of the U.S. Department of Defense-funded Prostate Cancer Clinical Trials Consortium (PCCTC). The PCCTC was launched in 2006 and includes 10 leading prostate cancer research centers. It has opened 51 clinical trials, and 1,386 patients have been accrued to those trial at member sites. This is well in excess of the original federal mandate that each participating center was to initiate at least one new clinical trial and maintain accrual of a minimum of 35 patients per year.

Oliver et al. have reviewed evidence that low-grade prostate inflammation is a precursor of prostate cancer development and the mechanisms by which it may account for the more than 50 years of natural history from first infection to cancer. They state that there is  clear evidence that some sexually acquired infections damage the prostate and increase serum PSA with slow recovery back to normal. They argue that  low-level solar exposure is protective and that vitamin D boosts macrophage-mediated immunoprotective effects. And they propose that trials of non-steroidal anti-inflammatory drugs (NSAIDs) and vitamin D combined with short courses of intermittent anti-androgen therapy are justified as preventive treatment for men at high risk of prostate cancer.

In an attempt to understand the nature of systemic prostate cancer and to identify those patients who might be at high risk for early relapse after a variety of treatments,  Weckermann et al. monitored disseminated tumor cells (DTCs) in bone marrow for up to 10 years and genetically analyzed such cells isolated at various stages of disease, taking a total of 900 bone marrow aspirates from 384 patients. They then attempted to determine the prognostic impact of positive cells detected before surgery (244 patients) and postoperatively (214 patients). Their data suggest that: (a) Detection of cytokeratin-positive cells before surgery was the strongest independent risk factor for metastasis within 48 months. That cytokeratin-positive cells detected 6 months to 10 years after radical prostatectomy were consistently present in bone marrow but had no influence on disease outcome. (c) That characteristic genotypes of cytokeratin-positive cells were selected at manifestation of metastasis.

Cheung et al. have reported on a Phase II study of the oral agent fenretinide in the treatment of men with biochemically recurrent prostate cancer. Based on data from 23 patients, this small, multi-center trial suggests that fenretinide is well tolerated but that as a single agent in the formulation used in this study, it had minimal ability to prevent progression of biochemical recurrence.

Filed under: Drugs in development, Management, Prevention, Treatment Tagged: | antiadrogens, disseminated tumor cells, fenretinine, Prevention, Prostate Cancer Clinical Trials Consortium