THE "NEW" PROSTATE CANCER INFOLINK

Today’s news reports include discussion of items on:

• Prostate cancer risk awareness
• Improving cryotherapy technique with 3D ultrasound
• Interposition (“sural”) nerve grafting
• Post-brachytherapy “PSA bounce”
• The potential of targeted, peptide-linked, α-emitting radioisotopes

Shavers et al. have published data suggesting that, despite statistics to the contrary, few African-American men perceive themselves to have a higher-than-average risk of prostate cancer, while a higher percentage of Hispanic men perceive their risk to be higher than that of the average man of the same age. Based on these findings, they suggest that all men, but particularly African-American and Hispanic men, need more and better information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening. The “New” Prostate Cancer InfoLink would note, however, that the data on which this study was based were collected 5 or more years ago, and that, at least in the African-American community, we suspect there is greater awareness today (although though more is very definitely needed).

Chalasani et al. have described the use of 3D-ultrasonography in association with cryotherapy at their institution in Canada, and how they believe that this has improved prostate cancer outcomes compared to older 2D techniques.

White and Kim have reviewed the available data on interposition (“sural”) nerve grafting in association with radical prostatectomy with the intent to preserve sexual functionality. Their basic statement is that this is still a controversial technique and that the numerous reports in the published literature “have demonstrated conflicting and contradictory outcomes.” Clearly we need a better and more detailed understanding of the techniques involved in this surgery if it is to be performed regularly with regularly effective outcomes.

Caloglu and Ciezki have reviewed the literature on the so-called “PSA bounce” that occurs in some 30-40 percent of men who are otherwise successfully treated with brachytherapy. We really do not understand what causes this phenomenon, and the authors note that patient age alone is  the most consistent predictor of the occurrence of the phenomenon. Post-brachytherapy PSA bounce is a worrisome issue for both clinicians and their patients because it may be many months before one can determine whether the PSA rise is “just” a bounce or a real signal of treatment failure.

A presentation on Tuesday at the Society of Nuclear Medicine’s annual meeting suggested that it may be possible to use α-emitting radioisotopes bound to rapidly clearing peptides that target prostate cancer cells as a form of treatment for prostate cancer. The presentation reported data from a very small study in mice, so we are unlikely to see this therapy being tested in men for a while yet. A more detailed report on this study is available on the Medscape web site.