THE "NEW" PROSTATE CANCER INFOLINK

Today’s prostate cancer news reports cover items on:

• Assessment of quality of life after radical prostatectomy
• Permanent seed brachytherapy in treatment of localized disease
• Cryotherapy in treatment of patients with Gleason 8-10 localized disease
• Actonel and/or estradiol in prevention of SREs

Hedgepeth et al. have compared the value of three different prostate cancer outcome survey tools in the assessment of quality of life after radical prostatectomy in a total of 640 men at their institution. They suggest that of the three survey tools, the Expanded Prostate Cancer Index Composite may provide the best survey for broad evaluation of quality of life as compared to the other two tools (the Incontinence Symptom Index and the Sexual Health Inventory for Men questionnaires).

Taira et al. have published data showing that high quality, permanent seed brachytherapy on its own (without neoadjuvant or adjuvant hormone therapy or external beam radiation) is a very effective form of treatment for appropriately selected patients with low- and intermediate-risk, clinically localized prostate cancer — as assessed by biochemical progression-free survival, prostate cancer-specific, and overall survival rates at up to 12 years. However, these data are from large patient series and are not strictly comparable to outcomes in patients receiving active surveillance or other forms of treatment.

Jones and Rewcastle have reported on management of patients with Gleason scores of 8, 9, and 10 who were treated with first-line cryoablation based on data from the Cryo OnLine Database (COLD) registry. The COLD registry contains data on 1,608 patients who underwent primary cryoablation at 27 centers; 77/1,608  patients (4.8 percent) had a Gleason score of at least 8 and a minimum of 24 months of follow-up. Of these 77 patients, 67 (87 percent) achieved a PSA nadir < 0.4 ng/ml. A total of 47 patients underwent post-treatment biopsy. A total of 12/47 showed evidence of disease resulting in a positive biopsy rate for those who underwent biopsy of 25.5 percent. This yields a positive biopsy rate for the entire population of 15.6 percent (12/77). The authors conclude that “Cryoablation, as a primary treatment for high-grade Gleason prostate cancer practiced over a wide spectrum of users, provides definable biochemical and local control for a hard-to-manage patient population with aggressive disease.” However, the authors provide no information in the abstract about adverse events or complications of treatment. While clearly cryoablation can be used effectively to treat some patients with high-risk, localized prostate cancer, we do not know for certain whether this is the best form of treatment for high-risk disease.

Kearns et al. have reported that risedronate (Actonel) and estradiol — either alone or in combination — appear to have limited impact on the prevention of bone loss as a consequence of androgen deprivation therapy. There was no difference in outcomes evident between patients receiving either each drug individually or the two drugs together.

Filed under: Living with Prostate Cancer, Management, Treatment Tagged: | Actonel, brachytherapy, cryotherapy, estradiol, Gleason score, outcome, permanent, quality of life, risedronate, seed, survey