THE "NEW" PROSTATE CANCER INFOLINK

So — given the paucity of prostate cancer news on this uniquely American holiday — it seemed appropriate to look back over the past 12 months and remind ourselves what, from a prostate cancer point of view, we ought to be thankful for!

So here’s a list … and others may wish to add their thoughts using the Comment box below.

• Last December, in Europe and in America, regulatory agencies approved the marketing of the new, second-generation LHRH antagonist degarelix (Firmagon) for the treatment of advanced prostate cancer. Although understanding of the most appropriate use for this agent is still evolving, it significantly increased the options available for first- and second-line hormonal therapy.
• In January, for the first time in years, a number of major prostate cancer advocacy groups started to cooperate in the development of a shared, national prostate cancer advocacy agenda — which is still evolving under the auspices of “America’s Prostate Cancer Organizations.
• In February, the AUA and ASCO issued a joint guideline about the use of 5α-reductase inhibitors (5-ARIs) for the prevention of prostate cancer, making these two drugs the first to be formally recommended as agents that could prevent prostate cancer in a significant percentage of patients.
• In March, the New England Journal of Medicine published data from two major prostate cancer screening trials, kicking off a major new controversy about the value of population-based “screening” for prostate cancer (and its impact on mortality) as compared to the value of individual testing in men perceived to be at high risk. Some might ask why we should be thankful for this, but see below.
• In March, two European studies appeared to finally validate the concept of intermittent (as opposed to continuous), long-term androgen deprivation therapy in the management of men with advanced prostate cancer (although of course many physicians have been carrying this out for years).
• Also in March, America’s Prostate Cancer Organizations issued their first, formal, joint statement (about the results of the two major screening trials) and The “New” Prostate Cancer InfoLink celebrated its first birthday (albeit somewhat belatedly).
• In April, Dendreon Corp. announced that sipuleucel-T (Provenge) had demonstrated a 4.1-month survival benefit compared to placebo in a randomized, double-blind, multi-center clinical trial, making it the first truly “personalized” medicine ever to show such an effect.
• Also in April, the REDUCE study demonstrated that dutasteride (Avodart) was capable of lowering the risk of prostate cancer by 23 percent in men aged between 50 and 75 years of age, again compared to a placebo, thereby confirming the earlier data showing that finasteride (Proscar) had a very similar effect.
• Throughout the year, but particularly in May (at the annual meeting of ASCO) it became increasingly clear that several investigational drugs — including abiraterone acetate, MDV3100, and OGX-011 — held significant potential for the treatment of men with progressive disease after standard forms of hormone therapy and after docetaxel-based chemotherapy.
• In July, Emberton et al. published the first really detailed report on a large series of patients treated for prostate cancer using high-intensity focused ultrasound (HIFU). The true potential of this technique is still unknown because of the relatively short follow-up data available.
• In August, Albertsen and Welch attempted to quantify the overtreatment of prostate cancer in America today (see below), while Yu-Lao and her colleagues were able to document the massive drop in risk for diagnosis with advanced forms of prostate cancer since the late 1980s.
• In September, some urologists started an initiative to insist on higher training standards for surgeons using robot-assisted techniques, particularly for the surgical treatment of prostate cancer.
• In November we saw the publication of two articles in major urology journals that raised really serious questions about the quality of prostate cancer surgery, and how data about the outcomes of prostate cancer surgery should be reported in the future.
• Also this November there was a Japanese report suggesting that medium-term outcomes following HIFU for the treatment of localized prostate cancer might be less good than “advertised” by the advocates for this technique — but “the jury is still out.”

Now, just for clarity, we should state why we think people should be “thankful” for all the controversy generated this year about prostate cancer “screening” and “over-treatment.”

The “New” Prostate Cancer InfoLink believes that, although there has been no resolution about any of these issues, the controversy has increased awareness about the potential risks and benefits of prostate cancer testing — particularly among the primary care physician community (which is, after all, the group likely to be responsible for initiating discussion of  prostate cancer risk and PSA testing with most patients). We further believe that the broad discussion of these topics has stimulated more physicians to really think carefully about how they discuss these issues with patients.

In the absence of consensus about guidance for prostate cancer screening and risk management, better a greater visibility of the lack of consensus and the varying points of view, so that the largest possible percentage of the popuation is stimulated to educate themselves and come to conclusions that are acceptable to them as individuals, as opposed to just accepting the point of view of whoever is shouting the loudest.

Happy Thanksgiving to all our readers. And remember … there is no specific evidence about the impact of turkey, stuffing, or pumpkin pie in reasonable quantities on risk for prostate cancer (pro or con).

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