THE "NEW" PROSTATE CANCER INFOLINK

In today’s news report we note new articles on:

• The AUA’s “best practice” statement on PSA testing
• Post-surgical upgrading and upstaging of low-risk prostate cancer
• Prostate cancer involving the rectum

Medscape has provided a new report on the AUA’s “best practice” guidance for the use of PSA testing, focused (as one might expect) on the appropriateness of beginning testing at age 40, but also emphasizing what Dr. Peter Carroll (the chairman of the guidance development committee) said at the time of the original release of the guidance document: “The single most important message of this statement is that prostate cancer testing is an individual decision that patients of any age should make in conjunction with their physicians and urologists. There is no single standard that applies to all men, nor should there be at this time.”

Davis et al. have carried out a retrospective review of data from 66/3,055 low-risk patients who received a radical prostatectomy at M. D. Anderson Cancer Center between 2000 and 2007. All 66 patients were predicted to have low-volume and low-grade (LV/LG) cancer based on a PSA level of < 10 ng/ml and not more than one core of cancer from an extended biopsy scheme showing a Gleason score (GS) of 3 + 3 = 6 of < 3.0 mm or 3 + 4 = 7 of < 2.0 mm. The authors showed that even in this highly defined set of patients, all of whom had organ-confined disease, 4/66 (6 percent) were upgraded to GS 4 + 3 = 7 or higher after surgery. Furthermore, only 17/66 patients (26 percent) had a single focus of cancer, whereas 49/66 patients (74 percent) had multifocal disease. The transition zone was a common location of under-sampled disease.

Guo et al. have reported on the poor prognosis of men diagnosed with prostate cancer that has extended into the rectum. Commonly such men present with severe perineal pain. In the series of 18 patients studied by Guo et al., all patients were clearly shown to  have prostate cancer invading the rectal wall after their initial surgery. Nine patients died at a mean time of 18 months (range, 2-69 months) after surgery. The remaining nine patients were alive with a mean follow-up time of 15 months (range, 3-34 months), but four patients had developed distant metastases.

Filed under: Diagnosis, Management, Risk, Treatment | Tagged: guidelines, low risk, PSA, rectum, upgrading, upstaging