THE "NEW" PROSTATE CANCER INFOLINK

News reports over the weekend included:

• Various review articles dealing with such matters as Gleason grading, numbers of cores taken at biopsy, the need for lymph node dissection, surgical technique and surgical margin control, and cryotherapy
• The effect of a water extract of white cocoa tea on prostate cancer cells in vitro and in a mouse model

Ramos et al. have reviewed the impact of changes in the pathologic criteria for reporting of Gleason scores before and after issuance of new recommendations in 2002. It should be apparent to the informed reader that direct comparisons of data from before and after that change in guidelines needs to be carried out with great care because of the major reduction in assignment of Gleason scores of < 6 after issuance of the new recommendations.

Lughezzani et al. have reviewed data on how the number of biopsy cores taken at biopsy effects the detection and clinical staging of prostate cancer.

Hyndman et al. have reviewed data on the appropriateness and need for lymph node dissection in newly diagnosed patients. They argue that pelvic lymph node dissection limited to the external iliac vein nodes is unnecessary in men with low-risk prostate cancer.However, they suggest that standard external iliac and obturator lymph node dissections, with or without extension to hypogastric nodes, make sense in men with intermediate- and high-risk disease. They also note that it is wise to harvest as many lymph nodes are is convenient for such patients.

Gettman and Blute have reviewed data on  the impact of surgical technique on margin control during radical prostatectomy and also evaluated the influence that stage migration, the individual surgeon, new technologic adjuncts, and specimen handling have had on margin control.

Pisters has reviewed current data on the effectiveness and safety of cryotherapy as a first-line treatment for prostate cancer and argues that whole-gland cryotherapy is “ready for prime time.” He also argues that focal cryotherapy “warrants further investigation.” The “New” Prostate Cancer InfoLink is less enamored of this idea, largely because cryotherapy is a difficult technique to learn to do well, and so the learning curve is steep and long. A significant number of men would be at some risk for less than high-quality of care if a large number of clinicians suddenly started to carry out cryotherapy for prostate cancer.

Peng et al. have reported that an extract of white cocoa tea (from the plant Camellia ptilophylla) against human prostate cancer shows activity against human prostate cancer cells in athymic nude mice. Whether this has any significance to treatment of prostate cancer in man is a very different question.

Filed under: Diagnosis, Management, Treatment Tagged: | biopsy, cryotherapy, Gleason grading, lymph node dissection, surgical margins, surgical technique, white cocoa tea