Prostate cancer news update: Friday, July 25

This morning’s news update includes data on:

  • The value of PSA testing in men who have already had a first, negative prostate biopsy
  • The potential of “partial cryoablation” as second line treatment for men who have disease recurrence following radiotherapy

Some researchers have questioned whether PSA data have a useful predictive value if a patient has already had a negative first biopsy. In the August issue of the Journal of Urology, Thompson et al. have again been able to use the Prostate Cancer Prevention Trial (PCPT) database to address this question. From the 18,882 participants in the PCPT they examined data from men in the placebo group who had only a first biopsy or a first and a second biopsy, together with associated PSA and DRE data within 1 year before each biopsy. Among this group of men, 5,608 had a first biopsy and 687 of those with a negative first biopsy underwent a second biopsy. By estimating what is known as the “receiver operating characteristic curve” for PSA for detection of prostate cancer on the first biopsy compared to the second, in association with relevant statistical analysis, Thompson and his colleagues have been able to demonstrate that PSA does not lose predictive value for the detection of prostate cancer, even after a first biopsy shows no evidence of cancer. Editorial comment on this paper is also available on the UroToday web site. (As an aside, it is worth noting just how valuable the PCPT database is now proving to be, way beyond its value in demonstrating the effectiveness and relative safety of finasteride as an agent that can be used to prevent prostate cancer in about 25-30 percent of men.)

Eisenberg and Shinohara have published a retrospective analysis of data on the effectiveness of “partial cryoablation” of the prostate as salvage therapy following the failure of radiation therapy in patients treated btween 2004 and 2007. By “partial cryoablation” the authors mean cryotherapy applied only to one of the two lobes of the prostate. A total of 19 patients (with a mean age of 71 years) met their inclusion criteria, of whom 15 had been followed for more than 6 months after salvage cryotherapy. The patients had received salvage therapy a mean of 6 years after their primary radiotherapy. The biochemical recurrence-free survival rates (according to the American Society for Therapeutic Radiology and Oncology definition) were 89, 67, and 50 percent at 1, 2, and 3 years after partial cryoablation, respectively. Complications included incontinence, urethral stricture, and urethral ulcer (each occurring in one of the 19 patients). A fourth patient apparently experienced prolonged rectal pain. The authors conclude that, “In properly selected patients with a unilateral focus of disease recurrence after radiotherapy, acceptable oncologic results can be achieved with partial cryoablation of the prostate, with low morbidity.”

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