Prostate cancer news update, PART A: Tuesday, July 28


There’s a lot of news this morning, so we are breaking it up into two sections (Parts A and B) to make it easier to read. Here are the items covered in Part A:

  • The clinical trial of torefemine in prevention of progression of high-grade PIN to prostate cancer
  • A UK-based clinical trial of decison support methods for newly diagnosed patients
  • Frequency of use of pelvic lymph node dissection associated with radical prostatectomy in the “modern” era
  • The potential for an association between type of anesthesia and surgical outcome for treatment of localized disease.

GTx, Inc. has announced that their pivotal Phase III clinical trial evaluating toremifene 20 mg for the prevention of prostate cancer in men with high-grade prostatic intraepithelial neoplasia (HGPIN) will continue as planned following a regular data safety monitoring board meeting (DSMB). Nearly 1,600 patients with HGPIN have been enrolled in this trial. The primary endpoint of the trial is a reduction in prostate cancer incidence. GTx anticipates being able to conduct an efficacy analysis of toremifene 20 mg for HGPIN in the summer of 2009.

In the United Kingdom, Chambers et al. have designed and are now implementing a randomized, controlled trial of a decision support/psychosocial intervention for men newly diagnosed with localized prostate cancer. A total of 700 men have been recruited after diagnosis and before treatment through urology private practices and hospital outpatient clinics and randomized to either a tele-based, nurse-delivered, five-session decision support/psychosocial intervention or a usual care control group. Two intervention sessions are delivered before treatment. Three further sessions are provided at 3 weeks, 7 weeks and 5 months after treatment. Participants are assessed at baseline (before treatment) and at 2, 6, 12, 24, and 36 months post-treatment. Outcome measures include: cancer threat appraisal; decision-related distress and bother from treatment side effects; involvement in decision making; satisfaction with health care; heath care utilisation; use of health care resources; and a return to previous activities. The authors hope that this study will provide recommendations about the efficacy of early decision support to facilitate adjustment after prostate cancer. It will also identify men diagnosed with localized prostate cancer who are at risk of poorer long-term psychosocial adjustment. The “New” Prostate Cancer InfoLink notes that this trial seems to have some similarities to the study being conducted in the US by the University of Arizona College of Nursing that we referred to last week.

Prasad et al. have conducted yet another retrospective data analysis of the Medicare prostate cancer database to investigate factors associated with use of pelvic lymph node dissection (PLND) among men being treated with open radical prostatectomy (ORP) and minimally invasive radical prostatectomy(MIRP). They used a 5 percent national sample of Medicare beneficiaries from 2003 to 2005, and identified 2702 men who had undergone radical surgery. Overall, 68 percent of men underwent PLND, although the rates varied by surgical approach (17 vs 83 percent for MIRP vs ORP, respectively). Men undergoing MIRP vs ORP , men ≥75 vs 65-69 years of age, and men with multiple vs no comorbidities were less likely to undergo PLND. High-volume minimally invasive surgeons were more likely to perform PLND And nen in the Western vs Southern United States were more likely to undergo PLND.

Biki et al. have conducted a retrospective review of data on prostate cancer recurrence in patients who received either general anesthesia with epidural anesthesia/analgesia or general anesthesia with postoperative opioid analgesia between January 1994 and December 2003.Follow-up evaluation was carried out through October 2006. The endpoint was an increase in postoperative PSA. After adjusting for tumor size, Gleason score, preoperative PSA, surgical margin status, and date of surgery, the epidural plus general anesthesia group was associated with an estimated 57 percent lower risk of recurrence compared with the general anesthesia plus opioids group. Gleason score and tumor size (percent of prostate involved) were also independent predictors of recurrence. A similar association between epidural use and recurrence was obtained by comparing patients matched on the propensity to receive epidural versus general anesthesia.

For more of today’s news update, please see PART B (coming soon if it’s not up when you read this).

One Response

  1. […] disease-specific at all on the wires so far. Probably there was so much news yesterday (click here and here). So we thought we’d update you on what The “New” Prostate Cancer […]

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