More prostate cancer news: Tuesday, August 12

There are several interesting new papers reported today, and two very important ones (which have been addressed in separate posts). This post addresses:

  • A retrospective analysis of the relative predictive value of positive surgical margins following radical prostatectomy in the pre- and post-PSA eras
  • A new nursing model for management of urinary incontinence post-prostatectomy
  • The importance of assessing risk for transitional zone prostate cancer in patients already diagnosed with bladder cancer, and
  • A review of developing strategies for the treatment of late-stage prostate cancer
  • Other reports today address adjuvant vs. salvage radiation therapy and quality of care in management of early stage prostate cancer.

Mann et al. have reviewed data from the 3,460 patients in the Columbia University Urologic Oncology database in an attempt to determine whether the risk associated with positive surgical margins (PSMs) has the same effect on prognosis today as it did before the PSA testing era. Out of this total patient database, 2,215 men (64 percent) underwent radical prostatectomy (RP) between 1991 and 2005, had at least 1 year of follow-up and sufficient pathologic data to be analyzed. The investigators divided these patients into three cohorts by time period: 1991-1995, 1996-2000, and 2001-2005. The median age, preoperative PSA level, and Gleason score were 61.6 years, 6 ng/mL, and 7, respectively. More than half the patients had pathologic stage T2 disease. After conducting a careful statistical analysis, the authors conclude that the predictive contribution of PSMs to the accuracy of outcomes prediction after RP has decreased over the past 15 years.

Yo Ku and Sawatsky have published information on a new set of nursing perspectives for the care of men with or at risk for urinary incontinence following radical prostatectomy (RP). Noting that, “Many men choose RP to remove the cancer,” they go on to observe that ≥ 50 percent of men who undergo RP suffer from urinary incontinence, which can lead to embarrassment, loss of a sense of control, depression, and decreased social interactions. They describe a “Human Response to Illness Model” which they claim “provides a framework to gain a comprehensive understanding of the physiologic, pathophysiologic, behavioral, and experiential perspectives” as well as other key factors in developing methods to manage urinary incontinence following RP.

Lerner et al. have reveived available data on cancer developing within the transition zone of the prostate gland (transitional zone carcinoma or TCC), with emphasis on implications for diagnostic and management strategies particularly as they relate to radical cystectomy and the treatment of patients who already have a diagnosis of bladder cancer. They note that TCC is observed in up to 48 percent of patients undergoing radical cystoprostatectomy. In patients already diagnosed with bladder cancer, prostatic TCC is potentially likely to impact prognosis independent of the primary bladder tumor stage, and so preoperative detection of prostatic TCC enables accurate staging and treatment planning. They argue that prostatic involvement with TCC in patients with bladder cancer is a common event. They further state that for “patients with recurrent high-grade nonmuscle invasive cancer and patients undergoing radical cystoprostatectomy, a thorough assessment of the prostatic urethra and stroma is imperative for accurate staging and treatment planning.”

Chen et al. have reviewed available data on the currently available and investigational treatments targeting the androgen receptor pathway in castration-resistant prostate cancer. They draw particular attention to such agents as novel antiandrogens, inhibitors of CYP17, inhibitors of 5α-reductase, inhibitors of HSP90, inhibitors of histone deacetylases, and tyrosine kinase inhibitors.

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