THE "NEW" PROSTATE CANCER INFOLINK

There are several interesting news items today, as follows:

• Ethnic variation in the performance of PSA and PSA density as markers for risk of prostate cancer
• Potential underuse of active surveillance in eligible patients
• Application of active surveillance in a 40-patient case series
• The potential to eliminate the need for a urethral (Foley) catheter post-surgery
• Circulating tumor cell levels as a predictor for response to androgen deprivation therapy

Elliott et al. have examined the performance of PSA, PSA density, and transition zone density in racial groups undergoing an extended prostate biopsy scheme. They conducted a retrospective review of prospectively collected data from 1,115 white, 288 black, and 161 Asian/Pacific Islander men referred for prostate needle biopsy. PSA density outperformed PSA for detecting any prostate cancer and high grade cancer across all races. PSA and PSA density performed best for diagnosing high grade cancer and diagnosing cancer in men with an abnormal DRE. When comparing differing races, PSA density performed the best in Asian/Pacific Islander men for high grade cancer detection. They conclude that racial variations exist in the performance of PDA and PSA density; that in men of Asian/Pacific Islander descent PSA and PSA density perform better than in white men, especially for diagnosing clinically significant, high grade prostate cancer; and that, in general, PSA and PSA density perform equally well in white and black populations.

Barocas et al. have conducted an observational study of 1,886 men diagnosed with clinically localized prostate cancer between 1999 and 2004 from the CaPSURE database. They assessed the proportion of men meeting Epstein surveillance criteria (PSA < 10 ng/mL, clinical stage T1 or T2a, PSA density < 0.15, fewer than 1 of 3 biopsy cores positive, and absence of Gleason pattern 4 and 5 on biopsy) and the proportion selecting active surveillance stratified by risk group. Of the 1,886 men with all five Epstein criteria documented, 310 (16.4 percent) met all five criteria and 28/310 (28 percent) of men in this very low risk category actually chose active surveillance compared with 68/1,576 patients (4.3 percent) in other risk groups. On multivariable analysis of the entire cohort, older age was the only demographic predictor of surveillance. The authors conclude that only a small subset of eligible men in this database chose active surveillance, suggesting that it may be underused in the management of very low risk prostate cancer. The “New” Prostate Cancer InfoLink suspects strongly that this underuse may reflect how management opptions are presented to patients by their physicians.

Ercole et al. conducted a retrospective analysis of data from 40 patients diagnosed with localized prostate cancer since 1990 who elected active surveillance. A total of 31 patients remained on active surveillance for a median of 48 months (range 12 to 168). The 5-year probability of remaining on active surveillance was 74 percent. The authors resport that most patients who abandoned this strategy did so within 33 months of diagnosis (range 12 to 84). An increasing PSA level and anxiety were the two most common reasons for the patients’ decisions. However, a delay in treatment did not appear to compromise subsequent outcomes. They conclude that men with low grade prostate cancer can elect active surveillance and have excellent long-term results.

Tewari et al. have reported on the feasibility of a new surgical technique that would avoid the need for a urethral catheter after (robotic) radical prostatectomy. In this pilot study, 10 of 30 patients received a custom-made suprapubic catheter with a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. The other 20 patients received a standard Foley catheter. The authors report that patients in the study group had significantly less postsurgical penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. Tehy conclude that urethral catheter-less (robotic) radical prostatectomy is feasible. The “New” Prostate Cancer InfoLink would urge that this procedure be investigated by other experienced surgical teams.

A Japanese study by Okegawa et al. appears to demonstrate that hormone-naive men with documented, metastatic prostate cancer, and a circulating tumor cell (CTC) level of ≥ 5 cells in 7.5 mL of blood, will normally respond to androgen deprivation therapy. Such patients responded for an average of 17 months. Patients with CTC levels of < 5 cells in 7.5 mL of blood responded for an average of 32 months.

Filed under: Diagnosis, Management, Treatment, Uncategorized | Tagged: active, androgen, cancer, catheter, CTC, density, deprivation, ethnicity, news, prostate, PSA, race, surveillance, update |