Prostate cancer news update: Monday, September 1

In today’s reports:

  • Zoledronic acid (Zometa) has confirmed it’s impact on skeletal strength in the “real world”
  • Time to recovered of “normal” testosterone levels after ADT has been measured in a prospective clinical trial
  • Acupuncture appear to work to relieve “hot flashes” in men on LHRH agonists

“Real world” data has recently confirmed the value of zoledronic acid in reducing the skeletal morbidity rate and delaying the time to skeletal complications among appropriate patients with advanced forms of cancer (including prostate cancer). Hatoum et al. conducted a retrospective claims analysis of patients with a diagnosis of bone metastasis who had a single type of solid tumor of the breast (women), prostate, or lung and who experienced one or more skeletal complication between January 2002 and October 2005. The mean follow-up for patients treated with zoledronic acid was 12.2 ± 9.05 months compared to 8.7 ± 9.28 months for untreated patients. The monthly rate of skeletal complications in treated patients was 0.29 ± 0.3  as compared to 0.43 ± 0.4 in untreated patients. In subgroup analysis, the mean time to first complication was 185 ± 210 days in the treated group versus 98 ± 161 days in the untreated group.

Yoon et al. have clearly demonstrated, in a prospective clinical study, that testosterone recovery after prolonged androgen suppression is protracted. They examined the extent and timing of testosterone recovery in 153 patients with pT3N0M0 prostate cancer or positive margins after radical prostatectomy or with prostate specific antigen relapse treated with radiation to the prostate bed plus 2 years of androgen suppression. Androgen suppression consisted of nilutamide for 4 weeks plus buserelin acetate every two months for 2 years. A total of 121 patients who completed 2 years of androgen suppression and 20 patients who received shorter durations of androgen suppression (median 16 months) were available for testosterone recovery analysis. Median followup after finishing androgen suppression was 38.9 months. All patients achieved castrate levels on androgen suppression. At 36 months after completion of androgen suppression, 93.2 had recovery to supracastrate levels (median time 12.7 months), and and 71.5 percent had recovery to baseline and/or normal testosterone levels (median time 22.3 months), respectively. Age < 60 years and shorter androgen suppression duration (< 2 years) were prognostic for faster recovery to baseline and/or normal testosterone levels after adjusting for baseline testosterone levels.

Vasomotor symptoms (e.g., “hot flashes”) in postmenopausal women have been successfully treated with auricular acupuncture (AA). Harding et al. therefore decided to evaluate the potential of AA in men receiving LHRH therapy for carcinoma of the prostate, as similar symptoms can affect the quality of life in such men. In all, 60 consecutive patients with prostate cancer and on LHRH agonist treatment (median age 74 years, range 58-83) consented to weekly AA for 10 weeks. A validated questionnaire was used to assess concerns and well-being before and after treatment. All men completed the treatment with no adverse events recorded, apart from transient exacerbation of symptoms in two men; The vast majority of the patients (57/60, 95 percent)reported a significant decrease in the severity of symptoms. The authors conclude that the symptomatic improvement was at levels comparable with that from pharmacotherapy, and cost analysis showed AA to be a viable alternative. They suggest that randomized studies are needed to fully evaluate AA against more conventional treatments.

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