THE "NEW" PROSTATE CANCER INFOLINK

This morning’s news update deals with two newly published studies:

• The relative effectiveness of two different types of artificial sphincter for the chronically incontinent post-treatment
• The impact of ADT on metabolic and cardiovascular processes and the risk for significant adverse reactions as a consequence of hypogonadism

Aaronson et al. have investigated two approaches to the placement of an artificial urinary sphincter (AUS) as a method for management of incontinence after treatment of prostate adenocarcinoma with radiotherapy or surgery, or both: the transcorporal (TC) and the standard (ST) approaches. They created a database that included data from all patients who had undergone AUS placement from January 2000 to August 2005 at the University of California, San Francisco, Medical Center. They noted the demographic features, comorbidities, type(s) of treatment for prostate cancer, technique for AUS placement, and postoperative outcome. A total of 30 patients underwent AUS surgery during the study period: 26 for incontinence after prostate cancer treatment. Of the 26 patients, 18 had undergone ST (ST group) and 8 had undergone TC (TC group) AUS placement, with a minimal follow-up of 12 months and a mean follow-up of 31 and 28 months, respectively. The 2 groups did not differ widely in age or comorbidities. Of the patients in the ST and TC groups, 44 and 50 percent had undergone external beam radiotherapy or brachytherapy and 78 and 100 percent had undergone radical prostatectomy, respectively. Of the patients in the ST and TC groups, 22 and 89 percent had undergone ≥ 2 types of urethral surgery before AUS placement, respectively. A total of 50 percent of the TC group underwent TC placement without having undergone a previous sling or ST AUS procedure. The AUS removal rates were equivalent between the 2 groups at 2 years. Finally, the success rates for social continence were 69 and 81 percent for the ST and the TC group, respectively. The authors conclude that TC AUS placement is an effective salvage or primary incontinence treatment for high-risk patients after prostate cancer therapy.

Androgen-deprivation therapy (ADT) is a common form of treatment for men with metastatic or recurrent prostate cancer. Indeed, the use of ADT has been increasing with the advocacy of adjuvant and neoadjuvant ADT for treating asymptomatic patients with locally advanced prostate cancer. However, ADT, with its resulting severe hypogonadism, causes profound metabolic side-effects. Hakimian et al. have conducted a systematic English-language literature search (1950 to the present), using the key terms “hypogonadism,” “testosterone,” “androgen deprivation therapy,” “hormonal treatment,” “prostate cancer,” “diabetes,” “metabolic syndrome,” and “cardiovascular disease.” The available literaure clearly shows that patients with prostate cancer who undergo long-term ADT are at greater risk of developing dyslipidemia, insulin resistance, hyperglycemia, and metabolic syndrome. These metabolic and physiological changes are a direct result of the induced severe hypogonadism and might predispose patients to a greater risk of cardiovascular morbidity and mortality. The authors conclude that there is a need for prospective studies aimed and designed to investigate the metabolic and cardiovascular adverse effects of ADT, and to assess the benefit/risk ratio, especially in special populations such as diabetics.

Filed under: Living with Prostate Cancer, Management, Treatment | Tagged: ADT, adverse, androgen, artificial, cancer, cardiovascular, deprivation, effects, hypogonadism, incontinence, metabolic, news, prostate, sphincter, update |