Prostate cancer news update, Thursday, September 11

Today’s prostate cancer update includes information on:

  • The lack of any specific connection between prostate cancer risk and a history of sexually transmitted infection
  • A review of current issues in the management of “high risk” prostate cancer patients
  • The effect the Medicare Modernization Action on the use of orchiectomy as compared to LHRH agonist therapy
  • The impact of prostate cancer treatment and outcomes of treatment on couples

Based on data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Huang et al. appear to have demonstrated that there is no currently establishable association between a history of sexually transmissible infections (STI) and an increased risk for prostate cancer.They examined risk of prostate cancer in relation to serum antibodies to Chlamydia trachomatis, human papillomavirus-16 and -18, herpes simplex virus-2, cytomegalovirus, and human herpesvirus-8 in 868 cases (765 Whites and 103 Blacks) and 1,283 controls matched by race, age, time since initial screening, and year of blood draw. All blood samples were collected at least 1 year before prostate cancer diagnosis, except for 43 Black cases. They also assessed risk associated with a self-reported history of syphilis and gonorrhea. RESULTS: Prevalences of the 7 STIs among controls were weakly correlated, and all were more frequent among Blacks than Whites, except for human herpesvirus-8. Among Whites, prostate cancer risk was not significantly associated with the individual infections or with their number; however, men with one or more STIs had a slightly higher risk for prostate cancer (odds ratio, 1.3). Among Blacks, excess risk was associated with IgA antibody to C. trachomatis (odds ratio, 2.1). The authors conclude that this large prospective study of prostate cancer shows no consistent association with specific STIs and a borderline association with any association as compared to no association at all.

Gonzalez et al. have reviewed current perspective on the management of “high-risk” prostate cancer and the roles of neo-adjuvant and adjuvant treatment options for such patients. They accurately begin by noting that, “Patients are often deemed high risk because they are at increased risk for biochemical failure after primary intervention. However, these ‘high-risk’ men may not be at significant risk of dying from their cancer.” They make an attempt to better define truly “high-risk patients” and to help to identify men at increased risk for mortality, not simply biochemical failure, after a diagnosis of localized prostate cancer. They also review available monotherapies and successful multimodality treatments. Finally, they offer a synopsis of ongoing randomized clinical trials using effective systemic adjuvant therapies following local treatment.

Katz and Andriole have reassessed a prior publication by Weight and colleagues, which evaluated the practice patterns of US physicians using androgen deprivation therapy (either medical castration with LHRH agonists or surgical castration by orchiectomy) for the treatment of Medicare patients with prostate cancer during the period 2001-2005. In 2003, the enactment of the Medicare Modernization Act (MMA), which lowered reimbursement for LHRH analog administration, was introduced. Weight et al. found that LHRH agonist use increased in 2001-2003, and decreased in 2004 and 2005, while surgical castration rates increased. Based on these data they speculated that treatment decisions for androgen deprivation therapy were financially influenced. Katz and Andriole argue that, although this study highlights the possible influence that reimbursement levels might have in the decision to prescribe androgen deprivation therapy, the original study has several limitations, and the conclusion that financial incentives were solely responsible for the observed decrease in LHRH agonist use can not be established.

Galbraith et al. have investigated health-related outcomes for couples dealing with prostate cancer before the patient started treatment and 6, 12, and 18 months after treatment. Their study used a series of surveys and was based on patients under treatment at a tertiary care, nonprofit medical center in the southwestern United States. A total of 216 patients under treatment for prostate cancer was enrolled, together with their partners. The mean age of patients was 68 years; the mean age of the partners was 64 years. The average length of marriage was about 35 years. About 75 percent of patients and more than 50 percent of partners had at least some college education. The results of this study showed that patients’ scores were associated with partners’ scores more than 50 percent of the time throughout the study. Relationship satisfaction was the most strongly related variable between patient and partner. Both patient and partner are significantly affected by prostate cancer and the treatment experience. The authors recommend that nursing personnel should actively include partners in all information and education sessions connected with prostate cancer treatment and follow-up. In addition, the unique experiences of partners of patients with prostate cancer should be identified and addressed.

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