The prostate cancer news update: Friday, October 10

Today’s news includes information about:

  • A review of the risk associated with testosterone therapy in men with low testosterone levels
  • Issues related to stress and coping among couples dealing with prostate cancer
  • The pivotal trial leading to approval of circulating T-cell counts as a means to evaluate treatment of men with very late-stage prostate cancer

Sabsigh et al. have just published a systematic review of the literature about prostate cancer risk associated with testosterone therapy for hypogonadism. Of the 44 studies that met inclusion criteria for this review, the authors state that none demonstrated that testosterone therapy for hypogonadism increased prostate cancer risk or increased Gleason grade of cancer detected in treated vs untreated men. They further note that testosterone therapy did not have a consistent effect on PSA levels.

Kershaw et al. have investigated a specific stress-coping model see if it could predict coping and quality of life for prostate cancer patients and their spouses by working with 121 prostate cancer patient/spouse couples. The found that their model accounted for a significant amount of variance in mental and physical quality of life at 8 months for patients (40 and 34 percent, respectively) and spouses (43 and 24percent, respectively). The authors concluded that prostate cancer patients commonly need interventions that assist them to manage the effects of their disease; that the stress-coping model suggests skills in several areas that could be improved; and that programs need to include spouses because they also are negatively affected by the disease and can influence patient outcomes.

de Bono et al. have now published the results of the prospective study that established the relationship between post-treatment circulating T-cell count (CTC count) and overall survival (OS) in castration-resistant prostate cancer (CRPC). Secondary objectives of the study included determining the prognostic utility of CTC measurement before initiating therapy, and the relationship of CTC to PSA changes and OS at these and other time points. Blood was drawn from CRPC patients with progressive disease starting a new line of chemotherapy before treatment and monthly thereafter. Patients were stratified into predetermined “favorable” (< 5 CTC in 7.5 ml) or “unfavorable” (≥5 CTC in 7.5 ml) groups. A total of 231/276 enrolled patients (84 patients) were evaluable. Patients in the “unfavorable” group (57 percent) had shorter median OS (11.5 vs 21.7 months). “Unfavorable” post-treatment CTC counts also predicted shorter median OS at 2-5, 6-8, 9-12, and 13-20 weeks (6.7-9.5 vs 19.6-20.7 months). The prognoses for patients based on their CTC count response to therapy was determined to be as follows: (a) patients with “unfavorable” baseline CTC counts who converted to “favorable” CTC < 5 improved (6.8 to 21.3 months); (b) patients with “favorable” baseline CTC who converted to “unfavorable” worsened (>26 to 9.3 months). The authors concluded that CTC counts are the most accurate and independent predictor of OS in patients with CRPC. These data led to the US Food and Drug Administration approval of this assay for the evaluation of patients with CRPC.

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