Thursday’s prostate cancer news: October 23, 2008

In addition to publication of the cryotherapy best practice guidance, other news today includes:

  • Information about selenium levels in blood and prostate tissues
  • An hypothesis about sex steroid-induced inflammatory events as a trigger for prostate cancer development
  • The role of free PSA in diagnosis of prostate cancer in men with a total PSA ≤ 2.5 ng/ml
  • The impact of hormone therapy on strength and musculoskeletal performance

A report from Germany gives data on selenium levels in the blood and tissue of patients with prostate cancer, patients with BPH, and normal, healthy volunteers. This is a small study and should be interepreted with caution. However, the authors conclude that, “Since the whole blood selenium levels measured in all men … participating in our study were significantly lower than the recommended normal range, our findings may support the recommendation of selenium supplementation.”

Vasto et al. have proposed that, “early inflammatory events stimulated by sex hormones [may] serve as a prerequisite for the onset of prostate cancer.” This is not an “off the wall” idea. It is widely accepted that inflammation has a role in many human cancers. Inflammation is thought to incite carcinogenesis by causing cell and genome damage, promoting cellular turnover and creating a tissue microenvironment that can enhance cell replication, angiogenesis, and tissue repair. Furthermore, there is a body of literature suggesting a link between chronic inflammation and prostate cancer, in which prostate inflammation may contribute to the promotion of prostate cancer development.

Based on data collected between 1999 and 2006, Walz et al. have assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in 543 men with total PSA levels ≤ 2.5 ng/mL. According to their data, the most accurate predictor of prostate cancer on biopsy was percent free PSA (0.68) versus age (0.50), total PSA (0.57), or rectal examination findings (0.58). Of patients with percent free PSA below 14 percent, 59 percent had prostate cancer.  We know that the risk of prostate cancer is not negligible in patients with PSA levels ≤ 2.5 ng/mL. Walz et al. argue that percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals.

Galvão et al. have studied the muscle strength and functional performance of men on androgen deprivation therapy (ADT) for prostate cancer and compared them to the capabilities of a group of age-matched controls. Men receiving ADT “were consistently impaired across a broad range of physical and functional musculoskeletal performance assessments” compared with the controls. The authors propose that their  findings are particularly relevant for patients considering hormone therapy for subclinical (i.e., non-metastatic) disease management, but whose physical reserve is marginal.

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