Thursday news update, Part A: October 30, 2008

There’s a lot of news today, so we will break it into two sections for reading convenience. In Part A, we deal with information about:

  • Physicial activity and prostate cancer risk
  • Vasectomy and prostate cancer risk
  • The use of surveillance and watchful waiting in men in Sweden
  • A modification to Walsh’s nerve-sparing radical prostatectomy
  • The risks of “multimodal” therapy in high-risk patients and
  • A new, long-acting form of testosterone therapy

A large Swedish study by Wiklund et al. involving over 2,500 prostate cancer patients and unaffected control subjects does not support the idea that a high lifetime level of physicial activity is associated with any protective effect on risk from prostate cancer.

For the umpteenth time, it has again been demonstrated that there is no relationship between vasectomy and risk for prostate cancer. This time the study was conducted by Holt et al. and focused on subgroups, such as men who have a family history of prostate cancer, men who undergo vasectomy at a younger age, and when several decades have passed since the procedure.

In another large Swedish study, Stattin et al. have estimated the use surveillance (i.e., active surveillance and watchful waiting) compared to immediate therapy. According to their data,  among 7,782 incident cases of prostate cancer in men < 70 years of age, diagnosed between 1997 and 2002, with clinical stage T1-2, N0 or Nx, M0 or Mx, and PSA levels < 20 ng/ml, the primary treatment was surveillance for 2,065 men (26 percent), radical prostatectomy for 3,722 (48 percent), radiotherapy for 1,632 (21 percent), and hormonal treatment for 363 (5 percent). Men on surveillance had lower local tumor stages, grades, and PSA levels, and were older than those who received active primary treatment. After a median surveillance of 4 years, 711 men on surveillance (34 percent) had received deferred treatment, which was radical prostatectomy for 279 (39 percent), radiotherapy for 212 (30 percent), and hormonal treatment for 220 (30 percent). A total of 66 percent of the men remained on surveillance.

Patrick Walsh and colleagues at Johns Hopkins have suggested that a modification to the nerve-sparing form of radical prostatectomy known as “unilateral or bilateral high anterior release of the levator fascia” is associated with improved postoperative sexual function. They do note, however, that this modification to the procedure does not affect the potential for positive surgical margins.

Wu et al. have used the CaPSURE database to assess risks associated with “multimodal” therapy in patients with theoretically localized prostate cancer at high risk for progression. Their study focused on patients who received active primary therapy (i.e., surgery or various forms of radiation) for prostate cancer with or without adjuvant or neoadjuvant therapy. They conclude that, “Multimodal therapy may lead to declines in health related quality of life especially in the domains of urinary function, urinary bother and sexual function.” They go on to state that, “These effects must be considered and patients must be counseled appropriately before initiation of multimodal therapy.”

Finally, Morgentaler et al. have reported on the use of long-acting, 750 mg depot injections of testosterone given intramuscularly at 0, 4 and 14 weeks to men with hypogonadism.

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