Thursday news update, Part B: October 30, 2008

Part B of today’s prostate cancer news update includes information about:

  • Screening behaviors of Afro-Caribbean men in Brooklyn, NY
  • Weight loss and prostate cancer risk
  • Potential of upgrading and upstaging of men with “favorable” prostate cancer on diagnosis
  • Effects of ADT on body lean and body fat mass
  • Salvage radiotherapy + androgen deprivation and toxic impact of treatment

Gonzalez et al. have reported that men of Afro-Caribbean ethnicity living in Brooklyn, New York, are no less likely than white men to undergo initial PSA screening but they are much less likely to maintain annual screening. They comment on the importance of comprehensive discussion and annual examinations and the role of [primary care] physicians in ensuring PSA screening continuity.

In a review published in the British Journal of Cancer, Wolin and Colditz have concluded that weight loss may have a effect on lowering risk of prostate cancer. However, The “New” Prostate Cancer InfoLink would point out that weight loss for many men would be likely to have much greater impact on risk for other disorders (such as heart conditions, diabetes, high blood pressure, etc.). Any lowering of prostate cancer risk is proably minor by comparison with the lowering of risk for these conditions, all of which are associated with high risk of mortality.

Thong et al. have studied the likelihood of pathological upgrading or upstaging at radical prostatectomy in patients initially diagnosed with Gleason score 6, microfocal prostate cancer (defined as 5 percent or less in just one biopsy core). Such men are commonly classified as having relatively “favorable” disease. The authors initially identified 1,271 patients with Gleason 6, microfocal prostate cancer from a prospective database of consecutive, robot-assisted laparoscopic prostatectomies performed between 2003 and 2008. Of these 1,271 patients, 192 had prostate cancer in ≤ 5 percent of one core on biopsy. However, 42/192 patients (22 percent) had adverse pathological outcomes, including upgrading in 35 (18 percent) and upstaging in 16 (8 percent). They conclude that although a microfocus of Gleason score 6 prostate cancer on biopsy is commonly considered low risk disease, in this study there was > 20 percent risk of pathological upgrading and/or upstaging following surgical treatment.

A study by van Londen et al. over a 2-year period appears to have confirmed what many men with prostate cancer already know from personal experience. Men with prostate cancer on androgen deprivation therapy (ADT) have significant gains in body fat mass and losses in lean body mass over. These changes are most pronounced with initiation of ADT.

Pearse et al. have investigated the incideance of acute and delayed gastrointestial (GI) and genitourinary (GU) side effects of salvage radiotherapy (RT) in men receiving external beam radiotherapy and androgen suppression following the failure of radical surgery. Based on data from this prospective trial in 75 men, they conclude that,”Salvage RT was generally was well tolerated. Grade 3 or higher late GI or GU toxicity was uncommon.” While no grade 4 toxicities were observed in this trial, the “New” Prostate Cancer InfoLink would note that the occurrence of grad 2 and grade 3 toxicities was not uncommon in either the acute or the delayed setting, and that patients should certainly be sure to ask their doctors about and understand these risks priopr to undergoing salvage radiation. The data from this satudy is in complete contrast to the data reported by Wu et al., and referred to in Part A of today’s news update.

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