The Halloween news for October 31, 2008

We have separately commented on a Swedish pilot study showing that men treated with captopril following radical prostatectomy had a  significant reduction in risk of biochemical recurrence. Other reports today deal with:

  • The potential of contrast enhanced eMRI in diagnosis and monitoring
  • Whether we can better identify high-risk patients with localized disease for curative surgery
  • Early-stage patients and risk for prostate cancer-specific mortality
  • Hot flashes and depression

The role of endorectal magnetic resonance imaging (eMRI) in the diagnosis and follow-up of patients with prostate cancer is evolving. Contrast-enhanced eMRI (CE-eMRI) is a further evolution of the original technique. Cirillo et al. have now demonstrated not only that that eMRI has “great accuracy for visualizing local recurrence” of prostate cancer after radical prostatectomy, but also that CE-eMRI “improved diagnostic performance” significantly in comparison with T2-weighted eMRI alone. Whether such diagnostic techniques can be considered to be cost-effective is a whole other question.

Based on their experience to date, Nakanishi et al. have proposed criteria for the selection of patients with clinical stage T1c-T2N0M0, high-grade prostate cancer (Gleason score ≥ 8) who are potentially appropriate patients for treatment with radical prostatectomy and can be expected to have a high probability of curative outcome. They claim that, “Applying our criteria for prostatectomy could significantly decrease the risk of inadequate cancer control and increase the probability of maintaining potency in patients with prostate cancer with biopsy Gleason score 8 or greater.”

Simone et al. have reviewed the complete CaPSURE database to assess available mortality data. The database included 13,124 subjects, of whom 5,070 had clinical T1c-T3a prostatic adenocarcinoma treated with radical prostatectomy (77 percent) or radiation therapy (23 percent) and post-treatment follow-up data. Of these 5,070 men, only 55 (1.1 percent) had died of prostate cancer; 296 (5.8 percent) had died of other causes; and 4,719 (93.1 percent) were still alive at the end of the observation period (at an average follow-up of 3.3 years). The authors report that, “Factors that exclusively predicted death from non-prostate cancer causes included age at diagnosis, having a high school education or less, high clinical risk, smoking at time of diagnosis, concurrent non-prostate malignancy and worse scores on the Short Form-36 Health Survey physical function scale.”

Finally, in one of those studies that seems to have been designed to confirm the completely obvious, a psychooncology research group has confirmed that for men starting androgen deprivation therapy (ADT), during the first 3 months of ADT, “men who did not experience hot flashes had a significant decrease in total cancer-related distress and avoidance over the 3-month period, while men with hot flashes exhibited no change in distress.” Surprise! They go on to say that, “Further research should extend these findings …  and provide evidence for the direction of causality between hot flashes and distress.” What?

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