All the Wednesday news: November 5, 2008

Today’s news addresses such issues as:

  • The potential of MRI/MSRI in the decision to treat men with low-risk, localized prostate cancer
  • Understaging of older patients with high PSA levels
  • Relative effectiveness and safety of LRP and RALP
  • An experimental technique called “irreversible electroporation”
  • The use of RALP in treatment of obese men

Based on a systematic review of the available data, Umbehr et al. suggest that the combination of magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) could offer a suitable test definition of low risk patients who do appear to need treatment (a so-called “rule-in” test).

Isariyawongse et al., using the Duke prostate cancer database, have demonstrated that older age (> 60 years of age) and high PSA levels (> 10 ng/ml) are associated with an increased risk for diagnostic undergrading. In other words, there is a high potential for older men with high PSA levels to be assigned a Gleason score that is lower than what would be found on post-surgical pathology. This finding has implications for the appropriate application of active surveillance in older patients.

Using retrospective analysis of patient information from two databases focused on surgical procedures all carried out by  the same surgeon, Hakimi et al. claim that robot-assisted laparoscopic radical prostatectomy (RALP) “is an equivalent, if not a superior, minimally invasive surgical option for localized prostate cancer with less blood loss and a shorter operative time and length of stay” when compared to non-robotic laparoscopic radical prostatectomy (LRP).

Rubinsky et al. have published techical information supporting the further development of an experimental prostate cancer therapy called “irreversible electroporation,” in which microsecond-long pulses of direct current are applied to create permanent defects in cell membranes.

Wiltz et al. have published data suggesting that obese men with prostate cancer being treated with RALP experience a longer operative time, and have less good  urinary and sexual outcomes that other patients. They further suggest that this is particularly the case when the surgeon is early in his or her RALP learning curve. They state that “These details … should be discussed with obese patients during preoperative counseling.”

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: