Thursday’s prostate cancer news: November 13, 2008

Today’s reports include items on:

  • Perceptions of pain and discomfort in men undergoing DRE
  • 10-year survival data of men with pT3 disease treated initially with a radical prostatectomy
  • Orchiectomy, medical castration, and acceptable social costs
  • Hemi-body radiation to treat pain in men with multiple bone metastases

Romero et al. have studied perceptions of pain and discomfort in Brazilian males undergoing DRE and the effects of these perceptions on follow-up screening activities and recommendations about screening to friends and family members. They conclude that, “Pain and discomfort during DRE are not negligible but they do not affect intention to have a prostate exam in the future. Urinating immediately before examination does not significantly reduce the incidence of pain, urinary urgency, or bowel urgency during DRE.”

Roche et al. have reported 10-year survival data on 246/606 consecutive patients with localized prostate cancer receiving radical prostatectomy as primary treatment and staged as pathological stage T3NxM0 following surgery. Based on the 2002 TNM staging system, 170/246 patients (69.1 percent) were staged as pT3a and 76/247 (30.9 percent) as pT3b. Patients received adjuvant radiotherapy, salvage radiotherapy, and/or hormone therapy as deemed necessary. Their results at 10 years are as follows: biochemical progression-free survival = 54 percent; metastasis-free survival = 86 percent; prostate cancer-specific survival = 92 percent; overall survival = 75 percent. Lymph node extension, high Gleason score, high preoperative PSA, seminal vesicle involvement, positive surgical margins, and lack of adjuvant radiotherapy were associated with less good survival data.

In a review of the value of surgical orchiectomy compared to medical castration with LHRH agonists in treatment of advanced prostate cancer for the German health technology administration, Rhode et al. state that while the available evidence clearly shows that the two techniques are equivalent in terms of efficacy, safety, and quality of life, “A change back to orchiectomy — even though it is more cost-efficient — cannot be recommended when taking the extended indications for temporary hormone deprivation into consideration.”

Berg et al. have reported that half-body or hemi-body radiation was effective and safe in relieving pain in 76 percent of 44 patients with multiple bone metastases. (41 of the 44 participants were prostate cancer patients.) For most patients, the pain relief was lasting throughout the follow-up period. However, fewer than 10 percent of the patients experienced complete pain relief with no residual pain in the treated field. About one third of the patients were able to reduce their intake of analgesics. Grade 1-2 diarrhea was the most common side effect, observed in 49 percent of the patients 2 weeks after treatment.

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