Your Monday News update: November 17, 2008

We apologize to readers the lack of a weekend news report due to travel constraints, but this report will include all the past 3 days news that we are aware of, including:

  • The relative value of PSAV and PSADT in predicting risk for positive results on rebiopsy
  • Prostate size and brachytherapy
  • Microspcopic bladder neck invasion of prostatectomy specimens
  • Early chemohormonal therapy + radiotherapy for high-risk patients

Ng et al. have reported that PSA velocity (PSAV) appears to provide a more accurate assessment of repeat biopsy results that PSA doubling time (PSADT) in men with localized, untreated prostate cancer being managed on an active surveillance protocol. Their trial was conducted between 2002 and 2005 and included 199 eligible men who had favourable-risk, localized prostate cancer (T1-T2a, PSA level ≤ 15 ng/ml, Gleason score ≤ 3 + 4 = 7, percentage positive biopsy cores ≤ 50 percent) and consented to active surveillance. Repeat biopsies were taken after 18-24 months, with adverse histology defined as any of the following: primary Gleason grade ≥ 4, >50 percent of cores positive, or initial Gleason score 3 + 3 upgraded to ≥ 3 + 4 = 7. The median PSAV and PSADT were 0.71 ng/mL/year and 5.29 years, respectively. Fifty-three patients (27 percent) had adverse histology on repeat biopsy. Both PSAV (P < 0.001) and PSADT (P = 0.019) were associated with adverse histology. However, PSAV was slightly better a predicting adverse histology.

Meyer et al. have shown that men with localized prostate cancer and prostate volumes ≥ 50 ml should not necessarily be excluded from consideration for treatment with real-time, three-dimensional seed implantation.

Based on a retrospective analysis of data from > 1400 patients, Rodríguez-Covarrubias et al. have reported that microscopic bladder neck invasion (BNI+) is not an independent risk factor for biochemical progression in men undergoing radical prostatectomy. They suggest that BNI+ should be regarded only as a factor that worsens the prognosis of the underlying tumour stage. However, they also state that longer follow-up is necessary to confirm these findings.

Kelly et al. have reported results of a small, Phase II, multicenter clinical trial of “TEC” combination chemotherapy with androgen deprivation and radiotherapy in the treatment of unfavorable risk, localized prostate cancer. Patients received 4 cycles (16 weeks) of continuous, weekly, intravenous paclitaxel with oral estramustine at  3 times a day for 5 days a week and carboplatin on Day 1 of every cycle followed by three-dimensional conformal or intensity-modulated radiotherapy (total dose of 77.4 Gy). All patients also received androgen deprivation therapy with either goserelin acetate or leuprolide acetate starting at Day 1 of therapy. Twenty-seven of 34 patients completed therapy and were evaluable for safety and feasibility. One patient had grade 3 nausea during chemotherapy. No other grade 3 or 4 gastrointestinal, cardiovascular, or genitourinary acute or late toxicities were reported. The most common grade 1 to 2 late toxicities were proctitis (11 percent), dysuria (11 percent), and urinary frequency/urgency (33 percent). Two deaths due to prostate cancer were observed. Median follow-up was 38 months among 24 surviving patients; median PSA progression-free survival was 12.1 months. The authors conclude that, “Neoadjuvant chemohormonal therapy with TEC followed by high-dose radiation therapy is safe and feasible in a multicenter setting.”

A Scottish researcher has been awarded a grant to explore why modifications in the structure of an un-named protein appears to be responsible for making prostate cancer unresponsive to treatment with standard froms of androgen deprivation therapy.

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