Your weekend prostate cancer news: November 22, 2008

Today’s reports cover such topics as:

  • Innaccuracies in use of the Partin tables in two cohorts of European patients
  • Additional evidence that “earlier is better” when radiotherapy is required following surgery
  • Lack of information about the effects of ADT on bone density (at least in Canada)
  • Individual variation in serum testosterone levels among patinets receiving ADT

Bhojani et al. have reported that the most recent update to the Partin tables seem to demonstrate worse performance in two cohorts of European men than they originally did in North American men. They suggest that that predictive models need to be externally validated in local populations before their implementation into clinical practice in individual countries. The “New” Prostate Cancer InfoLink has added a note to the page on the Partin tables warning users that they may not be accurate for all populations.

Jereczek-Fossa et al. have provided further information in support of the thesis that adjuvant radiotherapy and early salvage radiotherapy are more effective that delayed radiotherapy in the treatment of men at high risk for local progression or with a rising PSA post-prostatectomy (or presumably following other foms of localized treatment, such as HIFU, brachytrherapy or cryotherapy, although the study did not include such patients). This study also included detailed information about risks for early and late rectal and urinary adverse events following radiotherapy.

Panju et al. have published data suggesting that (at least in parts of Canada) a minority of patients is being informed of bone-specific side-effects of ADT. According to the data from this study, lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. The authors conclude that practices around bone health for men starting ADT are suboptimal.

Morote et al. have published a report on individual variation in testosterone levels in prostate cancer patients undergoing medical castration with LHRH agonists and other drugs.

4 Responses

  1. I know it has been a long day and my mind may not be too sharp but I can think of factors that would make the Partin Tables less valid for Italian and French men. Can someone explain? Is it differences in surgical technique? Is it related to frequency of screening? Differences in pathology standards? What other factors would explain this?

  2. Kathy:

    There are literally dozens of reasons why nomograms and tables like the Partin tables that are developed using data based on patient set A may not be as accurate for patient set B. The point of this study is that the German group actually proved it.

    People should always be cautious about applying predictive tools of this type. One specific example of a predictive tool that is almost certainly NOT appropriate for use outside the USA is the Prostate Cancer Risk Calculator, which was develped on the basis of the PCPT trial data and therefore is entirely US oriented. Europeans (not to mention Argentinians, Russians, and Japanese) have very different diets and genetics to the “average” American. That alone undoubtedly impacts their risk in ways not addressed by the PCPT trial.

  3. I guess I am asking because my mind likes to understand possibilities and risks. If I am understanding you the new Partin tables may not be applicable to men in Nebraska if the sample was men in Baltimore. The diet and genetic pool may be just as different in these areas as it is between Germany or Italy or France? If all the men are urban it may not be valid for rural men? if the men are all between 55 and 80 then it may not be valid for men in their 30’s or 40’s?

    I know without a lot of work the issues cannot be identified.

    Since we are talking to men all over the world how do we communicate about the Partin Tables?

    Men and physicians have enough problems already have enough problems interpreting the information they have to make decisions about prostate cancer.

    This just muddies the water even more. GRRRRRR

  4. Kathy: I don’t believe that you are correct in saying this. The men treated in Baltimore, on which the Partin tables were based, came from all over America when Patrick Walsh was the “go to” surgeon for prostate cancer therapy. They certainly didn’t just come from Baltimore. I can’t tell you for certainty that some came from Nebraska, but I bet a few did!

    With respect to the rest of the world, I think we need to urge caution. Men can use the Kattan nomograms rather than the Partin tables, for example (or both). But the bottom line is still going to be that all these predictive systems were developed using (at best) nationally-biased groups of patients, which MAY affect their application to other groups.

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