Early weekend news: Saturday, December 20, 2008

There are only three notable reports in today’s news stream … but one of them may be very important (if you can understand it) …

In the first report, Vander Griend and colleagues at Johns Hopkins suggest that we may be getting closer to understanding some of the very earliest biologic stages in the development of prostate cancer. In one of those dense scientific papers that are all but incomprehensible to anyone except a specialist in molecular biology, and using a stem cell marker known as CD133, they report that androgen receptor-expressing prostate cancer-initiating cells may be derived from a malignantly transformed intermediate cell that acquires “stem-like activity” and not from a malignantly transformed normal stem cell. They further point out the implication that, if their hypothesis is correct, then the androgen receptor signaling pathways are a therapeutic target for prostate cancer-initiating cells. If you really want to understand the details of this paper, you probably need to call Dr. Jonathon Isaacs at Johns Hopkins!

The second report simply confirms the results of the recent US-based trial showing that selenium levels are of minimal importance in risk for and prevention of prostate cancer. Allen et al. have reported data from a subset of men in the European Prospective Investigation into Cancer and Nutrition (EPIC) study designed to assess any relationship between plasma selenium concentration and prostate cancer risk in 959 men with incident prostate cancer and 1,059 matched controls. The study showed absolutely no significant differences in the association of plasma selenium with risk when analyzed by stage or grade of disease. Similarly, the association of selenium with risk did not differ by smoking status or by plasma alpha- or gamma-tocopherol concentration.

Data from the third report are rather more difficult to interpret. Taussky et al. sought to understand factors influencing treatment decisions in 110 consecutive patients with low risk prostate cancer referred to a Canadian brachytherapy clinic and had asked to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy. Their results indicate that 53 patients chose permanent seed brachytherapy, 33 patients chose expectant management, 12 patients chose external beam radiation therapy, and 10 patients chose radical prostatectomy. Patients who chose brachytherapy were significantly younger than those who chose external beam radiation therapy; patients living further away from the hospital than the median distance of 19.85 miles were more likely to choose brachytherapy than expectant management. We would probably need to know a great deal more about these patients and their decision processes to understand the significance of these data.

2 Responses

  1. The third report in this group is interesting to me. I wonder how the information was delivered to the men. It is normal to have personal biases communicated to men in conversations. This biases are not necessarily bad but rather the personal beliefs of the person sharing the information.

    I guess I am wondering what use this study was except possibly for this particular treatment center.

  2. That would seem to be the basic problem with the report (and I’ve only seen the abstract). There are so many unanswered questions that I am not sure how to interpret any of it, starting with why these men were referred to a brachytherapy center in the first place.

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