The Christmas day news: December 25, 2008

The Christmas day news is based on four review articles encompassing:

  • New molecular markers for prostate cancer diagnosis
  • The incidence of prostate cancer in China
  • The treatment of “locally advanced” prostate cancer in the UK
  • The mechanism of prostate cancer metastasis

Agrawal and Dunsmuir, noting that assessment of the lethality of “early,” potentially organ-confined prostate cancer (PCa) is one of the central controversies in modern-day urological clinical practice., have reviewed the state of research into new molecular markers and models that may be able to assist in such assessment. They point out that — at least to date — claims for “new,” unique markers commonly fall short of true clinical value, and that such “new” molecular markers are usually useful only in multivariate models. Their review summarizes relevant molecular markers and models reported up to and including 2008.

Zhang et al. suggest that the supposed low incidence of prostate cancer in China may be rooted in a simple lack of early detection. The current prostate cancer mortality-to-incidence rate ratio (MR/IR) in China is supposedly 0.63, which is higher than the average in Asia (MR/IR = 0.57) and much higher than that in North America (MR/IR = 0.13). These data indicate that in China most prostate cancers are in advanced stages at the time of diagnosis, and that patients had a short survival time thereafter. Zhang et al. refer to a somewhat contoversial paper by Stamey et al. , who conducted a retrospective study of prostate cancer in America for the years 1983-2003, and showed that most cases of prostate cancer detected by PSA screening were in advanced stages at the start of this 20-year period. It appears that these American data from early in the PSA era are quite similar to recent results obtained from mass PSA screening of elderly men in Changchun, China.

Payne has reviewed the current status of treatment of locally advanced prostate cancer in the UK. About one-third of new prostate cancer cases in the UK are diagnosed when locally advanced, and there is no real consensus about appropriate management for this stage of disease. She argues that within the structure of the National Health Service, treatment o0f such men, which may require multiple treatment modalities, should only be carried out after approproate assessment of the patient by a qualified, multidisciplinary team. [Dr. Payne is a member of the Scientific Advisory Board of The “New” Prostate Cancer InfoLink.]

Clark et al. have reviewed available data on the molecular basis of prostate cancer metastatis. Although we know that prostate cancer preferentially metastasizes to the bone marrow stroma of the axial skeleton,  the exact mechanism of prostate cancer metastasis is still unknown. Clark and his colleagues address the progress that has been made in determining the key players in this biologic process.

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