All the early Tuesday news: January 6, 2009

There are multiple news reports available today, including coverage of the following:

  • Vegetable consumption and prostate cancer risk
  • Anti-hypertensive medications and prostate cancer risk
  • Prostate cancer incidence among South Indian and Pakistani immigrants to the United States
  • Bladder neck contracture and type of surgery
  • Cytotoxic and targeted chemotherapies in the managment of prostate cancer
  • The impact of race on prostate cancer detection and choice of treatment

Chan et al. have reviewed data on vegetable consumption and risk for prostate cancer. This review does not appear to add significant knowledge to current awareness that “a diverse diet, rich in vegetables” may be able to help to reduce the risk of prostate cancer (as well as many other diseases).

A retrospective review of data from the 48,389 men enrolled in the Cancer Prevention Study II Nutrition Cohort, and published by Rodriguez et al., concludes that the results “do not support the hypothesis that anti-hypertensive medication is strongly associated with risk of prostate cancer.” 

South Asian immigrants living in the United Kingdom and Canada have been found to have lower rates of cancers of all types compared with the native-born population and most other immigrant groups. Goggins and Wong investigated the cancer incidence rates among Asian Indian and Pakistani people in the United States (a previously under-studied topic). They showed that Asian Indian and Pakistani people in the United States have relatively low incidence rates for most major cancers, which is consistent with studies from other countries. Specifically, they demonstrated that site-specific rates of incidence were lower for both genders for most sites including prostate, breast, colorectal, and lung cancers. They also noted that survival rates were generally better among Asian Indians and Pakistanis than among Caucasians (with the notable exception of breast cancer, for which Caucasians had slightly better survival).

Swords et al. carried out a retrospective review of the impact of race on prostate cancer detection and choice of treatment in a series of 500 consecutive men receiving a contemporary extended biopsy. All patients underwent a contemporary 10-12 core biopsy scheme between 2003 and 2005. Of the 500 patients, 65 percent were Caucasian American, 29 percent African American, and 7 percent “other” (including Hispanics, Asian Americans and Native Americans). The overall positive biopsy rate was 44 percent. African Americans were significantly younger than Caucasian Americans but were not younger than “others” (61.6 vs. 64.3 vs. 61.5 years). No differences were observed with regard to PSA density, prostate volume, or rate of abnormal digital rectal exam (DRE). The positive biopsy rate was closely comparable between Caucasian Americans and African Americans (46 vs. 46 percent), but significantly lower in “other” men (16 percent). Of the 223 men with positive biopsies, information on treatment choice demonstrated that African American men had a significantly higher probability of selecting radiotherapy of some type (odds ratio = 2.12) and a significantly greater likelihood of avoiding surgery (odds ratio = 0.35) than Caucasian American men.

Webb et al. have reported a lower risk for bladder neck contracture (BNC) post-surgery in men undergoing robot-assisted laparoscopic prostatectomy (RALP) than in men undergoing open radical retropublic prostatectomy (RRP). Their data are based on a retrospective review of 200 consecutive operations performed by a single surgeon between 2003 and 2007 (100 operations of each type). The authors suggest that the reason for the difference in risk for BNC is that patients treated using RALP had the urethra reattached to the bladder neck by a continuous suturing technique known as the “parachute” technique in association with RALP; by contrast, patients treated withe RRP were managed with a conventional stomatization and “racquet handle” repair technique. The “New” Prostate Cancer InfoLink would point out that while this result may be true for this particular surgeon, that does not necessarily make it true for other surgeons (which is one of the problems with all single-surgeon trials). We would also note that 200 procedures over a 5-year period (an average of 40 procedures a year) is well below what would be considered to be an acceptable case load for high prostatectomy skill level in the USA today (regardless of the technique being used).

Chang and Kibel have reviewed the current application of cytotoxic and targeted chemotherapies in the managment of prostate cancer in the January issue of BJU International. The full text of their article is available on the UroToday web site. It should be noted that some of the information provided in this review is a little outdated by events (e.g., the fact that the VITAL-1 and VITAL-2 trials of GVAX were terminated because of an increased risk of death in the GVAX arm of the VITAL-2 trial) because the review was accepted for publication last June but only published this month.

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