The Thursday morning news reports: January 8, 2009

This morning’s news reports address:

  • Prostate cancer risk and obesity (again)
  • Italian experience with HIFU at a median follow-up of about 2 years
  • The prognostic value of a 5-year PSA value <0.2 ng/ml in men treated with brachytherapy (with or without EBRT and/or hormones)
  • Proposed European guidelines on the need to remove the seminal vesicles during radical proostatectomy
  • Comparative quality of life in men treated with brachytherapy or EBRT
  • Data on picoplatin in treatment of HRPC

Pruthi et al. have investigated the impact of body mass index (BMI) on risk for prostate cancer in a series of 500 men undergoing a modern 10- to 12-core biopsy approach. Patient age, PSA level, PSA density, digital rectal examination findings, transrectal ultrasound prostate volume, and biopsy outcome (including grade) were compared to anthropometric measures, including BMI. A total of 130 men (26 percent) were obese according to BMI measurement, and 223 men (45 percent) had a positive biopsy. Obese men were younger, had a larger prostate, and were less likely to have abnormal digital rectal examinations. Although some trends toward a lower detection rate in obese men were observed, such differences were not observed on multivariate analysis, nor were any differences observed in the incidence of higher grade tumors, thus questioning the impact of obesity on prostate cancer detection and behavior in the authors’ cases series.

Mearini et al. have reported preliminary results of experience in Perugia and Turin (Italy) with high-intensity focused ultrasound  (HIFU) as a first-line treatment option for localized prostate cancer. Between 2004 and 2007, they treated 163 consecutive men with T1-3N0M0 prostate cancer using the Sonablate 500 equipment. Post-treatment PSA assays  were carried out at 1 month and then every 3 months, and a random prostate biopsy at 6 months. Failure was defined by the PSA nadir, by positive findings on follow-up biopsy, and by biochemical failure according to Phoenix criteria. The median patient age was 72 years; the median baseline PSA level was 7.3 ng/ml; and disease stage was T1 in 44.1 percent, T2 in 42.5 percent, and T3a in 13.4% percent of patients. Median followup was 23.8 months. Post-HIFU, patients’ PSA levels decreased to a median nadir of 0.15 ng/ml. Median PSA levels at 3 and 6 months were 0.30 and 0.54 ng/ml, respectively. At 6 months the negative biopsy rate was 66.1 percent. There was no biochemical evidence of disease in 71.9 percent of patients overall. The authors conclude that a favorable outcome of HIFU is associated with lower baseline PSA levels, lower PSA nadir levels, a lower Gleason score, and a lower tumor stage. They further state that longer-term data will be required before this technique gains widespread clinical acceptance.

Stock et al. have reported on the prognostic significance of the 5-year PSA value for prediction of prostate cancer recurrence after brachytherapy alone or brachytherapy combined with hormonal therapy and/or external beam radiotherapy. They treated 742 patients between 1991 and 2002. These patients were free of biochemical failure during the first 5 years post-treatment and had documented PSA values at 5 years. The median follow-up time was 6.93 years. The actuarial 10-year freedom from PSA failure rate was 97 percent using the ASTRO definition and 95 percent using the Phoenix definition. The results of this study show that the prognosis for patients treated with brachytherapy and who remain biochemically free of disease for ≥ 5 years is good; no patients developed metastatic disease during the first 10 years after treatment. The 5-year PSA value appears to have good prognostic accuracy, and patients with a 5-year PSA value < 0.2 ng/ml are unlikely to develop subsequent biochemical relapse.

The European Society of Urological Oncology (ESUO) has questioned the need for removal of the seminal vesicles during radical prostatectomy in patients with a PSA level < 10 ng/ml (except when the biopsy Gleason score is > 6 or >50 percent of the biopsy cores are positive. Secin et al. used independent data from 1,406 men who underwent radical prostatectomy and seminal vesicle removal between 1998 and 2004 to evaluate the accuracy of the proposed ESUO algorithm. Among patients who had seminal vesicles invasion, 81/90 were positive at a 90 percent sensitivity level, while 656/1,316 patients without seminal vesicle invasion were negative with 50 percent specificity. The negative predictive value was 98.6 percent. The authors suggest that a more formal decision analysis is needed to determine the clinical value of the European Society of Urological Oncology algorithm.

Pinkawa et al. have carried out a matched-pair comparative analysis of quality of life before and after first-line treatment of 104 prostate cancer patents with iodine-125 brachytherapy (n = 52) as compared to external beam radiation therapy (EBRT, n = 52). Patient pairs were matched according to age (± 5 years), prostate volume (± 10 cm3, use of antiandrogens, and erectile function. Urinary function/bother scores decreased significantly more after brachytherapy at 1 month after treatment and at a median of 16 months after treatment. Bowel function/bother scores tended to be higher after brachytherapy, with a lower percentage of patients with painful bowel movements and rectal bleeding. No differences were observed with respect to erectile dysfunction.

Poniard Pharmaceuticals has announced that results of a Phase II clinical trial of picoplatin (together with docetaxel and prednisone) in first-line treatment of metastatic, hormone refractory prostate cancer will be presented at the ASCO 2009 Genitourinary Cancers Symposium, in Orlando, Florida in February.

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