The weekend prostate cancer news: Saturday, January 31, 2009

Items covered in this weekend news report include:

  • Acrylamide exposure as a potential risk for prostate cancer
  • The relative merits of three standard first-line therapies in intermediate risk prostate cancer
  • Estramustine + etopside in hormone-refractory prostate cancer (HRPC)
  • Bone turnover markers and risk for skeletal-related events in patients receiving zoledronic acid

Acrylamide, a probable human carcinogen, is formed during the cooking of many commonly consumed foods. Data are scant on whether dietary acrylamide represents an important cancer risk in humans. Wilson et al. studied the association between acrylamide and prostate cancer risk. They were unable to find any significant associations between acrylamide exposure and risk of prostate cancer by stage, grade, or PSA level.

Using data from the Cleveland Clinic, Klein et al. have reviewed recent results from an institutional database and prospective quality of life study comparing cancer-related and quality of live (QOL) outcomes among men managed using three treatment modalities for intermediate risk prostate cancer. The results suggest similar short-term survival but varying domain-specific effects on QOL after treatment with radical prostatectomy, brachytherapy, or external beam radiotherapy.

Spitaleri et al. have reported on a phase II trial to determine the activity and safety of estramustine plus oral etoposide in HRPC. Patients were given estramustine (280 mg twice daily) and etoposide (100 mg/day, days 1-21) in 28-day cycles until disease progression or unacceptable toxicity. Between November 2001 to February 2007, 75 patients were enrolled. All patients were assessable for safety; 17 (22.6 percent) had grade 3/4 toxicity. PSA response was assessable in 69, 14 of whom had a > 50 percent reduction in PSA. Of 10 patients with one or more measurable lesions, 2 had partial responses and 2 had disease stabilization. The median overall time to progression was 4.4 months; themedian survival was 23 months.The authors conclude that estramustine plus etoposide is active and has a manageable safety profile in patients with HRPC. The “New” Prostate Cancer InfoLink is not so convinced that one can draw this conclusion from an unblinded and uncontrolled study of this type.

Bone turnover markers, such as  total and bone-specific alkaline phosphatase, amino-terminal procollagen propeptides of type-I-collagen (PINP), cross-linked N-terminal (NTx), cross-linked C-terminal telopeptides of type-I-collagen (ICTP), and C-terminal telopeptides of type-I-collagen as well as PSA are helpful in the diagnosis of bone metastases. Lein et al. attempted to evaluate the usefulness of these markers in 117 prostate cancer patients with bone metastases before and during treatment with zoledronic acid as predictive and monitoring tools of skeletal-related events (SREs). Fifty-six patients had and 61 patients did not have an SRE during a 60-week study period. Higher baseline concentrations of bone turnover markers were observed in the SRE group. With the exceptions of ICTP and tALP, levels of all bone turnover markers decreased to 20-80% of their baseline values at week 12 after drug administration, showing a generally higher decline in the non-SRE group except for NTx. At all time points during treatment, higher and increasing concentrations of bone turnover markers were observed in the SRE group compared with the non-SRE group. The autrhors conclude that bone turnover markers are useful tools to predict and diagnose SRE in prostate cancer patients with bone metastases who are receiving zoledronic acid therapy.

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