The Thursday prostate cancer news: February 12, 2009

Four new reports today deal with:

  • Higher grade disease in men diagnosed with prostate cancer because of LUTS
  • The role of MR/MRI in prostate biopsy for carefully defined patients
  • Risk for understaging of prostate cancer
  • Sorenafib in treatment of patients with castration-resistant prostate cancer

In Denmark, PSA testing is only recommended for men with a family history of prostate cancer, or those with lower urinary tract symptoms (LUTS) that could be caused by prostate cancer. However, many Danish men are now diagnosed as a result of unsystematic PSA screening and are undergoing RP even through they are asymptomatic. Borre has reported on data from 585 consecutive Danish men treated with RP between 1997 and 2008 at Aarhus University Hospital, of whom 47 had a family history of prostate cancer and were excluded. In total, 188 patients (35 percent) were asymptomatic at the diagnosis, while LUTS led to the diagnosis in 350 (65 percent). Except for tumor grade after RP, there were no significant differences between these two groups of men with respect to tumor characteristics and treatment outcome. However, the Gleason score of the RP specimen was a statistically significant prognostic indicator (P = 0.002) in favor of symptomatic patients.

Lawrentschuk and Fleshner have reviewed available data on the application of magnetic resonance technology (MR/MRI) as a means to improve biopsy results in men with prior negative biopsies and an elevated PSA level. They conclude that the value of endorectal MRI and MR spectroscopy in such patients appears to be significant. However, they also note that more data are needed to support standard use of this technology, and that a comparative trial of MRI-targeted vs saturation biopsy in this group of patients (inclusive of cost-efficacy data) would help to delineate the relative value of the two techniques.

Bolenz et al. have published yet another paper indicating the risk for clinical understaging of patients based on biopsy data. In this study, based on 559 consecutive patients undergoing radical prostatectomy at a German clinic, 149 patients (26.7 percent) initially diagnosed with prostate cancer in only one of two lobes of the prostate (cT2a,b disease) were subsequently shown to have cancer in both lobes (pT2c disease).

Aragon-Ching et al. have published the results of the second stage of a two-stage, Phase II trial of sorafenib (Sutent/Pfizer). The second stage of this trial accrued 24 patients, 21 of whom had had previous chemotherapy with docetaxel. All patients had bony metastases, either alone (in 11) or with soft-tissue disease (in 13). Overall this study showed that sorafenib has some limited activity as a second-line treatment for metastatic, castration-resistant prostate cancer.

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