The Thursday news report: March 5, 2009

There are a significant number of relatively long-term news items in today’s report. Of most immediate interest to the majority of prostate cancer patients and educators we include reports on:

  • The fact that over 70 percent of cancers thought to be unilateral at biopsy turn out to be bilateral post-surgery (which has implications for focal therapy)
  • The availability of degarelix for actual prescription and clinical use in the USA
  • The formation of a specialized new urologic oncology research institute at UCLA

According to a report from Tareen et al., “Unilateral prostate cancer on biopsy predicts unilateral disease on RP pathology in only 27.6% of cases. The predictive ability is not improved by adding biopsy and clinical characteristics.” This is a conclusion from a retrospective analysis of data from pretreatment biopsies and subsequent radical prostatectomies carried out 880 evaluable patients between January 2000 and June 2007. The authors further note the implication that, “Additional methods are needed to accurately identify men appropriate for focal therapy.”

Jeffery et al. have reported on the early stages of development of the proposed Cancer Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function instrument. One of the objectives of the development of this tool is to offer a standardized means to report impact on sexual function resulting from differing types of therapy in clinical studies.

Degarelix for injection, the injectable gonadotropin-releasing hormone (GnRH) receptor antagonist approved by the U.S. Food and Drug Administration (FDA) for the treatment of hormone sensitive advanced prostate cancer at the end of last year, is now available for prescription in the USA, according to a media release from Ferring Pharmaceuticals USA. No brand name for this product has been approved as yet.

Andrzejewski et al. have reported laboratory (in vitro) data on the potential activity of the combination of curcumin + tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) as an adjuvant therapy for men wioth hormone-refractory prostate cancer.

Mitsogiannis et al. have reviewed available data on the use of the long-acting somastatin analog lanreotide in the treatment of castration-resistance prostate cancer (CRPC). They argue that, on the basis of those data, a randomized Phase III clinical trial should be conducted to investigate whether this drug has a “real” clinical impact on the progression of CRPC.

Salvador-Morales et al. have reviewed the potential of multifunctional nanoparticles in the treatment of prostate cancer. (Most such work is still in very early stages of development.)

According to a media release, the University of California at Los Angeles (UCLA) has opened a new, multi-specialty, patient-centered institute dedicated to developing leading-edge therapies for the treatment of prostate and other urologic cancers: the Institute of Urologic Oncology at UCLA. The new institute will be a part of UCLA’s Jonsson Comprehensive Cancer Center.

3 Responses

  1. The statement: “The fact that over 70 percent of cancers thought to be unilateral at biopsy turn out to be bilateral post-surgery (which has implications for focal therapy)” is correct. “Contemporary transrectal prostate biopsy” doesn’t sort that out. That’s why focal therapy practitioners have gone to transperineal 3-D mapping biopsies.

    For those who believe that hemiablation is the way to roll, discovery of bilateral disease takes that treatment option off the table.

    Focal treatment would simply go after the cancer wherever it was found.

    As many articles Mike has posted show, conventional 12 needle transrectal prostate biopsies miss or undergrade over 25% of prostate cancers. Most urologists use them as little more than a trip wire. They should not be used as a basis for focal treatment, or to mind, to decide any course of action with the majority of low risk PCa being detected. Mapping biopsy may indicate radical treatment, hemiablation, focal treatment, or surveillance as appropriate.

  2. Steve,

    Are there any studies (even short-term studies) concerning potential problems with mapping biopsy? I know you’ve had one and I know how thorough you are, but it has always seemed to me that hitting the very small (and very well protected) prostate gland with 50 or more needles can’t be good for it.

  3. Terry,

    A quick googling wasn’t much help. Here’s what my doc’s assistant said when I asked the same question …

    Dr. Barqawi recently presented his findings at the AUA meeting in May [08] for the mapping biopsy. Out of 125 patients, here were some of the complications:

    9 patients experienced clot retention
    9 patients experienced urinary retention
    1 patient experienced a scrotal skin infection
    1 patient had a rising temperature 24 hours after the procedure; his cultures were negative and he was treated with a 7-day course of antibiotics.

    He said that most of the complications were self-limiting.

    The mapping biopsy is more rigorous, but I was sedated during the mapping biopsy. I was on a catheter for 24 hours after my 51 needles and had some discomfort and a little hematuria (60 hours). Urination was a little difficult for about the same period. Intercourse was OK after 5 days, but more blood than semen for ejaculate for about 2 weeks.

    Three weeks after the transrectal biopsy, I came down with a urinary tract infection that involved the prostate, my first ever. Transrectal can’t be the cleanest access route.

    Like any procedure, any biopsy involves risks. As I’ve noted other places, some think that the scarring that can result may complicate subsequent surgery. At least with transperineal mapping biopsy, you know what you have. With only minor discomfort and no lasting effects, I feel it was worth it.

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