The Friday news report: March 13, 2009

We have identified a total of eight new reports today, of which three are particularly interesting, dealing with:

  • Pelvic floor stimulation and biofeedback in the early recovery of continence post-surgery
  • Adjuvant radiation therapy in men with lymph node-positive prostate cancer after radical prostatectomy
  • The so-called “urinary flare syndrome” 16-24 months after permanent seed implant brachytherapy

The other five reports are briefly mentioned with links to the relevant abstracts.

Mariotti et al. have explored the potential benefit of the early combined use of functional pelvic floor electrical stimulation and biofeedback in terms of time to recovery and rate of continence after radical prostatectomy in an initial group of 60 patients. In the treatment group, a program of pelvic floor electrical stimulation plus biofeedback began 7 days after catheter removal, twice a week for 6 weeks. A control group received no treatment. Evaluation of continence was performed at time 0, at 2 and 4 weeks, and at 2, 3, 4, 5 and 6 months during follow-up. The mean leakage weight became significantly lower the treatment group compared to the control group starting at just 4 weeks of followup. At 4 weeks after surgery there was also a significantly higher percentage of continent patients in the treatment group (63.3 percent) compared to the control group (30.0 percent), and this difference was still apparent at 6 months of follow-up (96.7 vs. 66.7 percent). The authors conclude that early, non-invasive physical treatment with biofeedback and pelvic floor electrical stimulation has a significant positive impact on the early recovery of urinary continence after radical prostatectomy.

Da Pozzo et al. have demonstrated that adjuvant radiation therapy combined with hormone therapy offers good long-term outcomes for lymph node-positive prostate cancer patients treated with radical surgery. They conducted a retrospective analysis of data from 250 consecutive patients with pathologic lymph node invasion treated at a tertiary academic medical center between 1988 and 2003. All patients received adjuvant treatment as specificed by the treating physician after collection of detailed patient information: 129 patients (51.6 percent) were treated with a combination of RT and HT, while 121 patients (48.4 percent) received adjuvant HT alone. Mean follow-up was 95.9 months. Biochemical progression-free survival and cancer-specific survival rates at 5, 8, and 10 years were 72, 61, and 53 percent and 89, 83, and 80 percent, respectively. Adjuvant radiation treatment and the number of positive nodes were independent predictors of biochemical progression-free survival  and of cancer-specific survival. The authors state that this study is the first to report a significant protective role for adjuvant radiation therapy in biochemical-progression-free survival and cancer-specific survival of node-positive patients.

Keyes et al. have reported on the late transient worsening of urinary symptoms (“urinary symptom flare”) in 712 consecutive prostate brachytherapy patients treated between 1998 and 2003, with a median follow-up of 57 months. They also studied associated predictive factors, the association with rectal and urinary toxicity, and the development of erectile dysfunction. The incidence of flare was 52 percent and 30 percent using  flare definitions of an International Prostate Symptom Score (IPSS) of ≥ 5 and ≥8 points greater than the post-implant nadir, respectively. Of the patients with symptoms, 65 percent had resolution of their symptoms within 6 months and 91 percent within 1 year. The authors conclude that urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal post-implant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.

In other studies:

  • Reams et al. have carried out a pilot-stage microarray comparison of prostate tumor gene expression in African American and Caucasian American males
  • Cunha et al. have offered data suggesting that alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuitable for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of catheter insertion. In addition, alternative catheter patterns may decrease toxicity by avoidance of the critical structures near the penile bulb while still fulfilling the RTOG criteria.
  • Ferrer et al. have adapted and validated a Spanish language version of the  EPIC (Expanded Prostate Cancer Index Composite) questionnaire for patients with prostate cancer designed to evaluate the impact of treatments on their quality of life.
  • Fitzpatrick et al. have reviewed available data on the added value of PSA kinetics compared with single PSA measurements in the early detection of prostate cancer, and in predicting the outcome of patients with localized and advanced disease.
  • Oudard et al. have conducted a study to evaluate the potential benefit of starting early chemotherapy with docetaxel in patients with asymptomatic metastatic hormone-refractory prostate cancer (HRPC). They suggest that PSA doubling times may be useful in the identification of asymptomatic patients who are candidates for early treatment.

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