THE "NEW" PROSTATE CANCER INFOLINK

This weekend’s news reports include items on:

• Androgen pathway genes and prostate cancer risk
• Pre-treatment PSA doubling time and prediction of Gleason score
• The diagnosis of prostate cancer in men with a diagnosis of HG-PIN
• Neoadjuvant hormone therapy in men undergoing brachytherapy
• Acupuncture as a means to manage hot flashes

Mononen and  Schleutker have reviewed the association of androgen pathway genes and their polymorphic sites, and the risk of prostate cancer in individuals of different ethnic backgrounds. They state that the most recent data suggest that androgen pathway genes have a role in prostate cancer susceptibility. However, the effects of polymorphisms seem to vary in different patients, populations and ethnic backgrounds. They conclude that the association between androgen pathway gene polymorphisms and prostate cancer risk is complex and characterized by contradictory results. However, they also note that recent developments that reach beyond single gene studies, such as genome scale single nucleotide polymorphism studies and multinational collaborations, are a great prospect for future study and understanding more complex interactions.

Nowroozi et al. have evaluated pre-treatment PSA doubling time (PSADT) as a means to differentiate between patients with high-grade prostate cancer who require more aggressive therapy and those with lower-grade cancer. Their study was based on data from 59 patients who had extended 12-core transrectal ultrasonography-guided biopsies and who had confirmed prostate cancer. All 59 patients were previoulsy untreated and had at least two consecutive serum PSA tests with a rising trend. The authors showed that men with a short PSADT (< 12 months) were at a higher risk of harboring a high-grade prostate cancer. They conclude that PSADT may be able to identify patients with high Gleason score tumors who require more aggressive therapy. The “New” Prostate Cancer InfoLink thinks that the need for a highly structured prospective study to assess whether this type of application of PSADT (and/or PSA velocity) to predict the aggressiveness of and outcomes from prostate cancer pre-treatment is becoming critical.

Rapp et al. have suggested that, when initial biopsy cores show the presence of high-grade prostatic intraepithelial neoplasia (HG-PIN), the biopsy cores should be “recut” by the pathologist and re-reviewed. Data collected by this group of authors at the University of Chicago suggest that prostate biopsy recutting may increase cancer detection in patients initially found to have HG-PIN. Furthermore, a significant cost savings is associated with the recutting protocol. [Editorial comment: At present, guidelines suggest that a man diagnosed with HG-PIN should be rebiopsied at 3 or 6 months after the initial biopsy.]

Ishiyama et al. have proposed an interactive methodology that allows brachytherapy providers to reduce the risk of post-traumatic swelling following implantation — which is actually increased by cessation of hormone therapy.

Lee et al. have published a structured literature review assessing the effects of acupuncture as a treatment for hot flashes in prostate cancer patients who have or are receiving androgen ablation therapy. They conclude that, “The evidence is not convincing to suggest acupuncture is an effective treatment for hot [flashes].”

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: acupuncture, androgen pathway genes, brachytherapy, Diagnosis, HG-PIN, hot flashes, neoadjuvant hormone therapy, polymorphism, pre-treatment PSA doubling time |