Tuesday’s news reports: March 24, 2009


Comment on an article on PSA velocity and prediction of biopsy outcomes has been provided separately. Today’s other news includes reports on:

  • Pathological outcomes and criteria for active surveillance protocols
  • Outcomes to permanent seed implant brachytherapy: age does not affect outcome
  • Vacuum erectile devices and their value in post-prostatectomy erectile dysfunction
  • Biochemical recurrence post-prostatectomy and the role of hormone therapy

Conti et al. have used data from the University of California San Francisco database to evaluate the pathological outcomes of men meeting published criteria for active surveillance who elected immediate radical prostatectomy to assess the risk of under-grading and under-staging in candidates for active surveillance. They identified 1,097 men who underwent radical prostatectomy with a mean age of 59 years. Overall, 28 percent of the men experienced a Gleason upgrade, 21 percent had extracapsular extension, and 11 percent had seminal vesicle involvement. In men qualifying based on published active surveillance inclusion criteria, rates of upgrading varied between 23 and 35 percent, the incidence of extracapsular extension ranged from 7 to 19 percent, and seminal vesicle involvement ranged from 2 to 9 percent. The authors conclude that varying study entry criteria for active surveillance studies show different rates of adverse pathological features at radical prostatectomy. Apparently, predictably fewer men met the more stringent criteria but these men had a lower incidence of seminal vesicle involvement and extracapsular extension.

Shapiro et al. have reviewed data from 237 patients of < 60 years of age out of a total of 2,119 patients treated with permanent seed implant brachytherapy (with or without hormone therapy and/or external beam radiotherapy) between 1992 and 2005. All patients were clincial stage T1-2N0M0. Median follow-up was 56.1 months. The 5- and 10-year freedom from progression rates (using the Phoenix crieria for recurrence) were 90.1 and 85.6 percent, respectively, for the entire population of 2,119 patients. PSA level, biopsy Gleason score, and year of treatment were significantly associated with freedom from progression while age and clinical stage were not. In the younger cohort the 10-year freedom from progression for patients presenting with low, intermediate and high risk disease was 91.3, 80.0, and 70.2 percent compared to 91.8, 83.4, and 72.1 percnegt, respectively, for men 60 years or older.

Lehrfield and Lee have published a review article focused on the pathophysiology of post-prostatectomy erectile dysfunction and the role of vacuum erectile devices in erectile rehabilitation.

Van Poppel et al. have discussed the  diagnostic evaluation of biochemical recurrence following radical prostatectomy (RP) and offered an overview of the postoperative hormonal treatment (HT) options. No randomized trials of HT after RP have been reported in patients with  postoperative PSA recurrence, so there is no conclusive evidence that HT after RP prolongs survival or reduces morbidity. Intermittent androgen deprivation, non-steroidal anti-androgens, and a combination of finasteride with a non-steroidal anti-androgen may be acceptable options. Combinations of HT with radiotherapy and/or chemotherapy for treatment of recurrent prostate cancer are under study.

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