The news report: Wednesday, April 15, 2009

Today’s reports deal with:

  • Prediction of positive lymph pelvic nodes in newly diagnosed patients
  • Active surveillance: current criteria for management and outcomes overview
  • Metabolic complications of androgen deprivation therapy

Nguyen et al. have re-assessed the “Roach formula” that has been used historically to project risk for positive lymph nodes in men with an initial diagnosis of prostate cancer, prior to first line treatment. This Roach formula was constructed based on data from patients in the early days of the use of the PSA test. Men being diagnosed in the USA today are customarily found to have a lower incidence of positive lymph nodes than was normal in the early to mid-1990s. Based on data from 309 prostatectomy patients who were actually diagnosed with positive lymph nodes (3.29 percent) out of a total of over 9,000 who had surgical lymph node evaluation, Nguyen et al. were able to calculate that the Roach formula over-predicts risk of positive lymph nodes for all patients except those with an original Roach score of 30-40 percent. They propose suitable adjustment factors to the Roach formula.

Bastian et al. have carried out a systematic review of active surveillance protocols to assess the inclusion criteria for active surveillance and the outcome of treatment. Their review included all publications through October 2008. They report that recent inclusion criteria of the studies are generally similar. They state that, given the relatively short follow-up periods of all studies, the majority of men do in fact stay on active surveillance; that the percentage of patients receiving active treatment is of the order of 35 percent of all patients; that once patients require active treatment, most still present with prostate cancer that can be treated with curative intent; and that  few deaths due to prostate cancer have occurred.

Saylor and Smith have reviewed data on the more recently described metabolic complications of androgen deprivation therapy (ADT), including obesity, insulin resistance, and lipid alterations as well as the association of androgen deprivation therapy with diabetes and cardiovascular disease. They note that ADT decreases lean mass and increases fat mass. It also decreases insulin sensitivity while increasing levels of low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglycerides. They state that, consistent with these adverse metabolic effects, ADT may be associated with a greater incidence of diabetes and cardiovascular disease. Some of these ADT-related metabolic changes (obesity, insulin resistance and increased triglycerides) overlap with features of the metabolic syndrome. However, in contrast to the metabolic syndrome, ADT increases subcutaneous fat and high density lipoprotein cholesterol. The authors also note the commonly known adverse events associated with ADT, including vasomotor flushing, loss of libido, fatigue, gynecomastia, anemia, and osteoporosis.

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