The news report: Friday, April 17, 2009

In today’s news reports we address:

  • Prediction of freedom from biochemical failure after brachytherapy
  • Prediction of probability of unilateral prostate cancer in men eligible for focal therapy
  • Health-related quality of life 5 years after radiotherapy + androgen deprivation
  • Androgen receptor activity “signatures” in men with CRPC

Ho et al. report that the total dose of radiation delivered is predictive of freedom from biochemical failure in patients with intermediate risk prostate cancer receiving low dose rate brachytherapy as first-line therapy. Their conclusion is based on a prospectively collected database of 2,250 men treated between 1990 and 2004. Of these men, 558  had one or more intermediate-risk features (PSA level 10-20 ng/mL, Gleason score 7, or clinical stage T2b),  a minimum follow-up of 24 months, and post-implant, CT-based dosimetric analysis. The median follow-up was 60 months (range, 24-167 months). The authors found that the actuarialfreedom from biochemical failure at 10 years was 86 percent. Radiation dose (BED < 150 Gy2 vs. ≥ 150 Gy2) was the only significant predictor of freedom from biochemical failure. No other variable was found to be a statistically significant predictor of freedom from biochemical failure at 10 years.

Polascik et al. have evaluated pretreatment clinical parameters that may predict unilateral prostate cancer amenable to hemigland thermoablation (i.e., focal therapy using cryotherapy or high-intensity focused ultrasound). Their analysis is based on data from 538 patients with low- to low-intermediate-risk prostate cancer (PSA < 10 ng/ml, biopsy Gleason score ≤ 7, and clinical stage T1c-T2b) treated with radical prostatectomy. All patients underwent diagnostic prostate biopsy between 1996 and 2006. The authors state that the strongest predictor of pathologic unilaterality was unilaterality of the prostate biopsy result. A family history that was negative for prostate cancer was also associated with a higher probability of unilateral disease.

Berg et al. studied the self-reported health-related quality of life (HRQoL) and changes in sex hormones among 86 prostate cancer patients without distant metastases 5 years after radiotherapy + antiandrogen treatment. They compared these data to HRQoL scores from untreated, “normal,” age-matched controls without a cancer diagnosis The prostate cancer patients scored statistically and clinically lower than the “normal” controls on sexual domains, and statistically lower than the “normal” controls on physical function and vitality. These results are hardly surprising!

Mendiratta et al. have described a “genomic strategy” that may be helpful in individualizing and improving care for patients with castration-resistant prostate cancer (CRPC). This strategy is based on the development of genome  transcription-based androgen receptor activity signatures.

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