The news report: Thursday, April 23, 2009

We have reported separately on a study of the long-term durability of erectile function following brachytherapy using permanent seed implantation. Other reports today address:

  • Literacy levels and prostate cancer communication
  • Antiperspirant use as a possible cause of prostate (and breast) cancer
  • A gene-based tool to predict prostate cancer risk
  • Drugs in development for prostate cancer prevention
  • PSA velocity and prostate cancer diagnosis
  • Identification of good candidates for salvage radical prostatectomy

Kilbridge et al. have reported on the very low level of understanding of prostate cancer-related terms among an underserved group of men with low literacy levels. The “New” prostate Cancer InfoLink is not surprised by these data, and agrees with the authors that better tools are need to talk about prostate cancer with people who have low literacy skills.

McGrath has put forward the idea that unintentional, inadvertent, and long-term hormone exposure may occur from transdermal absorption of sex hormones and pheromones (androgens) from obstruction of sweat glands through the use of aluminum-based antiperspirants. The global rise in antiperspirant use parallels rises in breast and prostate cancer incidence and mortality rates. The paper provides literature-based evidence in support of this possibility.

Xu and colleagues have presented data on the potential for development of a genetic profile-based tool that would predict a man’s 20-year absolute risk for prostate cancer. The authors’ initial model is based on the number of risk alleles carried by a particular man and his family history of prostate cancer. It should be noted that the data currently available are suggestive of the viability of such a model, but this does not mean that a clinically useful version of such a tool is anywhere near to ready for “prime time.”

Fitzpatrick et al. have reviewed the evolving data on the potential to reduce the risk of prostate cancer. They note that proof of principle has been demonstrated by the Prostate Cancer Prevention Trial, which used the first 5α-reductase (5AR) inhibitor, finasteride. They also note that other agents are under currently under investigation, selective estrogen receptors modulators (e.g., toremifene) and the dual 5AR inhibitor dutasteride. They rightly point out that a successful risk-reduction strategy might decrease the incidence of the disease, as well as the anxiety, cost, and morbidity associated with its diagnosis and treatment.

Tilling et al. hypothesized that men with prostate cancer identified as a consequence of clinical symptoms might have a steeper annual increase in PSA level than men with PSA-detected cancer. To study this possibility, they compared data from men who participated in the SPCG-4 trial (in Scandinavia, who were all diagnosed clinically) and the ProtecT study (in the UK, who were diagnosed based on PSA alone). In the SPCG-4 participants, the mean PSA level of patients at age 50 was similar to the mean PSA of men in the cancer-free cohort but with a steeper yearly increase in PSA level (16.4 vs 4.0 percent). In the ProtecT participants, the mean PSA level of prostate cancer patients was higher than that in the cancer-free cohort (due to a PSA biopsy threshold of 3.0 ng/ml) but there was a similar yearly increase in PSA level (4.1 percent). The authors conclude that, for PSA-detected prostate cancer patients, the annual change in PSA was similar to that in cancer-free men, whereas in men with symptomatic prostate cancer, the annual change in PSA level was considerably higher.

Heidenreich et al. have studied prognostic factors that can be used to identify men with post-radiation disease recurrence who are more likely to do well if treated with salvage radical prostatectomy. They note that this analysis is based on only 55 patients, and is therefore not conclusive. However, with that limitation, the authors indicate that the biopsy Gleason score after radiation but prior to surgery, the percentage of positive biopsy cores compared to the total number of cores taken (< 50 percent), the PSA doubling time (> 12 months), and the prior use of low dose brachytherapy as the form of radiatiation treatment were all significant predictors of organ-confined PCa with negative surgical margins on multivariate analysis.

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