The news report: Friday, April 24, 2009

In today’s news report we touch on papers that address:

  • Genome studies and identification of real genomic risk for prostate cancer
  • More on the potential of 5-ARIs in prevention of prostate cancer
  • Whether we really need more studies on selenium as a potential prostate cancer prevention agent
  • The evolving potential of targeted focal therapy

Waters et al. have published an interesting paper entitled, “Generalizability of associations from prostate cancer genome-wide association studies in multiple populations.” They start by making the point that genomic studies have already identified “multiple common alleles associated with prostate cancer risk in populations of European ancestry.” In other words, we already know that lots of mutations may be associated with risk for prostate cancer — but “having an association” is not the same as “having a causative role.” In their study, Waters et al.  examined 13 of these risk variants in a multiethnic sample of 2,768 incident prostate cancer cases and 2,359 controls from the Multiethnic Cohort (African Americans, European Americans, Latinos, Japanese Americans, and Native Hawaiians). They go on to show that a large percentage of prostate cancer gene variants in populations of European ancestry are global markers of risk. The critical point for readers to learn from this study is that it may be extremely difficult for us to identify which gene variations (SNPs) really have a clearly causative or prognostic role in prostate cancer management for the future. We may be able to identify literally hundreds of SNPs that are “associated with” prostate cancer in different ways, only to find that we cannot tell if any of them have a truly causative or prognostic impact.

Reed and Parekh, reviewing the available data on the role of 5α-reductase inhibitors (5-ARIs) in prevention and diagnosis of prostate cancer, state that recent updates of the findings of the Prostate Cancer Prevention Trial (PCPT) confirm that finasteride reduces the risk of clinically significant prostate cancer, including high-grade tumors. They state that , “Finasteride is a valuable chemopreventive tool because it reduces the risk of prostate cancer, including high-grade cancer, and enhances our ability to detect high-grade disease.”

Facompre and El-Bayoumy appear to be unaware of both the results of the SELECT trial and the recently issued guidelines on the use of finasteride. Their article appears to be an unjustifiable plea for further study of selenium in treatment of “worried well” patients with high-grade prostatic intraepithelial neoplasia (HG-PIN). We suppose it is possible that this article was accepted for publication before the results of the SELECT trial was published.

Hou et al. have summarized available data on the potential roles of targeted focal therapy (TFT) using cryotherapy or high intensity focused ultrasound (HIFU) as an alternate treatment for low-risk prostate cancers. TFT uses 3D mapping biopsies to guide treatment so that key lesions are ablated while surrounding prostate tissue is spared. Hou and colleagues state that improvements in cryotherapy and HIFU have increased efficacy and decreased complications. They report that prostate cancer control following TFT should now be considered as promising. They further state that TFT provides an alternative to active surveillance and more aggressive treatments for patients with low-risk tumors.

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