The weekend news report: April 25, 2009

So before I run out the door to get my plane to Chicago, here are non-AUA reports on:

  • Perspectives on applications of PSA data in diagnostic profiling
  • The adverse events of androgen deprivation therapy
  • Potential new form of pain management in very late stage disease

Botchorishvili et al. have reviewed current applications of PSA-related data to improve prediction of risk, detection, and prediction of clinical endpoints of prostate cancer treatments. They note that no specific PSA cut-point (e.g, 2.5 or 4.0 ng/ml) achieves both high sensitivity and high specificity; that the accuracy of prostate cancer detection can be increased by additional predictive factors and a combinations of markers; that a panel of kalikrein markers can be used to increase the specificity of PSA testing, and reduces costs by eliminating unnecessary biopsies; that large, population-based studies have shown that PSA can be used to predict prostate cancer risk many years in advance; but that there is no definitive evidence that PSA screening lowers prostate cancer-specific or overall mortality. They suggest that statistical prediction models and the integration additional markers with PSA data may be able to improve and individualize prostate cancer diagnostic and prognostic information. They also point out, again, that a single PSA measurement at early middle age can predict risk for advanced prostate cancer decades in advance, and stratify patients for intensity of subsequent screening.

Schwandt and Garcia have provided yet another review on the adverse events associated with long-term androgen deprivation therapy for the management of progressive and/or advanced prostate cancer. They emphasize the importance of optimizing the timing of therapy based on the natural history of the individual patient’s prostate cancer natural history and medical risk profile. They also emphasize quality of life concerns, adequate pretreatment education of anticipated side effects, and the application of strategies for prevention of side effects.

Lam et al. have reported results of a Phase I clinical trial of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP, an injectable radiotherapeutic) in combination with capectabine (an oral chemotherapeutic) as treatment for bone-related pain in patients with hormone-refractory prostate cancer. This was a very small study intended to evaluate the maximum tolerable dose (MTD) of capecitabine in this drug combination, which proved to be the 2,500 mg/m2 per day. The effectiveness and safety of this combination will be studied in a Phase II trial.

One Response

  1. Everyone attending the AUA Annual Meeting ought to be provided with a copy of Schwandt and Garcia’s report on the side-effects of long-term androgen deprivation, and should be made to raise their right hand and swear to pay attention to their recommendations: “optimizing the timing of the therapy,” “adequate pretreatment education,” “the application of strategies for prevention of side effects.” My experience in spending most of 2008 on Lupron/Casodex is that the side-effects are cumulative, and are far worse at the end than at the beginning. If I hadn’t been given leave by doctors to take a break from them I might have taken one anyway just to try to hang onto my sanity. Not sure what I will do when my PSA starts rising again. Long-term androgen deprivation isn’t worse than death, but it is very close to it!

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