The prostate cancer news report: Tuesday, May 5, 2009

We are returning to “normal” today with the standard “news reports.” Today’s items deal with:

  • Evolving biomarkers and new tests and their future application
  • MRI in diagnosis, staging, and prognosis of prostate cancer
  • Intraprostatic injection of LHRH agonists and antagonists: is it viable?
  • Gefitinib in HRPC: no evident impact on quality of life

Fradet has reviewed current information on evolving biomarkers and tests that may be able to improve our ability to differentially diagnose patients with different levels of risk for aggressive forms of prostate cancer. As the author notes, in the immediate future we need to be able to demonstrate that new gene-based diagnostic and prognostic tests will make a significant difference when they are introduced into available algorithms that are currently based on such known risk factors of age, ethnicity, family history and PSA level to better tailor diagnostic and therapeutic strategies.

Villers et al. have the current utility and accessibility of MRI in the diagnosis, staging and prognosis of organ-confined prostate cancer. This review gives a European perspective on this topic as well as discussing future implications for focal therapy and active surveillance. They note that 1.5 T MRI already offers excellent imaging of the prostate gland including the challenging anterior part; that improvements in accuracy for cancer detection and volume estimation result from dynamic contrast-enhanced and diffusion-weighted MRI sequences; and that 3 T MRI might improve cancer identification. MRI results allow focused use of biopsy techniques that can lead to better data on extent and grade of individual cancers. They express the opinion that current focal therapy protocols and active surveillance treatments should benefit from these imaging advances. At least in Europe, high-resolution MRI with pelvic coil appears to offer the most readily available and useful imaging.

Noting that LHRH agonists and antagonists have apoptotic effects on prostate cancer cells, Clementi et al. have suggested that these agents may have beneficial clinical impact if used for injection directly into the prostate instead of systemically into the body. This is an interesting if somewhat radical idea that may have some value in the treatment of men with locally progressive prostate cancer. Such men commonly need hormone therapy in conjunction with radiation as second line treatment. It would need careful testing in clinical trials, however.

A small European study was designed to investigate whether treatment with gefitinib (Iressa) had beneficial effects on the quality of life of patients with hormone refractory prostate cancer. Curigliano et al. gave patients gefitinib 250 mg daily together with an antiandrogen and an LHRH agonist for at least 2 months or until disease progression. They then evaluated the patient’s quality of life, their daily pain levels, and their monthly pain intensity. Only 6/23 patients (26 percent) showed an improvement of their global health status. Improvement of symptoms was correlated with antiandrogen withdrawal. Global health status and quality of life decreased during treatment according to tumor progression. The authors concluded that there were no beneficial effects of gefitinib on quality of life in hormone refractory prostate cancer patients.

2 Responses

  1. The abstract of the review of the use of MRI says in part: “Histological correlations showed high sensitivity and specificity for significant volume cancers larger than 0.5 cm3. I’d guess that most of us wouldn’t really relate to a size expressed as 0.5 cm3. My guess is about a large pea. Any other guesses ?

    I’m not sure that this review shows a position that is significantly changed for the majority of men who are diagnosed with microscopic tumours that simply would be too small to be accurately defined by MRI.

  2. A cancer of 0.5 cc is indeed about the size of a pretty large pea (with a diameter of just under 1 cm or nearly 0.4 in).

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