Prostate cancer news reports: Tuesday, May 12, 2009

Today’s news reports cover items on:

  • The feasibility of gene expression analysis and prostate cancer prognosis
  • The potential of color Döppler ultrasound to assess prostate cancer risk
  • Radical perineal prostatectomy and quality of life in Japanese patients
  • Outcomes and satisfaction with treatment among patients < 65 years of age
  • LHRH agonist therapy and cognitive dysfunction

Sun and Goodison have demonstrated, in principle, that it is possible to use gene expression information to increase the accuracy of prostate cancer prognosis. They conducted a computational analysis of gene expression profile data obtained from 79 patients, 39 of whom had disease recurrence. Their goal was to see whether advanced computational algorithms could be used to develop more accurate prognostic signatures for prostate cancer. They report that, at the 90 percent sensitivity level, a newly derived prognostic genetic signature achieved 85 percent specificity, which significantly outperforms a clinically used postoperative nomogram. They also report that a hybrid prognostic signature derived by combination of the nomogram and gene expression data significantly achieved a specificity of 95 percent. Application of such sophisticated prognostic systems is certainly not “ready for prime time” as yet, but this study does appear to confirm the potential of combining gene expression data with clinical data to improve diagnostic and prognostic capabilities.

Merkle has reported data on 418 patients with slightly elevated PSA values and/or hereditary risk for prostate cancer who were tested for risk of prostate cancer using 3D color Döppler transrectal ultrasound (3D CDI-TRUS) in a prospective and histologically verified study. Patients were intially classified as benign or malignant according to ultrasound criteria and then all patients were biopsied. In this study 3D CDI-TRUS diagnosed these patients correctly with a sensitivity of 0.82 and good specificity (0.91). The authors concludes that 3D CDI-TRUS may be used for initial prostate cancer risk assessment while reducing unnecessary biopsies in men with elevated PSA levels.

Inoue et al. have reported on the positive impact of radical perineal prostatectomy on health care-related quality of life in a cohort of 194 Japanese patients at 5 years of follow-up. They note that while nerve-sparing surgery “conferred the benefit of the recovery” of sexual function, older Japanese patients were not greatly concerned about a decrease in their sexual-function-related quality of life.

Jayadevappa et al. recruited 318 younger men with newly diagnosed prostate cancer for a study in which they wanted to analyze the association between race/ethnicity, biochemical recurrence risk, and outcomes in younger men (less than 65 years of age). The patients completed generic and prostate-specific health-related quality of life (HRQoL), out-of-pocket cost, and “satisfaction with care” surveys at baseline and at 3, 6, 12, and 24 months of follow-up. The results showed that African Americans report lower generic and prostate-specific HRQoL scores at diagnosis and required more time to return to baseline values for generic HRQoL. Low risk for biochemical recurrence was associated with better physical function, vitality, mental health, and general health. For prostate-specific HRQoL items, low risk of biochemical recurrence was associated with impaired urinary function and better bowel function and bowel bother. The authors conclude that, “Biochemical recurrence risk and treatment groups, not ethnicity, were associated poorer post-treatment outcomes.”

Jim et al. have confirmed what might be considered “common knowledge” in the world of prostate cancer by demonstrating a clear association between  treatment with LHRH agonists and defects in cognitive function. They did this by comparing rates of clinically significant cognitive impairment in men treated with LHRH agonists to a matched sample of healthy men without cancer. Although there were no statistically significant differences between a small group of 48 patients and 48 matched controls, the patients clearly displayed greater overall impairment in cognitive functioning than comparison subjects (42 percent of patients versus 19 percent of controls, p < 0.05). Interestingly, prior prostatectomy was also associated with impaired immediate and delayed verbal memory. The authors recommend that patients undergoing LHRH agonist therapy should be monitored for cognitive changes while on treatment.

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