Prostate cancer news reports: Wednesday, May 13, 2009

This morning’s reports deal with:

  • New Japanese guidelines on prostate cancer screening
  • PCA3 — “from bench to bedside”
  • Impact of hormonal therapy on bone mineral density and risk for fractures
  • The initial results of the RENEW trial

Historically, the incidence of prostate cancer in Japan has been significantly lower than in the Western world in general and in the USA in particular. (There were 9,264 deaths from prostate cancer in Japan in 2005.) A study by Hamashima et al., from the Japanese National Cancer Center, has now concluded that, “Overall, the evidence that screening reduced mortality from prostate cancer was insufficient. Furthermore, prostate cancer screening is associated with serious harms, including overdiagnosis, adverse effects of needle biopsy and adverse effects of local prostatectomy.” The article continues: “At present, the evidence for the effect of prostate cancer screening is insufficient. … PSA and DRE [are] not recommended for population-based screening programs, but they could be conducted as individual-based screening if basic requirements were met.” The English abstract of this report does not specify the basic requirements, but we would assume that these refer to well-understood risk factors such as ethnicity and family history.

Readers with an interest in the “translational” research process (i.e., how an initial scientific discovery gets converted into practical clinical application) may want to get themselves a copy of an article by Hessels and Schalken that reviews the steps along the path from discovery to clinical application of the PCA3 test.

Wadwha et al. have reported long-term data on the bone mineral density (BMD) of 618 men receiving androgen deprivation therapy (ADT) using LHRH agonists or antiandrogen therapy with bicalutamide. All patients were newly diagnosed with advanced prostate cancer. They were carefully stratified at presentation in order to allow for prediction of alterations in fracture risk. In total, at diagnosis, 41 percent of patients were osteoporotic (which means that their bones were relatively brittle), 39 percent were osteopenic (which means that their BMD was lower than normal but they didn’t yet have britttle bones), and only 20 percent had a normal BMD. In the normal group, treated with an LHRH agonist, there were significant decreases in BMD over 7 years (>12 percent at 6 years). This effect was also apparent in the patients with osteopenia with 60% developing osteoporosis after 2 years. However, the osteoporotic group of patients maintained their BMD over the course of the study. The authors were able to conclude that patients treated with an LHRH agonist have significant and sustained decreases in BMD, whereas bicalutamide maintains BMD.

HealthDay has commented on data from the RENEW study appearing in today’s edition of the Journal of the American Medical Association, which concludes that “a home-based diet and exercise program slowed the decline of physical function in older, overweight cancer survivors.” The full text of the report on the results of the RENEW trial is available on the web site of the Journal of the American Medical Association. In this study, the researchers divided 641 participants between a control group and a group which participated in a 12-month intervention program. The trial included 261 patients with prostate cancer. The program “included telephone counseling, mailed materials promoting exercise, improved diet, and modest weight loss.” The researchers discovered “that duration of strength-training exercise and endurance exercise minutes increased in the intervention group but stayed the same in the control group.” Additional reports on this study are available on WebMD and on MedPage Today, and a video report is provided on the JAMA web site (but did not work well on your sitemaster’s computer).

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