Prostate cancer news reports: Wednesday, May 20, 2009

Today’s news reports address:

  • Prevalence of comorbidities in black and white patients
  • PSA screening and the criteria for biopsy
  • Screening and management of men > 65 years of age
  • Genitourinary toxicity of intensity modulated radiation therapy (IMRT)

Putt et al. have used Medicare data to demonstrate that, among patients with a diagnosis of prostate cancer who survived for at least 12 months from data of diagnosis, comorbidities were significantly more common among black males than whites. Higher levels of comorbidity were also associated with lower survival.

Schröder and Roobol, using data from the European Randomized Study of Screening for Prostate Cancer, suggest that PSA cutoff values of >2.5, 3.0 or 4.0 ng/ml still offer a reasonable balance between excessive prostate cancer detection rates and the risk of missing clinically significant prostate cancer. They propose that men presenting with PSA values of 2.0-3.0 ng/ml should be reexamined more frequently, and that available nomograms (e.g., the PCPT nomogram) should be used specifically to determine risk and the need for biopsy in this category of men.

Cooperberg and Konety argue that, among men 0f more than 65 years of age, decisions regarding screening and treatment should should take account of patient comorbidity, life expectancy, and treatment preferences rather than chronologic age. They recommend that: treatment must be tailored to the level of tumor risk; that increased use of active surveillance, together with diet and lifestyle intervention, is appropriate for many older men with lower-risk tumors; and that, conversely, those with high-risk disease should not be denied the opportunity for curative local therapy on the basis of age alone.

Fonteyne et al. report that among 260 prostate cancer patients treated with intensity modulated radiation therapy (IMRT) at their institution, and followed for at least 12 months, acute genitourinary toxicity of grades 3, 2 and 1  occurred in 8, 42, and 42 percent of the patients, and late stage genitourinary toxicities of grades 3, 2 and 1 occurred in 3, 19 and 40 precent. They conclude that IMRT induces mild genitourinary toxicity in a significant proportion of prostate cancer patients.

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