Prostate cancer news reports: Sunday, May 24, 2009

Today’s news reports deal with such matters as:

  • Advances in radical prostatectomy
  • Variations in mutation in androgen-resistant patients
  • Data from a Phase I/II trial of AT-101
  • The link between CTC level and response to therapy with abiraterone

Galvin and Eastham have reviewed advances in radical prostatectomy over the past 25 years (since the initial introduction of nerve-sparing surgery). They note such improvements as the use of smaller incisions, reduced blood loss, shorter hospital stays, and surgical refinements to improve the recovery of continence and potency. They point out that, despite the lack of randomized controlled trials, observational cohort studies demonstrate lower rates of positive surgical margins, high 10-year and 15-year biochemical recurrence-free rates, excellent prostate cancer-specific mortality rates, and improved recovery of urinary incontinence and erectile function after open radical prostatectomy. They also point out that, although open radical prostatectomy now accounts for a minority of radical prostatectomies in the United States, the concepts that have improved oncologic and quality-of-life outcomes are equally applicable to minimally invasive procedures.

Steinkamp et al. appear to have confirmed the suspicion that differing types of treatment induce differing mutations to the androgen receptors among men who become androgen resistant. These mutations do not occur among men who are hormone naive.

Liu et al. report evidence of clinical activity of AT-101 in men with chemotherapy naïve, castrate-resistant prostate cancer (CRPC) in a Phase I/II clinical trial. This drug is undergoing further investigation in combination with androgen deprivation and in combination with docetaxel. The appropriate dose regimen for AT-101 appears to be 20 mg/d for 21 of 28 days.

Attard et al., using data from men with CRPC in clinical trials of abiraterone acetate, have been able to confirm that circulating T cells (CTCs) are malignant in origin and that hormone-regulated expression of the ERG gene persists in CRPC. They also showed that there is a strong association between ERG rearrangements and CTC level and magnitude of PSA decline in CRPC patients treated with abiraterone acetate.

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