Prostate cancer news reports: Wednesday, May 27, 2009

Today’s news reports cover such items as:

  • Identification of prostate cancer cells in urine
  • Prognosis after radiation therapy
  • The effect of bisphenol A on prostate cancer therapy
  • The appropriateness of primary androgen deprivation for localized prostate cancer
  • Data from clinical trials of Phase II clinical trial of docetaxel + samarium-153 lexidronam and cyclophosphamide + dexamethasone in late stage disease

Fujita et al. have reported yet another study suggesting that pre-testing prostate massage may allow for expulsion of identifiable markers in urine or seminal fluid. In this case the authors report that they were able to identify the presence of prostate cancer cells in urine following prostate massage as a possible means to identify risk for prostate cancer. However, this is hardly the “non-invasive” method we most need to be able to identify risk for clinically significant as opposed to indolent prostate cancer!

Proust-Lima and Taylor have developed a new prognostic tool based on PSA follow-up data for individual prediction of risk for progression in men treated with radiotherapy for prostate cancer.

Hess-Wilson has suggested that environmental exposure to relatively low levels of bisphenol A may have significant impact on the ability of standard therapies to slow progression of prostate cancer. Bisphenol A may act as an estrogen mimic and thus activate mutant androgen receptors.

Wong et al. have reported on the appropriateness of androgen deprivation therapy (ADT) as primary (first-line) treatment for patients with localized prostate cancer as compared to observation followed by delayed use of ADT. There are no clinical trial data supporting such use. To do this they studied data from 16,535 men identifiable in the SEER Medicare database who were aged between 65 and 85 years, had well-differentiated or moderately differentiated, organ-confined prostate cancer, survived for at least a year following diagnosis, and did not undergo treatment with prostatectomy or radiation therapy within 6 months of diagnosis. Analysis showed that patients who received primary ADT actually had a worse overall survival rate than patients who were observed.

Fizazi et al. have reported data from a Phase II clinical trial of docetaxel + samarium-153 lexidronam (an injectable radiotherapeutic agent) in treatment of 43 patients with metastatic castration-resistant prostate cancer (CRPC). It is not clear from the abstract whether these patients had previously failed docetaxel-based chemotherapy or whether they were chemotherapy-naive. A PSA response was obtained in 77 percent of patients. The pain response rate was 69 percent. The combination regimen was well tolerated. The median overall survival was 29 months; the 1-year survival rate was 77 percent; and the 2-year survival rate was 56 percent.

Nelius et al. have reported data from a small study of the use of “metronomic,” low-dose cyclophosphamide + dexamethasone in treatment of 17 men who were docetaxel refractory. There data suggest that cyclophosphamide + docetaxel may be able to lower PSA levels and relieve pain in a proportion of these patients, with minimal toxicity.

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