Prostate cancer news reports: Thursday, May 28, 2009

Today’s prostate cancer news reports address:

  • A review of data on the potential for prostate cancer prevention
  • A review of appropriate strategic options for rebiopsy in patients at risk
  • Prostate cancer in men with a PSA < 2.5 ng/ml
  • The sequential use of multiple cycles of docetaxel therapy

Colli and Amling have reviewed data on the use of a variety of prostate cancer prevention strategies, inclusive of data on the use of 5α-reductase inhibitors, statins (a class of compounds used to reduce cholesterol), NSAIDs, selenium, vitamins E and D, lycopene, allium vegetables (garlic, scallions, onions, chives, and leeks), soy/isoflavones, and green tea polyphenols. (This paper was written prior to the recent announcement of the results of the REDUCE trial.)

Terris has reviewed the strategic options for recurrent biopsy in men with one or more prior negative biopsies but continuing indications of risk of prostate cancer. She states that indications for repeat biopsy include “sustained or worsening of the findings that prompted the initial biopsy;” PSA velocity, PSA doubling times, and other PSA-derived data; and “the histology from the initial biopsy” (i.e., high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation). Terris recommends that repeat biopsies should include a combination of standard sextant, lateral, anterior apical, and possibly transition zone biopsies, and that repeat biopsies should consist of at least 14 cores but may include more than 36 samples. She concludes that, in patients who are not at high risk for prostate cancer, more than two sets of repeat biopsies are unlikely to find any indication of prostate cancer.

Meeks et al. have presented retrospective data on management of 77/1,278 patients treated with radical prostatectomy between 2003 and 2008 by one surgeon. These 77 patients were all initially diagnosed with a PSA level < 2.5 ng/ml, and 51/77 (66 percent) had a suspicious digital rectal examination (DRE). Pathologic examination of biopsy cores and the surgically removed prostate indicated that 8/77 (10.4 percent) and 20/77 (26 percent) of these men had Gleason scores of ≥ 7 at biopsy and after radical retropubic prostatectomy, respectively, while 7/77 (9 percent) and 6/77 (7.8 percent), respectively, had extracapsular tumor extension or positive surgical margins. Compared to men with a normal digital rectal examination, mean tumor volume was significantly higher in those with a suspicious digital rectal examination. The authors emphasize the importance of an abnormal finding on DRE in this group of patients.

Olbert et al. have reported data from a single-institution study of the use of repetitive docetaxel treatment cycles in a group of 46 patients.In the first cycle of treatment, 26/46 patients (56 percent) achieved a reduction in PSA level of > 50 percent, another 10/46 patients  (22 percent) had a reduction in PSA of up to 50 percent , and 10/46 patients (22 percent) had a rising PSA. The median overall survival of the whole cohort calculated from the first docetaxel infusion was 16 months (range, 3 to 60+ months). A total of 18 patients who did well on the first cycle of treatment went on to a second cycle. The median overall survival of the 18 patients who received at least two cycles of therapy was 35 months;  13/18 patients achieved a biochemical response in cycle 2. Toxicity did not rise significantly. Finally, 5 patients received a third cycle of docetaxel and 3/5 had a third response to treatment. The authors conclude that such sequential docetaxel therapy is well tolerated and shows high response rates in the second and third cycles of treatment in selected patients who showed low levels of docetaxel toxicity, were in good clinical condition, and responded to the prior cycle of docetaxel-based treatment.

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