Prostate cancer news reports: Tuesday, June 2, 2009

There continue to be a multitude of news reports from the ASCO meeting today — some of which seem to be based more on media releases than on what was actually presented by the investigators who carried out the research (caveat emptor). The news items mentioned below deal with items unrelated to ASCO:

  • The prognostic value of undetectable ultrasensitive PSA data post-surgery
  • A review of the role of adjuvant radiation therapy post-surgery
  • A review of neuroendocrine types of prostate cancer and their management

Eisenberg et al. have reviewed data from 525 men who had an undetectable ultrasensitive PSA level (UUPSA) — defined as a PSA level of ≤ 0.05 ng/ml — at between 1 and 3 months post-radical prostatectomy with at least 2 years of follow-up. Recurrence was defined as two consecutive PSA levels ≥ 0.2 ng/ml or secondary treatment. They found that 456/525 patients (87 percent) had a UUPSA immediately post-prostatectomy. Among the 456 men with  a UUPSA post-prostatectomy, there was a 5-year biochemical recurrence-free rate of 86 percent compared with 67 percent in the group with the detectable PSA group. Patients with a UUPSA were 67 percent less likely to recur. The authors conclude that, an undetectable PSA after radical prostatectomy is prognostic for biochemical remission-free survival at 5 years and may be of assistance in predition of outcome in higher risk patients.

Graham and Holzbeierlein have summarized current knowledge around the role of adjuvant radiation therapy after prostate cancer surgery, and when it is most appropriate. They note that accepted treatment options for men with biochemical recurrence include salvage radiation therapy, hormone therapy, or a combination of both, depending on whether the disease recurrence is biochemical, local, or systemic. However, the role of adjuvant radiation therapy (ART) after prostatectomy in patients with adverse pathological risk factors before biochemical or clinical recurrence is still unclear. They state that, in their opinions, evidence in support of using ART is evolving based on long-term follow-up data from several long-term prospective trials.

Mazzucchelli et al. have reviewed data on the diagnosis and treatment of neuroendocrine tumors of the urinary tract. These types of cancers are well known in the prostate but fall into four veryt different categories: prostatic carcinoid tumor (exceedingly rare but highly curable), small cell neuroendocrine cancer (uncommon but highly aggressive with a median survival of < 1 year), large-cell neuroendocrine cancer (extremely rare but highly aggressive), and focal neuroendocrine differentiation in prostatic adenocarcinoma (relatively common but of very variable prognosis). The authors provide a general overview of each of these types of cancer with specific reference to their occurrence in the prostate. They also emphasize the importance of close collaboration between the pathologist and the urologist in optimal patient management of these types of cancer.

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