Prostate cancer news reports: Friday, June 5, 2009


Today’s news reports refer to a series of reviews that appeared this month in a supplement to Urology as well as other articles:

  • 20 years of experience with the PSA test in assessment of risk for prostate cancer
  • Biomarkers in the assessment of future risk for prostate cancer
  • Treatment choice, outcome, and quality of life
  • Using PSA to assess overall survival in CRPC
  • Prognosis of death in hormonally treatment men with metastatic prostate cancer

Pienta has reviewed 20 years of experience of using the PSA test to assess risk for prostate cancer and its impact on the early detection of clinically localized prostate cancer. He notes that this use remains controversial. However, he goes on to state that, “Although it has its limitations, PSA still remains the best-studied marker for the detection of” prostate cancer.

Fleshner and Lawrentschuk have addressed the role of biomarkers in assessing the presence of and the risk for prostate cancer at some in the future. Specifically they note that this evolving use of PSA is supported by clinical trial data from the Baltimore Longitudinal Study of Aging, the European Randomized Study of Screening for Prostate Cancer, and the Malmö Preventive Medicine Study. Data from the European Randomized Study of Screening for Prostate Cancer have demonstrated that men with a PSA level of ≥1.5 ng/ml are at a significantly elevated risk of developing prostate cancer compared with patients with a PSA level < 1.5 ng/mL. The Malmö study showed that the PSA level could independently the predict cancer risk as far as 25-30 years into the future. Secondary non-serum-related risk factors (e.g., age, family history, ethnicity) can also offer predictive value for determining the risk of developing future disease. Furthermore, recent investigations of novel biomarkers have yielded promising PCa prognostic candidates, including the PCA3 test.. However, PSA remains the most reliable measure in assessing the risk of developing prostate cancer. What none of these markers can do at this time, however, is accurately assess the risk for clinically significant as opposed to indolent prostate cancer at a point in time.

Gomella et al. review the complex issues associated with patient choice, multiple therapeutic options, limitations of the availbale evidence, and the quandaries of prostate cancer-specific clinical outcome vs. side effects of treatment (along with their impact on overall quality of life [QOL]).The authors argue that, when determining treatment options, patients and physicians should consider the efficacy of the therapy, as well as the safety, effect on QOL, and cost. As a part of a risk reduction strategy, effective screening programs, along with possible therapeutic agents, could have a positive effect on QOL and offer a preemptive benefit to patients at increased risk of prostate cancer.

Halabi et al. have used data from nine Cancer and Leukemia Group B (CALGB) trials that enrolled 1,296 men from 1991 to 2004 to assess whether progression-free survival (PFS) or biochemical PFS can be used as a predictor of overall survival (OS) and to investigate the dependence between PFS and OS in men with castration-resistant prostate cancer (CRPC).  Their data, interestingly, appear to suggest a similar result to those just published by Hussain et al., on which we commented only yesterday. The median survival time among men who experienced progression at 3 months was 9.2 months compared with 17.8 months in men who did not experience progression at 3 months. Compared with men who did not progress at 3 and at 6 months, the adjusted hazard ratios for death were 2.0 and 1.9 for men who experienced progression at 3 and 6 months, respectively. In addition, biochemical progression at 3 months predicted overall survival.

Mikkola et al. have used data from 200 patients in the Finnprostate 6 study to develop three prognostic risk groups for disease-specific mortality based on age, haemoglobin concentration (Hb), erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP) level, PSA level, plasma testosterone level, and estradiol level prior to treatment. All patients in this study were hormonally treated patients with metastatic prostate cancer. Pre-treatment ALP, PSA ESR, and age were shown to be the most influential factors on risk for disease-specific mortality. Patients were given one risk point each for ALP > 180 U/l, PSA > 35 ng/ml, ESR > 80 mm/h, and age < 60 years. Three risk groups were formed: risk group A (0-1 risk points); risk group B (2 risk points); and risk group C (3-4 risk points). The risk of prostate cancer-specific mortality increased  significantly wfor patients in each prognostic group.

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