Prostate cancer news reports: Thursday, June 11, 2009

Today’s prostate cancer news report deals with:

  • A recent review of appropriate penile rehabilitation strategies
  • Management of biochemical recurrence after first-line treatment failure
  • Initial use of hormone therapy by French clinicians

Mulhall has provided a current review of and “a common-sense, practical guide”  to the appropriate use of penile rehabilitation after radical prostatectomy (RP). He notes that the purpose of penile rehabilitation is to maximize the chances of a man having recovery of functional erections and to return him to his preoperative erectile function level. According to Mulhall, appreciating the value of penile rehabilitation requires understanding five concepts: the pathophysiology of erectile dysfunction after RP, cavernosal oxygenation, venous leak, and both the animal and human data supporting this strategy.

Roberts and Han have reviewed current data on the clinical significance and management of biochemical recurrence  following definitive treatment for clinically localized prostate cancer using either radical prostatectomy (RP) or external beam radiation therapy (EBRT). In the case of biochemical recurrence after  RP, they state that any detectable serum PSA level indicates biochemical recurrence. They confirm that the decision to administer salvage therapy locally or systemically depends largely on factors that include the PSA doubling time, the Gleason score, the pathologic stage, and the time interval between RP and biochemical recurrence. They also note that, “Early initiation of salvage therapy has been shown to significantly impact on cancer outcomes.” In the case of biochemical recurrence after EBRT, no single PSA level can define biochemical recurrence. Instead, it has been defined by increases in the PSA level above the nadir. Following EBRT, PSA doubling time and Gleason score play important roles in determining the need for local versus systemic salvage therapy. The authors conclude that, at the time of biochemical recurrence, it is critical to perform a timely clinical assessment using the prognostic factors mentioned above. They also state that prompt initiation of salvage therapy may prevent subsequent clinical progression and prostate cancer-specific mortality. However, The “New” Prostate Cancer InfoLink wants to emphasize the recent data also from Johns Hopkins suggesting that PSA doubling time is the single most dominant factor affecting the need for salvage therapy for patients with biochemical recurrence after RP.

de la Taille has assessed the circumstances under which French physicians initiated the use of hormone therapy. This was a purely observational study carried out between October 2006 and March 2007 and based on data collected from 2008 urologists and radiotherapists. The study incorporated data from 1,187 patients with an average age of 73.5 ± 8.0 years. Their cancer had been diagnosed 1.1 ± 2.3 years earlier, had most commonly been made at localized stage (n = 562), and less often at the locally advanced (n=442) or metastatic (n=183) stages. In > 60 percent of the patients, the initial use of an LHRH agonist was driven by a biological recurrence (n=263), by the presence of bone or visceral metastasis at time of diagnosis (n=262), or by a contraindication to local treatment at localized stage (n=190). The decision to use hormone therapy was taken jointly by the doctor and the patient in just over half of cases,with 92 percent of  patients being treated with an injection every 3 months.

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