Prostate cancer news reports: Friday, June 12, 2009

Todays news reports adddress:

  • Surgeon and hospital volume and outcomes to radical prostatectomy
  • Adverse events associated with the use of hypofractionated, dose-escalated, IMRT
  • Quality of sexual function after external beam radiation therapy
  • Percentage of positive biopsy cores and response to first-line hormone therapy

Barocas et al. have reviewed available data on the impact of surgeon and hospital volume on outcomes of radical prostatectomy (RP). They identified 13 original studies and a meta-analysis which focused on the impact of hospital RP volume on surgical outcomes and eight studies that explored the relationship between individual surgeon case volume and outcomes. The data suggest a clear association between higher hospital RP case volume and improved outcomes. Also increasing individual surgeon volume also suggests better outcomes, not only perioperatively, but even with respect to long-term cancer control and urinary function. The authors also discuss methods that may be appropriate to improve the quality of radical prostatectomy through certification of surgeons and broader dissemination of the techniques used by highly successful, high volume surgeons.

Pervez et al. have reported on early adverse events associated with the use of hypofractionated, dose-escalated, intensity-modulated radiation therapy (IMRT) combined with androgen suppression in treatment of high-risk prostate cancer patients. According to this report, 21/60 patients (35 percent) had Grade 2 gastrointestinal (GI) toxicity; 4 (6.7 percent) had Grade 3 genitourinary (GU) toxicity; and 30 (33.3 percent) had Grade 2 GU toxicity during the course of their radiation. These toxicity scores all declined over the follow-up period; there were only 8 patients with Grade 1 GI toxicity, 11 with Grade 1 GU toxicity, and 5 with Grade 2 GU toxicity at 3 months of follow up.

Siglin et al. have used validated sexual function questionnaires to develop data on the long-term follow-up of 143 patients to clarify the rate and timing of erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer. The median follow-up was 4.03 years. The strongest predictor of sexual function after EBRT was sexual function before treatment. The only statistically significant decrease in function occurred in the first 24 months after EBRT. The authors report that sexual function stabilized 2 years after treatment completion, with no statistically significant change in any area of sexual function >2 years after the end of EBRT.

Normand et al. have published data suggesting the possibility that the percentage of positive biopsy cores at the time of diagnosis would predict time to hormonal independence and survival in prostate cancer patients treated by androgen deprivation therapy (ADT) as first-line therapy. While their initial data do indeed demonstrate this possibility, the patients in their study were all diagnosed in France between 1980 and 1999, which suggests that they may have been being diagnosed relatively late in the disease process. The “New” Prostate cancer InfoLink would question whether this was commonplace even in France today.

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