Prostate cancer news reports: Tuesday, June 16, 2009


This morning’s news reports address:

  • Patterns of use of PSA and DRE testing in the USA
  • The value of ADT in men receiving combined brachytherapy + EBRT
  • Skeletal and cardiovascular adverse effects of ADT
  • LHRH agonist treatment and effects on LHRH agonist receptors

Ross et al. have reported on changes in patterns of the use of PSA and DRE testing in 2002, 2004, and 2006 in nearly 230,000 men > 40 years of age. Overall trends suggested a significant increase in the use of PSA only and a significant decrease in the combined use of PSA and DRE. The probability of having had a recent PSA test (within 2 years) only, a recent DRE only,; or both tests varied by sociodemographic and health-related variables, including age, race/ethnicity, marital status, levels of education and income, body mass index, health insurance status, and having a personal doctor or health care provider. The authors state that the PSA test and DRE continue to be utilized regularly by a majority of American men over age 40.

Demanes et al. have reported on the value of androgen deprivation therapy (ADT) when added to the combination of high-dose-rate brachytherapy + external beam radiation for the treatment of localized prostate cancer. Their data are based on 411 patients treated between 1991 and 1998. This is a retrospective analysis, not a prospective study, and so patients were not randomized to receive ADT or not. Rather, patients received ADT if they met certain clinical criteria. There were 200 patients in the “ADT Group” and 211 in the “No ADT Group”. The median follow-up was 6.4 years. The projected 10-year biochemical progression-free survival for all 411 patients was 81 percent (low risk, 92 percent; intermediate risk, 87 percent; and high risk, 63 percent). However, there were no significant differences for any outcome variable between the ADT Group and the No ADT Group of patients, and improved outcome from the use of ADT was not observed in these patients.

Taylor et al. have conducted a careful literature review focused on the skeletal and cardiovascular adverse reactions to ADT (as opposed to such expected effects as loss of libido, sexual dysfunction, sweating and hot flashes, etc.). According to their review of 683 articles published between 1966 and mid-2008, a total of 14 articles met inclusion criteria from the original 683 studies. These 14 articles showed that men who underwent ADT for prostate cancer had an increased risk of overall fracture of 23 percent compared with men who had prostate cancer but who did not undergo ADT. Furthermore, men who underwent ADT had a 17 percent increase in cardiovascular-related mortality compared with men who did not undergo with ADT. Significant elevations in the risk of diabetes also were observed from two large studies.

Angelucci et al. appear to have shown that LHRH agonists like leuprolide acetate, at least when used in laboratory experiments, are capable of significantly increasing the expression of their own LHRH agonist receptors, i.e., the molecules that they need to bind with to affect the expression of LHRH itself. This effect is observed in both androgen-sesnitive and androgen-insensitive prostate cancer cells. Over time, this piece of information may have all sorts of interesting implications for prostate cancer therapy.

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