Prostate cancer news reports: Saturday, June 20, 2009

Today’s news reports cover just two recent review articles, on:

  • Current indications for repeat biopsy
  • MRI, CT, and PET scanning in prostate cancer patients with biochemical progression after first line therapy

Presti has reviewed current indications for a repeat biopsy in men with a persistently elevated or a rising PSA level following a prior negative prostate biopsy. He writes that: assessing the adequacy of the initial biopsy is important;  the free/total PSA ratio is currently the most useful marker for predicting cancer on repeat biopsy; newer markers, such as PCA3, are promising; and repeat biopsies should include a minimum of 14 cores, the 12 cores recommended for an initial biopsy and two additional cores obtained form the right and left anterior apex. In patients for whom repeat biopsies fail to identify cancer, yet the clinical suspicion remains high, a saturation biopsy can be considered.

Pasquier et al. have reviewed literature on progress in radiological and nuclear medicine techniques and their performance levels in assessing the potential effectiveness of salvage radiation therapy in men who have biochemical recurrence after first-line therapy. Magnetic resonance imaging (MRI) has the greatest sensitivity and specificity for examination of the prostate bed and enables simultaneous assessment of the pelvic region — diminishing the utility of compute-assisted tomography (CAT scanning). The performance levels of MRI should to improve, with the use of dynamic MRI and MR spectroscopy. The sensitivity of positron emission tomography (PET scanning) is still low.

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