Prostate cancer news reports: Saturday, June 27, 2009

Today’s news reports deal with such items as:

  • Genomic testing for prostate cancer and the value of specific SNPs
  • What do pre-treatment MRI/MRSI tests and molecular profiling add to prognostic significance?
  • Quality of life following salvage brachytherapy

Another study — by Kader et al. — has confirmed earlier reports that the majority of single nucleotide polymorphisms (SNPs) previously shown to be common in prostate cancer patients are not actually predictive of  either aggressiveness of or specific risk for prostate cancer. (In this study, only 2/20 SNPs evaluated appeared to have either diagnostic or prognostic potential.) An “association” between a possible biological marker and a specific disorder does not necessarily mean that that marker is potentially diagnostic or prognostic for the disorder in question. In a separate publication on this general topic, Li-Wan-Po et al. discuss the appropriate use of genomic testing using a proposed genomic test for prostate cancer as a case example.

Shukla-Dave et al. have demonstrated that pre-surgical data from MRI/MRSI scans and selected molecular profiling tests can add slightly to the accuracy of standard clinical data in prediction of post-surgical disease recurrence. However, the improvement is small, and seems unlikely to justify the routine preoperative use of MRI/MRSI and these molecular profiling tests for the majority of prostate cancer patients (unless the costs of these tests drop very considerably by comparison with the current costs involved).

Nguyen et al. have reported on quality of life of a small group of patients receiving salvage brachytherapy following the failure of first-line external beam radiation for localized prostate cancer. The authors report that, just as for patients receiving first-line brachytherapy, those who receive salvage brachytherapy report a worsening of bowel and urinary symptoms followed by some improvement at 2-3 years of follow-up, while sexual function steadily declines over time.

2 Responses

  1. With regards to the MRI/MRSI — even if the use of an MRI machine was slightly more accurate in predicting post-surgical disease recurrence, then why would this not become standard procedure? What would the arguments for and against be on a financial level?

  2. The question as yet unasked in any study that I am aware of is whether the results of currently available MRI/MRSI tests actually change what a treating physician recommends. The routine use of MRI/MRSI in the work-up of older patients diagnosed with low-risk prostate cancer (who are therefore highly unlikely to die of their cancer or even, necessarily, ever have any clinical symptoms of their disease) would appear to some to be a classic case of over-analyzing the problem (whether prompted by the need for “defensive medicine” or not). If we are going to suggest that all such patients should have an MRI, then why not a PET scan while we’re at it? What is it that we are trying to accomplish?

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