Prostate cancer news reports: Tuesday, July 7, 2009

In today’s news reports we address new data on:

  • The possible association between PSA levels and SNPs
  • Patient age at diagnosis and prostate cancer outcomes
  • Revalidation of the Stephenson nomogram for outcomes after salvage radiation therapy
  • Failure to follow best practices for radiation of bony metastases

Loeb et al. have published data suggesting that the presence of certain specific single nucleotide polymorphisms (SNPs) in a patient’s DNA, when considered in association with his PSA level, may be used to predict prostate cancer risk better than PSA data alone.

Lin et al. have conducted an analysis of data on > 300,000 men diagnosed with prostate cancer between 1998 and 2003 and aged between 35 and 74 years. They have used these data to show that: (a) the percentage of men aged ≤ 55 years at diagnosis increased from 2.3 percent between 1988 and 1991 to 9 percent between 2000 and 2003; (b) the median age at diagnosis decreased from 72 years in 1988 to 68 years in 2003; (c) younger men were diagnosed less often with organ-confined tumors; (d) younger men were less likely to be diagnosed with high-grade cancer; (e) older men were more likely to receive no local therapy or external beam radiation than young men; (f) overall survival was worse with advancing age among men who had tumors with a Gleason score between 5 and 7; and (g) the youngest men (ages 35-44 years) were at the highest risk of all-cause and cancer-specific death from prostate cancer among all age groups with high grade and stage. However, it should be appreciated that this is a historical, statistical analysis, and may not accurately reflect outcomes in men being diagnosed today.

Moreira et al. have revalidated the Stephenson nomogram — which offers predictive information about outcomes in men with a rising PSA after radical prostatectomy who undergo salvage radiotherapy — using data from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. While this nomogram “adequately predicted progression in SEARCH with reasonable accuracy,” the authors also point out that the performance of the model in this validation cohort was “modest overall” and that “there is still room for improvement” in the development and apllication of predictive models for disease progression after salvage radiation therapy.

In yet another example of how poor we are at getting medical professionals to change their practices to conform with the best clinical evidence, Fairchild  et al. have shown that radiation oncologists practising in Canada, Australia, New Zealand, and the USA have yet to accept that a single radiotherapy treatment (“single-fraction” radiotherapy) is just as good as multiple treatments (“multi-fraction” radiotherapy) for the palliative management of painful bone metastases (which occur commonly in prostate cancer patients as well as in patients with breast and lung cancers). The authors note that the value of single-fraction radiotherapy has been demonstrated in several randomized, controlled clinical trials and that single-fraction radiotherapy is used least by members of the American Society for Therapeutic Radiation and Oncology (ASTRO) practising in the USA.

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