Prostate cancer news reports: Thursday, July 9, 2009

Today’s news reports address such items as:

  • Finasteride in the prevention of prostate cancer
  • Nitric oxide treatment in men with a rising PSA after first-line therapy
  • Decreased use of LHRH agonist therapy since 2003

A new report by Elliott et al. has confirmed the earlier suggestions by the authors of the Prostate Cancer Prevention Trial results that there is no significant risk that use of finasteride to prevent prostate cancer is associated with an increase in incidence of more aggressive forms of the disease. Rather, Elliott and his colleagues confirm that the appearance of a higher incidence of aggressive disease is an artefact of the effects of finasteride in shrinking prostate size, with resulting effects on PSA levels over time and on the likelihood of finding cancers on biopsy.

Siemens et al. have reported data from a prospective, open-label, Phase II clinical trial of the effect of nitric oxide — delivered via a low-dose glycerol trinitrate (GTN) patch — in men with an increasing PSA level after surgery or radiotherapy. A total of 29 patients were enrolled in the study, and 18/29 patients (62 percent) completed the 24-month protocol, with 3/29 (10 percent) experiencing clinical disease progression. The calculated PSA doubling time of the treatment group before initiating GTN was 13.3 months, which was not significantly different from that of patients in a matched control group (at 12.8 months). However, the end-of-study PSA doubling time for the treatment group was significantly different at 31.8 months.

Chang et al. have reported a significant decrease in use of LHRH agonist therapy in the treatment of prostate cancer among US Medicare and Veterans Administration patients between 2003 and 2007.Their data show that, after implementation of the Medicare Prescription Drug, Improvement and Modernization Act in 2004, reimbursement for LHRH agonists in the Medicare population decreased by 54.8 percent and annual claims decreased by 25.1 percent from 2004 to 2007. LHRH agonist use decreased by 16.8 percent in the Veterans Administration population over the same period. However, there was no compensatory increase in the use of surgical orchiectomy for androgen deprivation therapy during the study period. This change in practice patterns “is likely due to a decrease in Medicare reimbursement for these drugs, an increase in the use of intermittent therapy and increased recognition of the adverse effects associated with androgen deprivation therapy.”

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