Prostate cancer news reports: Saturday, July 25, 2009

Today’s news reports address items on:

  • The burden of prostate cancer in Canada
  • Pelvic lymph node dissection and RALP
  • Data from early trials of sipuleucel-T in advanced prostate cancer
  • Implementation of osteoporosis screening guidelines in prostate cancer patients

A recent review by Fradet et al. summarizes information about the clinical and economic burden of prostate cancer in Canada. Studies indicate that 1 in 7 Canadian men can now expect to develop prostate cancer during their lifetime, and 1 in 27 patients diagnosed will die because of it. It was previously estimated that 4,300 Canadian men would die of prostate cancer in 2008. As in the USA and Europe, age, family history, race, and diet are all risks associated with the development of prostate cancer, and a diagnosis of cancer is a cause of significant anxiety and depression.

Two recent publications address issues around the current use of pelvic lymph node dissection (PLND), with a particular emphasis on whether the increasing use of robot-assisted laparoscopic prostatectomy (RALP) has led to under-use of PLND. Cooperberg et al. seem to suggest that current application of PLND in association with RALP at their institution is appropriate and sufficient. By contrast, Silberstein et al., suggest that PLND “is currently underreported during robotic procedures.” It seems likely that there may be significant variation in the use of PLND from one institution to the next, and even between individual surgeons in operating at specific institutions.

Higano et al. have finally published full combined data from the two original studies suggesting the effectiveness of sipuleucel-T (Provenge) compared to a placebo in extending the survival of patients with hormone-refractory prostate cancer. The most common adverse events associated with sipuleucel-T treatment were chills, pyrexia, headache, asthenia, dyspnea, vomiting, and tremor. These events were primarily grade 1 and 2, with durations of 1 to 2 days.

Van Tongeren et al. have reported significant variation in the implementation of osteoporosis screening guidelines in prostate cancer patients on androgen ablation for ≥ 6 months at the four major cancer centers in British Columbia, Canada. They conclude that this variation indicates a need for greater efforts to implement guidelines when they are issued and monitor their implementation over time.

3 Responses

  1. Personally, I concur that PLND should be performed in company with RALP to be assured that pelvic lymph nodes are clear of cancer. I’m pretty sure the current procedure is to only include PLND if the surgeon sees something suspicious during RALP, and my concern is that if what they see is not clearly suspicious, they will continue to ignore PLND. Seminal vesicles continue to be removed in RALP just as they are in RP. I support RALP, but I have been concerned by the lack of PLND that is routinely part of RP but given less concern with RALP. Obviously including PLND with RALP is more time consuming, and that may be the over-riding factor.

  2. Hmmm … PLND should be performed on those at possible risk for positive lymph nodes (regardless of type of surgical procedure) — but there has never been a consensus on exactly what defines that risk. Most surgeons today would not perform a PLND on a patient with a Gleason score of less than 8 unless he had a PSA of more than 20 ng/ml, I suspect.

  3. It has been my experience in reviewing patient pathology reports following open RP that at least regional lymph nodes were removed and reviewed for metastasis despite Gleason score. In the report above, Silberstein et al. remark that, “Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer.” And one of the review papers made note that, “Proper assessment of lymph node status is of crucial importance in the management of newly diagnosed prostate cancer. Early stage metastatic disease takes the form of microscopic tumor-cell deposits rather than grossly enlarged nodes. So far there is no imaging technique, however, which allows detecting small metastases in the range of a few millimetres. Therefore pelvic lymph node dissection (PLND) is the only reliable method of staging for clinically localized prostate cancer.”

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