Prostate cancer news reports: August 13, 2009

In today’s prostate cancer news reports we address:

  • The role of RALP in men ≥ 70 years of age
  • The development of the COMPARE prostate cancer registry
  • The risk for mortality within 30 days of a TURP for men with a history of ADT for prostate cancer
  • Micro-RNA 221 levels as a marker for metastatic prostate cancer

Greco et al. have published data on 23 patients, all ≥ 70 years of age, treated with robot-assisted laparoscopic prostatectomy (RALP) by a single surgeon between 2005 and 2008. The outcomes for these patients were compared to outcome of the other 180 patients (all < 70 years of age) treated in the same way by the same surgeon during the same timeframe. The older patients has comparable characteristics to the younger men before, during and after surgery. The post-surgical Gleason score was significantly higher in older men, but surgical complications were not significantly different between the groups. Continence rates were significantly lower in older men at 6 months after surgery, but returned to levels equivalent to those in younger men within 12 months after surgery. Older patients took significantly longer to be capable of driving after surgery. The authors conclude that, “Advanced chronological age should not be a contraindication [for RALP] in patients with clinically localized prostate cancer, but expectations should be managed preoperatively.”

Sartor et al. have described the development of a multicenter prostate cancer registry — the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma Registry (COMPARE) — which has been collecting data for a prospective, multicenter, observational study on patient characteristics, management practices, and outcomes of men presenting to their physician for the management of an increasing PSA level after definitive treatment of localized prostate cancer (with surgery or radiotherapy). Between February 2004 and March 2007, 1,120 men were enrolled at 150 sites throughout the United States. The men had a median age of 73 years (range, 46-95 years), were predominantly white (77 percent), and had a median PSA level of 7.9 ng/ml (range, from 0 to 710.8 ng/ml) at diagnosis. Observation (74 percent) was the most common initial management choice at registry enrollment, and androgen-deprivation therapy (22 percent) was the most common initial treatment choice. The authors believe that data from COMPARE should provide a valuable source of prospectively collected information on the contemporary management of prostate cancer and patient outcomes after PSA failure.

Isbarn et al. have reported a significant risk for mortality at 30 days after transurethral resection of the prostate (TURP) in men treated with primary androgen deprivation therapy (ADT) or radiation therapy followed by ADT. According to their data, in Canada, 7 percent of men with prostate cancer who are exposed to ADT may need a TURP. The authors assessed the 30-day mortality rate after TURP in 853 prostate cancer patients being treated with ADT, and they assessed the influence of multiple variables (e.g., age, comorbidity, previous TURPs, history of radiation therapy, and type and duration of ADT). Their results showed that 38/853 patients (4.5 percent) died within 30 days of their TURP, and that, of all variables considered, only comorbidity (assessed using the Charlson comorbidity index or CCI) was a statistically significant predictor of 30-day mortality after TURP. The authors do point out, however, that certain variables (e.g.m prostate volume and PSA level) were not assessed as part of this study and may also be predictive of risk for 30-day mortality in this cohort post-TURP.

Spahn et al. have published data suggesting that the expression of micro-RNA 221 is is linked to tumor progression and recurrence in a high risk prostate cancer cohort. Their results indicate that progressive down-regulation of micro-RNA 221 is a possible hallmark of metastasis and may present a novel diagnostic and prognostic marker in high risk prostate carcinoma.

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