Prostate cancer news reports: Friday, August 14, 2009

Today’s news reports cover items on:

  • Patient understanding of the risks and benefits of active surveillance
  • Outcomes after RALP assessed using subjective and objective evalauation criteria
  • Viagra and post-surgical recovery of erectile function
  • Combining 153Sm-EDTMP and zoledronic acid to treat bone pain in patients with metastatic disease

van den Bergh et al. have assessed the degree to which patients fully understand the implications of going on to active surveillance protocols in a cohort of 150 Dutch patients. They report adequate knowledge about prostate cancer and realistic perceptions of the active surveillance strategy (as well as its potential risks and benefits)  in patients with early prostate cancer who go on active surveillance. They state that their findings suggest either adequate counselling by the physician or adequate patient self-education.

Shikanov et al. have assessed “trifecta” outcomes following robotic-assisted laparoscopic prostatectomy (RALP). The trifecta rate of achieving continence, potency, and an undetectable PSA level following radical prostatectomy has been estimated to be approximately 60 percent at 1-2 years in open radical prostatectomy series. A prospective, institutional RALP database was analyzed for preoperatively continent and potent men with ≥ 1 year follow-up after a bilateral nerve-sparing RALP. Continence and potency were evaluated preoperatively and at 3, 6, 12, and 24 months after surgery by surgeon interview (subjective) and using a validated, self-administered questionnaire (objective). A total of 380 out of 1,362 patients receiving consecutive RALPs were preoperatively potent and continent, underwent bilateral nerve-sparing surgery, and had sufficient follow-up. Trifecta rates applying subjective continence and potency definitions were 34, 52, 71, and 76 percent at 3, 6, 12, and 24 months, respectively. The corresponding  rates using objective continence and potency definitions were 16, 31, 44, and 44 percent. The authors conclude that RALP offers trifecta outcome rates comparable to open surgery, but that the outcome rates vary significantly depending on the methods used for evaluation of continence and potency.

A small, restrospective, Spanish study by Fernández Arjona et al. has suggested that patients treated with sildenafil (Viagra) in fixed doses of 100 mg every second day (Monday, Wednesday and Friday) plus 100 mg on demand after their surgery demonstrated a 60 percent recovery of full erectile function 9 months after radical prostatectomy. For those patients who underwent bilateral or unilateral nerve sparing surgery, the recovery rate was nearly 90 percent of erectile function. Given the size of this study and the relatively small number of patients, these resulst should be interpreted with caution.

Lam et al. have reported the treatment of a patient with hormone-refractory prostate cancer (HRPC) and multiple painful osseous metastases using samarium-153 ethylenediaminetetramethylphosphonic acid (153Sm-EDTMP or Quadramet) in combination with zoledronic acid (Zometa). He was treated for 6 months with 4 weekly intervals of zoledronic acid in combination with 3 monthly intervals of 153Sm-EDTMP. No negative interaction was found, toxicity was low, and efficacy high. He experienced a total relief of pain, a significant decrease of prostate-specific antigen (PSA) and, surprisingly, a significant decrease of tumor burden. Although 153Sm-EDTMP and zoledronic acid are both indicated for to palliation of pain symptoms or to prevent skeletal-related events in patients with cancer with painful osseous metastases, and they may have an additive or even synergistic palliative effect, combined use of these drugs has been considered controversial because of the possibility of competition between them at the bone level.

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