THE "NEW" PROSTATE CANCER INFOLINK

Other news reports today — from sources not related to the ASTRO annual meeting — address such topics as:

• Perceptions about the US Preventive Services Task Force recommendations regarding the use of PSA testing men men > 75 years
• Renal insufficiency in men of long-term drug therapy for prostate cancer
• Cetuximab + doxirubicin in the treatment of CRPC
• The mechanism of action of estrogens in treatment of advanced prostate cancer

Caire et al. have reported that, based on men seen at their (admittedly tertiary level) clinic, neither patient survey data nor patient survival data for men with prostate cancer recurrence or metastasis after 75 years of age support the recommendation of the US Preventive Services Task Force (USPSTF)  to discontinue prostate-specific antigen (PSA) screening at age 75. Whether men making the effort to get treatment at this type of thertiary level clinic are actually representative of the US population as a whole is, of cource, open to some question. The “New” Prostate Cancer InfoLink continues to stand by the Iowa Consensus with regard to the role of PSA testing in men of > 75 years of age.

Launay-Vacher et al. have provided data from a recent French study on the relatively common occurrence of renal insufficiency in 222 men being treated with drug therapy for prostate cancer. Detailed information on the precise drugs being used is not available in the abstract of this paper. However, only 29.1 percent of the drugs being prescribed are formally classified as nephrotoxic. The actual degree of renal insufficiency of these patients is also open for discussion since only 14.9 percent of the patients had a serum creatinine level of > 110 μmol/l, but Cockcroft-Gault and aMDRD formulae suggested that 62.6 and 55.9 percent of the patients, respectively, had renal insufficiency. It may, however, be worth getting your renal function checked every so oftgen if you are on long-term drug therapy for progressive prostate cancer.

Slovin et al. have published data from a Phase II clinical trial of the anti-EGFR cetuximab (Erbitux) combined with doxirubicin in the treatment of 36 men with metastatic castration-resistant prostate cancer (CRPC). The data suggest that while this combination may have some degree of activity in very late styage prostate cancer, the potential clinical benefit seems to be relatively small, and there is no evident effect on PSA levels. Furthermore, there was a significant range of adverse reactions associated in this group of patients.

Aggarwal et al. have provided some additional insights into the mechanism of action of estrogenic agents in the treatment of advanced prostate cancer, noting that a decrease in dehydroepiandrosterone sulfate levels and a rise in dihydro0testosterone levels are both associated with a decline in PSA while patients receive estrogen therapy.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Treatment | Tagged: cetruximab, doxirubicin, estrogen, PSA testing, renal in sufficiency, USPSTF |