Non-ASTRO prostate cancer news reports: Friday, November 6, 2009

In today’s news reports from sources other than the ASTRO meeting, we note items dealing with:

  • PSA bounce in brachytherapy patients
  • Fatal prostate cancer and a history of smoking
  • Ketoconazole + dutasteride in treatment of CRPC

McGrath et al. have reported data on the relationship between the so-called “PSA bounce” effect that can occur after prostate brachytherapy. Their goal was to assess the  impact of PSA bounce on biochemical failure and clinical failure in brachytherapy patients treated with or without neoadjuvant androgen deprivation therapy (ADT). They analyzed data on 691 patients with clinical stage T1-T3N0M0 treated between 1987 and 2003 who were treated with one of three types of radiation therapy: external beam radiotherapy (EBRT) + a high-dose-rate (HDR) brachytherapy boost (n = 407); HDR brachytherapy alone (n = 93); and permanent seed implantation (n = 191). Nearly half the patients (317/691 or 46 percent) received neoadjuvant and/or adjuvant ADT with RT. The mean patient follow-up was 4.0 years. Without going into a lot of the detail, the bottom line to this study is that PSA bounces of ≥ 1.0 ng/ml are rare after brachytherapy with or without neoadjuvant ADT, and occured in < 10 percent of the patients in this study.

Weinmann et al. have reported data from a case analysis study conducted in four health maintenance organizations. They were examining associations between fatal prostate cancer and a range of medical and behavioral characteristics. The cases encompassed  768 health plan members who died of prostate cancer between 1997 and 2001. Thes cases were randomly matched against 929 “controls” from the health plan membership on the basis of health plan, age, race, and pattern of health plan membership. Anthropometric characteristics, as well as personal histories of benign prostatic hypertrophy, transurethral prostatectomy, cancer, diabetes, prostatitis, hypertension, and vasectomy were largely similar for cases and controls. However, the men who died from prostate cancer were 1.5 times more likely than the controls to have been cigarette smokers. The authors were not able to identify any other connection between fatal prostate cancer and a prior health condition or measures of body size.

Sartor et al. have published data from a pilot study (in 10 patients) suggesting that the addition of dutasteride to ketoconazole “might prolong time to PSA progression in patients with CRPC.” The patients in this study had all progressed after treatment with ketoconazole alone. After the addition of dutasteride, 8/10 patients (80 percent) showed some decline in the PSA level compared to the baseline level, but no patient had a PSA decline of ≥ 50 percent. Median progression-free survival after dutasteride addition was 4.9 months. Clearly these data will need confirmation in a larger, preferably randomized, and placebo-controlled trial.

One Response

  1. Unfortunately, when I “clicked” on the “Sartor et al.” link, above, to read the abstract, it opened to only a portion of that abstract and failed to include the “conclusion.” For those interested, here is that conclusion: “We conclude that dutasteride added to ketoconazole at the time progression might prolong time to PSA progression in patients with CRPC.” And I would add –- would also apply to earlier triple hormonal blockade.

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