Prostate cancer news report: Monday, November 16, 2009

Three reports discussed today address the refinement of risk information in the diagnosis and prognosis of prostate cancer, with specific regard to:

  • Whether PSA levels should be adjusted based on BMI
  • The prediction of Gleason score upstaging after surgery
  • Tumor volume and percent cancer as predictors of prostate cancer progression post-surgery

Recognizing that obesity may be associated with lower levels of PSA as a consequence of hemodilution, Loeb et al. examined the relationship between body mass index (BMI) and PSA level by age in men without prostate cancer to determine whether PSA levels should be adjusted for BMI. Theit study population included 994 men (who ihad 4,937 observations) without prostate cancer in the Baltimore Longitudinal Study of Aging. The authors were able to show that, in men without prostate cancer, BMI was not significantly associated with PSA level after adjusting for age. They did note found an inverse relationship between obesity and serum PSA level, but the magnitude of the difference was small. They conclude that adjusting PSA levels Based on BMI does not appear to be warranted.

Tilki et al. have attempted to identify factors that might indicate the probability of an increased Gleason score at post-surgical pathology compared to the biopsy-based, pre-treatement Gleason score. Such upstaging tends to occur in 25 percent or more of patients. Their study is based on data from 684 patients treated at a single institution, of whom 203 (29.7 percent) were upstaged after surgery. The authors were able to show that, at least in this series of patients, a smaller prostate volume and a higher PSA level were associated with clinically significant upgrading of patioents’ Gleason score, and that PSA density as a function of both is a significant predictor of Gleason score upgrading in low- and high-risk patients.

A new article by Chung et al. suggests that tumor volume and percentage of cancer are independent predictors of recurrence after radical prostatectomy. However, in the Stanford University series of 739 patients, on which this study was based, tumor volume predicted cancer-specific death significantly better than percent cancer. The authors therefore conclude that accurate, post-surgical determination of tumor volume, along with other accepted pathologic indices, is sufficient and preferred over percent cancer for prognostication after radical prostatectomy.

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