Prostate cancer news reports: Saturday, November 21, 2009

In today’s prostate cancer news reports there are brief comments on a number of interesting (if technically dense) articles dealing with such topics as:

  • The need for regularity of post-treatment PSA testing
  • Surgical outcomes of men with Gleason 8-10 disease over 20 years of experience
  • Loss of penile length after radical prostatectomy
  • Does bladder cancer invasion meet the standard for pathologic stage T4?

Ciezki et al. have conducted a retrospective analysis of data on time to biochemical and clinical relapse for 5,616 patients with low-, intermediate-, or high-risk prostate cancer treated (brachytherapy, external beam radiotherapy, or surgery) between 1996 and 2007. The median follow-up was 45 months. According to their analysis, the  frequency with which post-treatment PSA testing is carried out is strongly associated with the detection of biochemical and clinical relapse. They recommend that the frequency of post-treatment PSA testing should be standardized, and they state that, “The sensitivity and specificity can be optimized by obtaining 2 PSA tests per year,” effectively recommending that after treatment men get a PSA test taken at least every 6 months for at least 4 years after their initial treatment.

Bahler et al. have reported on their experience of treating patients with high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy of the past nearly 20 years. Their database included 119 patients with pathologically confirmed high-grade cancers (Gleason 8-10) at the time of RP. Twenty-four patients (20 percent) had organ-confined disease, 60 (50 percent) had specimen-confined cancer, and 14 (12 percent) had nodal metastasis. The overall survival rates at 5 and 10 years were 90 and 75 percent, respectively; the cancer-specific survival rates were 92 and 82 percent, and the biocemical recurrence-free survival rate at 5 years was 31 percent. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. The authors conclude that, “High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival …. The PSA recurrence-free follow-up is poor …. However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.”

Benson et al. have reviewed the recent literature on penile length loss after radical prostatectomy (RP). They note that penile shortening following RP can be a devastating and unwelcome side effect of this operation; that the majority of men undergoing PR for prostate cancer have a measured loss of penile length; that recent studies have investigated the mechanisms resulting in penile shortening; and that various treatments have emerged to prevent and treat postoperative penile shortening.

Pierorazio et al. have argued that bladder neck invasion on post-surgical pathologic staging does not justify categorization as a pathological T4 stage. They provide  a strong argument that: (a) the occurrence of isolated bladder neck invasion is rare and (b) that the long-term outcomes of patients with isolated bladder neck invasion are very similar to the outcomes of patients with pT3a and pT3b disease. Given the source of this paper (Dr. Jonathon Epstein’s laboratory at Johns Hopkins, where they have examined > 17,000 prostate cancer surgical specimens over the past 25+ years, it seems likely that this suggestion should be considered with care.

3 Responses

  1. “Is stage T4 a necessary component of the AJCC staging system for prostate cancer?”

    With all due respect, I believe your statement (quoted above) is improperly worded and thereby conveys a COMPLETELY erroneous implication. In my opinion, a careful reading of the Pierorazio et al. study abstract makes it quite clear that true question raised by the JHU Study, is whether “isolated positive bladder neck margin” should properly be classified as T4 disease. That is far different from the question posed above.

    I am sure that knowledgeable readers will discern the difference, but I want to be sure that newer members are not, unintentionally, confused by a poorly worded headline. – (aka) az4peaks

  2. Dear John:

    Thank you. You are quite correct. I have modified the text above accordingly. Sometimes I try to do too many things with one hand tied behind my back.

  3. Now it is correct. Thank you for the correction. –

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