Prostate cancer news reports: Wednesday, November 25, 2009

There have been a number of interesting reports over the past couple of days that are summarized briefly below. They encompass such topics as:

  • The validity of the Epstein criteria in predicting clinically indolent prostate cancer
  • MRI and MRSI in patient work-up prior to treatment for stage T1c disease
  • Contrast-enhanced, color Döppler ultrasound and prostate biopsy
  • Gleason scores and cancer “laterality” on biopsy and after surgery
  • Accuracy of prediction of “unilateral” prostate cancer, and implications for focal surgery
  • Patient age and probability of indolent disease
  • Testosterone levels, comorbidities, ADT, and mortality
  • A new “prostate mechanical imaging system”

According to Lee et al., the so-called Epstein criteria, developed at Johns Hopkins as a set of criteria to determine which men might be appropriate candidates for active surveillance because they had a high probability for indolent disease, are actually highly predictive only for organ-confined disease and the absence of biochemical failure up to 5 years after RP. Lee and colleagues conclude that these criteria are “insufficiently robust to predict the presence of biologically insignificant disease.”

Zhang et al. have explored the potential role of magnetic resonance imaging (MRI) and magetic reonance spectroscopic imaging (MRSI) in prediction of the pathologic stage and the presence of clinically insignificant disease in patients with clinical stage T1c prostate cancer. They conclude that, “Clinical stage T1c prostate cancers are heterogeneous in pathologic stage and volume. MR imaging may help to stratify patients with clinical stage T1c disease for appropriate clinical management.” However, The “New” Prostate Cancer InfoLink continues to be of the opinion that the use of MRI and MRSI routinely prior to treatment cannot be justified as yet. On the other hand, there are clearly patients for whom pre-treatment workup that includes detailed imaging studies are appropriate and justified.

A study by Mitterberger et al. suggests that a transrectal, contrast-enhanced, color Döppler ultrasound (CECD)-guided process can be used to increase the probability of detection of prostate cancer — with fewer biopsy cores — than a systematic 10-core, “grey scale,” TRUS-guided biopsy technique in patients previously diagnosed with HG-PIN.

Nepple et al. investigated the “concordance” between Gleason scores and “laterality” of prostate cancer found at biopsy and at subsequent radical prostatectomy. They conclude that, “Prostate biopsy underestimated prostatectomy Gleason score in 34% of men and bilateral involvement in 80% of those with unilateral disease on biopsy.” They state that, “Taking at least eight cores improves the accuracy of the prostate biopsy.” The “New” Prostate Cancer InfoLink notes that a 12-core biopsy is now closer to what would be considered “standard practice” for biopsy in the USA.

Yet another study (this one from Isbarn et al. in Hamburg and Montreal) has concluded that it is not possible to accurately predict exclusively unilateral prostate cancer in patients believed to have low-risk, localized disease. They conclude that, “Two-thirds of patients with unilateral low-risk [prostate cancer], confirmed by clinical stage and biopsy findings, have bilateral or non-organ-confined [prostate cancer] at radical prostatectomy.” They go on to question the safety and effectiveness of the current (and increasingly popular) use of “focal” or “hemiablative” therapy. The “New” Prostate Cancer InfoLink is also concerned by the increasing popularity of this therapy, given data like these and the accumulating evidence of post-treatment recurrence in such patients.

Barlow et al. have reported data on patient age at time of radical prostatectomy (RP) and risk for recurrence of prostate cancer initially presumed to be localized to the prostate. It has been presumed that increasing age is associated with more indolent behavior (at least in some cancers). However, according to Barlow et al., based on their single-institution series of 1,984 patients, “Older patients who undergo RP appear to have an increased risk of recurrence. However, age is not an independent predictor of recurrence when accounting for PSA level, grade, and stage.” In other words, there is no prognostic relationship between age and risk for recurrence if you take other standard clinical factors into account.

Taira et al. have reported — based on a retrospective analysis of data from the treatment of 803 patients using brachytherapy ± androgen deprivation therapy (ADT) — that, “Low pretreatment testosterone level may be a marker for men at increased risk of premature death with ADT” and that “The combination of low pretreatment serum testosterone level and multiple preexisting comorbidities is associated with decreased [overall survival] when ADT is incorporated into treatment.” This report is likely to raise questions about whether men with 2 or more comorbidity risks should routinely have their testosterone levels checked prior to the use of ADT.

ProUroCare Medical is seeking marketing approval from the US Food and Drug Administration for “a prostate mechanical imaging system” that “can be used as an aid to visualize and document abnormalities of the prostate detected and/or monitored by digital rectal examination (DRE).”

2 Responses

  1. Regarding the employment of MRI/MRSI with T1c staging, medical oncologist Stephen Strum has been remarking for several years that this has been a huge waste of money in this regard. The likelihood of imaging cancer development at this stage is nil.

  2. Hmmmm … I’m not sure that I would agree that it is “nil.” I think, however, that it is only going to be potentially valuable in highly selected patients, which then raises serious questions about its cost-effectiveness.

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