Prostate cancer news reports: Friday, December 11, 2009

Today’s news reports comment on:

  • Prostate cancer incidence in Asia vs. the West
  • PSA density as a risk factor for upgrading after surgery
  • The mechanisms of progression of CRPC

In a presentation at the recent meeting of the Society for Urologic Oncology, Chang presented data on the relative rates of incidence of prostate cancer in Asia and the West. He used data from the Singapore Cancer Registry to demonstrate that the relative incidence of prostate cancer in Singapore was still 30 times lower than in the USA, but he also noted that prostate cancer has recently gone from being the 10th most common form of cancer in men to become the third most common. However, authopsy rates of prostate cancer in Asia are very similar to autopsy rates in the West, which suggests that the increasing prevalence of clinically significant disease in Asia may reflect changes in the environment and in lifestyle that may have occurred decades ago in the West. Such changes may have reduced more natural human ability to limit the clinical impact of very early stage prostate cancer.

Magheli et al. have demonstrated that PSA density is an independent predictor of risk for upgrading of a patient’s Gleason score (e.g., that a biopsy-based Gleason score of 3 + 4 = 7 might be restaged as 4 + 3 = 7 or even 4 + 4 = 8 after radical prostatectomy). The authors note that use of PSA density to estimate risk for upgrading could be highly relevant for patients with low-risk disease who are considering active surveillance.

For the technically minded reader, it is worth noting an article by Dutt and Gao that reviews the mechanisms of progression of castration-resistant prostate cancer (CRPC). This review makes the point that, even though the androgen receptor “plays the most influential role in development of prostate cancer,” the molecular structure of the androgen receptor in CRPC varies widely from the structure observed in hormone-sensitive patients. Such variation in the structure of the androgen receptor molecule may be at the heart of the difficulties associated with finding a simple mechansim for the effective management of later stage prostate cancer.

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