THE "NEW" PROSTATE CANCER INFOLINK

Today’s news reports summarize papers recently published on:

• Optimism, pessimism, and long-term health outcomes
• External beam radiation + hormone therapy for high-risk patients
• Quality of life and health utility after radical prostatectomy
• Paclitaxel + estradiol combination therapy in men progressing after docetaxel-based chemotherapy

A study by Tindle et al. in the journal Circulation last August apparently suggested (and not for the first time) that women with an optimistic attitude to life tend to have better health outcomes than those with a pessimistic mindset. Specifically, the study included data showing that optimists (versus pessimists) had a lower hazard of coronary heart disease (CHD), CHD-related mortality, cancer-related mortality (in blacks only), and total mortality. The study was based on women enrolled in the Women’s Health Initiative, so it may not be relevant to men — but on the other hand, it may! Since a lot of how one looks at prostate cancer does indeed depend on one’s mindset from day 1, the question of whether you (and perhaps your spouse or partner too) are an optimist or a pessimist may be highly relevant. And in the interests of full disclosure, this information is being provided by someone with a strong tendency to see every glass as being half-full!

Al-Mamgani et al. have offered a new review of the controversies surrounding the risks and benefits of conventional-dose (< 74 Gy) vs. escalated-dose (≥ 74 Gy) radiation therapy for the treatment of men with high-risk prostate cancer, and the concomitant use of hormone therapy. They conclude that the benefit of hormonal therapy in combination with conventional-dose radiotherapy (< 74 Gy) in high-risk prostate cancer is well established, and that there is some evidence for the combination of hormonal therapy with moderately escalated dose (74 Gy) and high escalated dose (≥ 78 Gy) in these patients. However, they also conclude that the optimal duration and timing of hormonal therapy are not well defined.

Ku et al. have reported data from a prospective study of health-related quality of life (HRQoL) and health utility in 213 men with localized prostate cancer treated by radical prostatectomy (RP) at their institution between 2003 and 2006. (It is, of course, well understood that RP can have serious effects on patients’ quality of life.) Their patients had a mean age of 60.9 years and a median Gleason score of 7. They showed that HRQoL in these patients was high prior to their surgery, declined by about 22 percent in the first 3 months after surgery, and then climbed again over the next 6-15 months, but never returned to the initial baseline level. A similar pattern of sharp drop followed by a gradual return toward baseline (without reaching the baseline) was observed for health utility status. The authors conclude that symptom scores (as measured using HRQoL data) and global health status are and remain affected for at least 12 months after RP.

According to a media release from Vivus, Inc., an analysis of the recently completed REVIVE TA-301 Phase III trial of avanafil (an investigational drug for the treatment of erectile dysfunction) has shown that patients who attempted intercourse within 15 minutes of dosing were successful 67, 69, and 72 percent of the time on 50, 100, and 200 mg of avanafil, respectively, as compared to 29 percent of the time for the patients on placebo. However, it should be pointed out that this trial did not include men who had been treated for prostate cancer, so we do not know (yet) whether avanafil has specific potential in prostate cancer patients after initial treatment for their cancer. (Avanafil patients have reported relatively low rates of common side effects associated with PDE5 inhibition, including headaches, flushing, and nasal congestion.)

Beer et al. have published data confirming that there are insufficient data to justify large-scale trials of paclitaxel poliglumex (PPX) in combination with transdermal estradiol for the treatment of metastatic castration-resistant prostate cancer after docetaxel chemotherapy. PPX is a specific formulation of the chemotherapy paclitaxel with a macromolecular polymer. Although PPX + transdermal estradiol had some activity in patients who relapsed after docetaxel-based chemotherapy, the median time to disease progression for these patients on the proposed combination was only 4 weeks.

Filed under: Drugs in development, Living with Prostate Cancer, Management, Treatment | Tagged: "high risk", estradiol, hormone therapy, HRQOL, optimism, outcomes, paclitaxel, pessimism, quality of life, radiation, radical prostatectomy |