Prostate cancer news reports: Sunday, February 7, 2010

Today’s news reports address recent articles on:

  • Ethnicity and first-line treatment for localized prostate cancer
  • Management of biochemical relapse after first-line radiation therapy for localized disease
  • “Pelvic floor rehabilitation” therapy after nerve-sparing surgery
  • The DAB2IP gene and metastatic prostate cancer

Moses et al. have used the CaPSURE database to offer us further data supporting the fact that, in the USA, African-American men are more likely than Caucasians to receive first-line treatment with radiation and/or androgen deprivation therapy (ADT) than surgery. The most striking fact in this study is that African Americans with low-risk disease were 71 percent more likely to receive ADT than white males with similar disease — and there is minimal evidence to support this use of ADT. The reasons for this difference are probably complex. What is clear is that research on the influence of patient/physician education and perception and the role that socioeconomic factors play in the treatment of prostate cancer may be useful areas of focus for public health initiatives.

Boukaram and Hannoun-Levi have offered us a new review of the treatment of patients in biochemical relapse after first-line radiation therapy. These patients have numerous options, but “best practices” for such patients are not well defined and long-term outcome data are relatively sparse. Not surprisingly, the biggest problem with such patients is being able to identify precisely where the recurrence has occurred — within the previously radiated area (local relapse) or somewhere else entirely (potentially micrometatstic disease). As the authors state in their abstract, “Each clinical situation should be discussed in a multidisciplinary setting. Different options should be explained to the patient and decision should be taken after balancing treatment outcomes with life expectancy.”

Sighinolfi et al. have published data on the use of “pelvic floor rehabilitation treatment” for men with incontinence and erectile dysfuction after nerve-sparing radical prostatectomy. This is a very small series (of just 3 patients), and some are likely to dispute the authors’ claim that this paper presents “the first clinical case series dealing with this topic.” However, what this paper does do (again) is suggest that there is real value to the role of a structured program of pelvic floor rehabilitation for most men after a radical prostatectomy. Such a 4-month program would likely assist the majority of patients to maximize their potential for continence and erectile function post-surgery. When you get an orthopedic surgical procedure, it is customary to have a period of physiotherapy to ensure full recovery post-surgery. So why do we routinely ignore this possibility after a radical prostatectomy?

Xie et al. have reported that expression of the DAB2IP gene may offer a prognostic biomarker for prostate cancer metastasis — and a potential therapeutic target for the prevention or treatment of metastatic prostate cancer. Based on a mouse model, their paper offers an explanation of how loss of expression of the DAB2IP gene can lead to metastasis and how restoration of expression of this gene can reverse the process in metastatic prostate cancer cells.

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