A “last word” from the Genitourinary Cancers Symposium

Over 200 posters and other presentations of new data, as well as many other discussions and lectures, were offered yesterday in the prostate cancer sessions at the Genitourinary Cancers Symposium in Orlando.

In preceding commentaries posted to this site since Tuesday night, we have attempted to give readers a summary of most of what we saw as the most interesting new data being presented at this meeting. Many other presentations were highly focused on the minutiae of everything from the potential roles of genomics in prostate cancer diagnosis and prognosis to subset analysis of data from previously reported clinical studies that are scientifically interesting but of limited clinical importance to most patients.

Here is what we see as the most important “take aways” from this symposium this year, as far as prostate cancer is concerned:

  • Dutasteride clearly can and does help to delay the progression of prostate cancer in men diagnosed with low-risk disease who are on active surveillance. Who are the most appropriate patients (and the least appropriate) for this type of therapy is still a question that will need to be resolved.
  • Low-doses of pomegranate extract certainly appear to affect PSA doubling times in men diagnosed and previously treated for prostate cancer, regardless of their prior treatment history (although one commentator at the meeting did carefully note that until we had similar data comparing the effects of POMx treatment to a placebo, there was still an outstanding question about just how real this clinical effect actually is).
  • Stereotactic body radiation therapy (CyberKnife therapy) continues to show good outcomes in early stage, low-risk patients at 4 and 5 years of follow-up — but longer follow-up is still needed in larger numbers of patients.
  • Intermittent ADT is now (according to Dr. Klotz) the standard of care for hormonal treatment of men with a rising PSA after failure of first-line or salvage radiation therapy based on data from the large, randomized Phase III NCIC CTG PR.7 Intergroup trial.

Two other interesting papers were also presented at the meeting that confirm things that, at least in our minds, have been well understood already.

Bul et al. presented yet another re-analysis of data from the ERSPC trial. This re-analysis led them to the conclusions that the risk for aggressive forms of prostate cancer and prostate cancer-specific mortality in a screened population of men who have an initial PSA < 3.0 ng/ml increases significantly with higher PSA levels, but that conversely the risk of dying of prostate cancer is very small in men with an initial PSA of < 1.0 ng/ml. They also concluded that interval-detected prostate cancer is more aggressive and has a substantial influence on risk for prostate cancer-specific mortality.

These data need to taken in context with an excellent commentary on PSA screening by Sartor in the Friday issue of the symposium’s daily news (unfortunately not available on line, as far as we are aware). In his commentary, Sartor concludes with the following paragraph:

PSA testing promotes the early detection of prostate cancer but has become equated with over-treatment in the United States. Our patients deserve better. Unless we are able to separate the screening and over-treatment, PSA testing should have a problematic future. Stated simply, we should not embrace PSA screening unless we [also] embrace [active] surveillance.

The “New” Prostate Cancer InfoLink couldn’t agree more.

Finally, a large randomized clinical trial (RTOG 9601), conducted by Shipley et al., and started back in the late 1990s, has clearly shown that the combination of external beam radiation and bicalutamide, with bicalutamide given at a dose of 150 mg/d over a period of 2 years, significant increased freedom from biochemical progression compared to external beam radiation alone in men with a rising PSA after radical prostatectomy but no evidence of metastatic or node-positive disease. This trial was originally designed to assess whether the addition of 2 years of bicalutmide would be associated with an overall survival benefit. This endpoint is still to be reached after a median follow-up of 7.1 years.

This result is not exactly a surprise. However, a daily dose of 150 mg of bicalutamide has never been formally approved in the USA. Patients receiving this daily dose of bicalutamide had a very high incidence of gynecomastia (swelling and pain of the breast and the nipples), but use of this form of adjuvant hormone therapy in clinical practice would normally be associated with prior radiation of the breast to lower risk for this side effect.

One Response

  1. As someone who did do I believe it was three external beam radiations treatments to my breasts after growth and pain were both occurring, I can reassure anyone contemplating such treatments that they were fast, absolutely painless, and with no side effects I was ever aware of, other than an inability to wash off the red targeting circle they drew around my nipples, which showed though my shirts! They did wash off eventually. … And in my case, even though the problem was already occurring, the treatments were successful; I’ve had no further growth or pain.

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