ProstateCancer

Prostate Cancer
         

• JBW Rietbergen, AEB Kruger, RF Hoedemaekar, et al [ Erasmus Univ, Rotterdam, The Netherlands; Academic Hosp, Rotterdam, The Netherlands]
  Repeat Screening for Prostate Cancer After 1-year Follow-up in 984 Biopsied Men : Clinical and Pathological Features of Detected Cancer
  J Urol 160: 2121-2125, 1998
     
  Conclusion– This article describes the tumor and prostate characteristics of 984 men who underwent repeat screening 1 year after having a negative biopsy of the prostate.
     
  Eleven percent of men undergoing a second biopsy were found to have prostate cancer. The only difference between men whose cancer was discovered at the first biopsy and those discovered at the second biopsy was prostate size [42.6 vs. 34.9 cc]. There were no differences in other parameters such as prostate-specific antigen, pathologic tumor stage, or tumor grade.
     
  This finding underscores the limitations of standard biopsy techniques as applied to a heterogeneous group of men with prostates of varying sizes and shapes. 
      
  In this study, a standard sextant biopsy technique was utilized for all men regardless of prostate size and configuration. One wonders whether tailoring the specific biopsy approach according to prostate size or configuration would be more helpful in identifying prostate cancers during the initial biopsy session. Computer-simulated models suggest that this is indeed possible, but as of yet no firm guidelines have been established to enhance cancer detection on an initial US-guided biopsy of the prostate.
        

• F Rabbani, N Stroumbakis, BR Kava, et al [ Mem Sloan-Kettering Cancer Ctr. New York]
  Incidence and Clinical Significance of False-Negative Sextant Prostate Biopsies
  J Urol 159: 1247-1250, 1998
    
  Conclusion – 23% of patients with known prostate cancer had negative repeat sextant biopsies despite a diagnosis of prostate cancer and despite receiving no therapy.
    
  These results underscore the limitations of using biopsy, after cryotherapy or interstitial radiation therapy, as a surrogate for exclusion of prostate cancer
     

• AS Robbin, AS Whittemore, SK Van Den Eeden [Stanford Univ, Calif; Kaiser Permante Med Care Program, Oakland, Calif]
  Race, Prostate Cancer Survival, and Membership in a Large Health Maintenance Organization
  J Natl Cancer Inst 90: 986-990, 1998
    
  Conclusion – The data are consistent with those reported from most settings, that is, that African American men have poorer survival than white men, even after adjustment for stage of diseases. Whether this reflects differences in virulence or higher levels of co-morbidities among African American is not known.
    
  It is suggested in this study that causes of death other than prostate cancer are unlikely to account for the findings as cancer-specific death rates were also evaluated.
    

• K Brasso, S Friis, K Juel, et al [univ of Copenhagen; Danish Cancer Society and the Danish Inst of clinical Epidemiology, Copenhagen]
  Mortality of Patients with Clinically Localized prostate Cancer Treated with Observation for 10 years or Longer: A Population Based Registry study
  J Urol 161-524-528, 1999
    
  Conclusion – In this study, patients who had clinically localized prostate cancer for 10-years or longer and who were likely candidates for curative therapy as the time of diagnosis had significant excess mortality when treated expectantly.
    
  This study from Denmark is interesting because prior to 1995 no radical prostatectomy was performed for potentially curable disease and less than 1% of patients were subjected to radiation.
     

• RO Roberts, EJ Bergstralh, SK Jatusic, et al [Mayo Clinic and Mayo Found, Rochester, Minn]
  Decline in Prostate Cancer Mortality from 1980 to 1997, and an Update on Incidence Trends in Olmsted County, Minnesota
  J Urol 161: 529-533, 1999
    
  Conclusion – The rates of prostate cancer mortality, which increased in the early years of PSA testing may have declined in recent years to levels lower than those of the early 1980s. Increased screening may account for this change.
     

• OP Heinonen , D Albanes, J Virtamo et al [ Univ of Helsinki; Natl Cancer Inst Bethesda, Md; Natl Public Health Inst, Helsinki; et al]
  Prostate Cancer and Supplementation With a -Tocopherol and b- Carotene: Incidence and Mortality in a Controlled Trial
  J Natl Cancer Inst 90: 440-446, 1998
    
  Conclusion – Long term a -Tocopherol supplementation may markedly decrease the incidence of and mortality from prostate cancer in smokers. Further research is needed to verify these results.
     

• LN Nguyen, A Pollack , GK Zagars [Univ of Texas, Houston]
  Late Effects after Radiotherapy for Prostate Cancer in a Randomized Dose-Response Study: Results of a Self-Assessment Questionnaire
  Urology 51: 991-997, 1998
    
  Conclusion – the incidence of incontinence after radiotherapy [30%] is similar to that after radical prostatectomy as reported in the literature [31%]. Only a few patients required urinary protective devices after radiotherapy.
    
  The percentage of patients who could achieve full erection after radiotherapy [36%]. Compares favorably with that after radical prostatectomy [39%].
    
  Conformal boost radiotherapy with 78 Gy is a safe and effective treatment for prostate cancer that is associated with few significant late effects 2 years or more after radiation therapy.
      

• JD Slater, Yonemoto LT, CJ Jr Rossi, et al [ Loma Linda Univ Med Ctr Calif] 
  Conformal Proton Therapy for Prostate Carcinoma
  Int J Radiat Oncol Biol Phys 42: 299-304, 1998
    
  Conclusion – Proton therapy at doses of 74 to 75 CGE was associated with minimal treatment related toxicity and excellent outcomes in patients with low initial PSA levels.
    
  At 5 years, 91% of patients who achieved a PSA nadir of 0.5 ng/ml or less had no clinical or biochemical evidence of disease.
     

• MA Elsenberger, BA Blumenstein , Ed Crawford, et al [Johns Hopkins Hosp, Baltimore, Md; Southwest Oncolofy Group Statistical Ctr, Seattle, Univ of Colorado, Denver; et al]
  Bilateral Orchiectomy with or Without Flutamide for Metastatic Prostate Cancer
  N Engl J Med 339: 1036-1042, 1998
    
  Conclusion – This is a well defined study that suggests that the benefit of combined androgen blockade in patients with prostate cancer is negligible. It also points out that using prostate specific antigen as a response criterion is hazardous, as patients receiving flutamide had a higher prostate-specific antigen response rate compared with the placebo group but no benefit in survival.
     

• Tyrrel CJ, Kaisary AV, Iversen P, et al [Derriford Hosp, Plymouth, England: Royal Free Hosp, London; Univ of Copenhagen; et al
  A Randomized Comparison of ‘Casodex’TM [Bicalutamide] 150 mg Monotherapy Versus Castration in the Treatment of Metastatic and Locally Advanced Prostate Cancer 
  Eur Urol 33: 447-456, 1998
     
  Because of concern over hot flashes, sexual dysfunction, and other constitutional side effects with castration therapies, increased interest in antiandrogen monotherapies has evolved.
     
  It is worth to maintain sexual interest and function if it means a shorter life expectancy, breast pain, and gynecomastia for men with advanced prostate cancer?
    

• Yasunaga Y, Shin M, Fujita MQ, et al [Osaka Univ, Suita, Japan; Osaka City Univ; Japan
  Different Patterns of p53 Mutations in Prostatic Intraepithellial Neoplasia and Concurrent Carcinoma : Analysis of Microdissected Specimens
  Lab Invest 78: 1275-1279, 1998
    
  Conclusion – Approximately 25% prostate cancer manifest mutations of the P53 gene and that 19% of cases of high grade prosthetic intraepithelial neoplasia also demonstrate P53 abnormalities. 
     
  This study confirms the association between high grade PIN and prostate cancer and the lack of association of low-grade PIN with prostate cancer.
       

• GD Grossfeld , DM Stier, SC Flanders, et al [Univ of California, San Francisco; Technology Assessment group, San Francisco; TAP Holdings Inc, deefield, III
  Use of second Treatment Following Definitive Local Therapy for Prostate Cancer; Data From the CaPSURE Database
  J Urol 160: 1398-1404, 1998
     
  Conclustion – Registry data suggest that about one fifth of patients with prostate cancer receive some from of second treatment a mean of 3 years after their initial local treatment.
  
  Patients whose primary treatment is radical prostatectomy, particularly those at low risk, are least likely to require second treatment.
     
  In this study, 14% radical prostatectomy patients, 27% of radiation patients and 22% of cryosurgery patients underwent second therapies within 2 1/2 to 3 years of completing their initial treatment.
     

• D Kahn, RD Williams, MJ Manyak, et al [ Univ of lowa, lowa City; George Washington Univ, Washington DC, Sutter Gen Hosp, Sacramento, Calif; et al ]
  111Indium-Capromab Pendetide in the Evaluation of Patients with Residual or Recurrent Prostate Cancer After Radical Prostatectomy
  J Urol 159: 2041-2047, 1998
    
  Conclusion – This study evaluated about 180 men with a detectable postradical prostatectomy PSA. About one third of the patients had a scan positive in the prostatic fossa, a quarter within the abdominal or pelvic lymph nodes.
    
  The finding of a positive scan in the prostatic fossa was only corroborated by the finding of a positive biopsy of the fossa half of the time.
    
  The finding of a scan negative for recurrence in the prostatic fossa was associated with a positive biopsy 30% of the time. Thus, it seems that knowing if a patient is scan positive or negative in the prostatic fossa is not especially helpful in determining if there is disease in that location. In this regard the authors did not scan patients who had an undetectable postradical prostatectomy PSA, and evaluation of these patients may give us a clue as to this overall false-positive probability of this study.
    
  This study may not be optimal for excluding extraprostatic fossa disease; therefore, the use of this study in guiding the selection of patients to receive postradical prostatectomy radiation therapy does not appear promising.
    

• Felnyk O, Zimmerman M, Kim KJ, et al [ Univ of California at San Francisco, Genentech Inc, South San Francisco, Calif
  Neutralizing Anti-Vascular Endothelial Growth Factor Antibody Inhibits Further Growth of Established Prostate Cancer and Metastases in a Pre-clinical Model
  J Urol 161: 960-963, 1999
       
  Angiogenesis i.e. deriving blood supply from the existing vasculature promotes tumor growth metastasis. Vascular endothelial growth factor [ VEGF], a potent angiogenic factor and vascular permeability mediator, promotes tumor growth through neovascularisation. Inhibitors of VEGF would reverse this process has been well-studied in previous experimental studies. This study also gives an insight that inhibitors of VEGF through monoclonal anti VEGF neutralizing antibody suppressed the primary tumor growth in mice and also inhibited metastatic dissemination to the lung in human prostate cancer cell line study.
   

• Levesque PE, Nieh PT, Zinman LN, et al [ Lahey Clinic Ctr, Burlington, Mass]
  Radiolabeled Monoclonal Antibody Indium 111-Labeled CYT-356 Localizes Extraprostatic Recurrent Carcinoma After Prostatectomy
  Urology 51: 978-984, 1998
    
  Elevated prostate-specific antigen [PSA] can detect recurrence but not the locations of the disease. Murine monoclonal antibody, 7E11-C5. 3-glycyl-tyrosyl-[N, e-diethylenetriamine pentaacetic acid] – lysine [CYT-356], linked to 111In was used to localize primary and metastatic prostate cancer. A large majority with elevated PSA, the CYT-356 was taken up outside the prostate fossa. Approximately, two third have activity in pelvic lymph nodes. Even when the lymph node dissections were negative at the time of prostatectomy.
      
  Scan failed to localize the disease in 21% of the patients with elevated PSA possibly because the antibody fail to bind to all the tumors or is unable to find small foci.
      

• Djavan B, Kadesky K, Klopukh B, et al [Univ of Vienna; Presbyterian Hosp of Dallas; Univ of Texas, Dollas]
  Gleason Scores From Prostate Biopsies Obtained with 18-Gauge Biopsy Needles Poorly Predict Gleason Scores of Radical Prostatectomy Specimens
  Eur Erol 33 : 261-270, 1998
    
  The Gleason grading system is a well accepted prognostic factor for prostate cancer. This study has correlated with Gleason score from needle biopsy with that from radical prostatectomy. For needle biopsy 37.2% of patients had no scoring change, 12.7% were overgraded, and 50.1% undergraded. To conclude 50% of all gleason score when obtained from needle biopsy specimen had to be revised in the direction of a worse. The clinician have to keep this in mind when advising patients when gleason grading system is taken into consideration for planning the therapy.