Prostate cancer news reports: Wednesday, May 5, 2010
Posted May 05 2010 12:00am
In today’s news reports we address data from studies dealing with:
Cancer risk in young Korean males with an elevated PSA level
Mushroom-based supplements in the treatment of prostate cancer
Outcomes after brachytherapy in intermediate-risk Canadian patients
Traumatic stress among African American prostate cancer patients
Yang et al. have reported data from 81 Korean men of ≤ 40 years of age referred to their center as a result of elevated PSA levels between 1997 and 2008. Of these 81 patients, 75 were asymptomatic, had normal DREs, and received transrectal ultrasound-guided prostate biopsy for possible prostate cancer. The median age of these 75 men was 33 years (range, 26 to 40 years) and their mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). At primary biopsy, 1 man (1.3 percent) was shown to have prostate cancer, 1 man had high-grade intraepithelial neoplasia (HGPIN) and 1 man had atypical small acinar proliferation (ASAP); 70 men (93 percent) had benign tissue; 2 patients (2.6 patients) showed signs of prostate inflammation. Ten (10) men underwent a second (repeat) biopsy, and all had benign findings. Three men underwent a third biopsy, and again all had benign tissue findings. The authors conclude that in Korean men ≤ 40 years of age with elevated PSA levels and a normal DRE the rate of detection of prostate cancer has been very low, and repeat biopsies in such young man may not be justified. It would be interesting to know how these data compared to data from young African American males with a similar clinical profile.
Yoshimura et al. have reported that the “medical mushroom” supplements Senseiro (containing extracts from Agaricus blazei Murill) and Rokkaku Reishi (containing Ganoderma lucidum), when used to treat Japanese patients prostate cancer patients for a period of up to 6 months, had no significant impact on PSA, no identifiable anticancer effects, and no noticeable side effects either.
Zebentout et al. have reported data from 157 Canadian patients with intermediate-risk prostate cancer treated in Quebec with first-line, iodine-125-based brachytherapy between 1994 and 2007. (Their entire database included 200 eligible patients, but 43/200 lacked sufficient data for a complete analysis of long-term outcomes). The average (mean) age of the patients was 65.6 ± 6.0 years; their average ( mean) pretreatment PSA was 8.7 ng/ml; 51 percent of the patients were clinical stage T2b/T2c; 44.6 percent of the patients had a PSA value> 10; and 4.5 percent of patients had a Gleason score of 7. A short course of hormone therapy (< 6 months) to reduce the size of the prostate was necessary for 57.4 percent of patients. The median follow-up was 60 months. Biochemical failure-free survival was 87.1 percent at 60 months of follow-up and 81.0 percent at 96 months based on the Phoenix definition (nadir PSA + 2 ng/ml). The patients’ mean International Prostate Symptoms Score (IPSS) a measure of genitourinary “bother” rose from 5 immediately after brachytherapy to 15 at 1 month after treatment and then decreased to 8 at 24 months post-treatment. Acute urinary retention necessitating catheterization occurred in 10.9 percent of patients. The authors state that only 4.3 percent of patients had erectile dysfunction at 5 months post-implant.
Purnell et al. have reported data from what they state to be “the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer.” The results of this study suggest: (a) significantly higher levels of traumatic stress for African American men compared to non-African American men independent of type of clinical intervention, demography, and relevant clinical variables; (b) a higher prevalence of clinically significant traumatic stress among African Americans as compared to men of other races. These elevations were sustained over a period of 24 months. However, the number of African American men in this study was only 30 (9 percent) compared to 287 non-African Americans (91 percent). It would be helpful to see data from a comparable study in which the level of participation of African American patients was closer to 20 percent or even higher, and in which there was a clear distinction between the ethnic origins of non-African Americans.