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The prostate cancer “news de jour”

Posted Sep 28 2008 1:49pm

Four recently published studies provide updates on selected topics of interest.

An Australian group ( Sharpley et al. ) set out to develop a psychological questionnaire that specifically addressed issues related to the effects of prostate cancer on lifestyle. It is well understood that depression among prostate cancer patients can be a major source of distress for the patients themselves (and for their families), has been linked with suicide, and has been shown to contribute to poorer long-term treatment outcomes.  A total of 150 prostate cancer patients completed self reports on anxiety, depression, and lifestyle changes that they had experienced after a diagnosis of and treatment for prostate cancer. The principal instrument being investigated was a measure of 50 lifestyle changes that had been developed from previous interviews with prostate cancer patients. The authors were able to use the reulting data to develop a clinical analysis and a research scale of 36 items for use with prostate cancer patients (the Effects of Prostate Cancer on Lifestyle questionnaire).

Shikanov et al. have carried out a careful analysis of the results of robot-assisted laparoscopic radical prostatectomy (RALP) on 1,225 patients at the University of Chicago Medical Center between February 2003 and September 2007, and used these data to evaluate the pathologic results and postoperative outcomes for men with biopsy (pre-surgical) Gleason scores of 8 to 10.  Their primary goal was to find ways to predict organ-confined cancer in such patients. Seventy-two (5.9 percent) of their patients had preoperative biopsy Gleason scores of 8 to 10. Two patients received neoadjuvant hormonal therapy and were excluded. Among 70 patients evaluated, 33 (47 percent) had organ-confined (pT2N0) disease. Forty (60.6 percent) patients had pathologic downgrading to Gleason scores of ≤ 7. Their overall positive surgical margin (PSM) rate was 24.2 percent. In pT2 and pT3 patients, their PSM rates were 6 and 42.3 percent, respectively. The authors show that PSA levels ≤10 ng/mL (P = 0.04) and a percentage of cancer in the biopsy cores (%MCB)  of ≤ 30 percent (P = 0.001) were statistically significant predictors of pT2N0 disease. They conclude that while  preoperative biopsy Gleason scores of 8 to 10 predict a significant likelihood of finding non-organ-confined prostate cancer on the final pathology report, a preoperative PSA level of ≤ 10 ng/mL and %MCB ≤ 30% may be used to predict favorable pathologic outcome for these patients during surgical counseling. The “New” Prostate Cancer InfoLink finds it particularly interesting that > 60 percent of their patinets were downgraded to Gleason scores of 7 or less post-surgery. This would suggest that pathologists at the University of Chicago Medical Center were tending to err on grading biopsy reports on the high side, which seems to be relatively uncommon, based on other available information.

Loeb et al. at Johns Hopkins have compared PSA doubling time and PSA velocity as potential predictors for high-risk prostate cancer, based on data from the Baltimore Longitudinal Study of Aging (BLSA). This group has previously argued that pretreatment PSA velocity is associated with the presence of life-threatening prostate cancer. However, it is recognized that we know less about the relative value of pretreatment PSA doubling time (PSADT) to predict tumor aggressiveness. From the BLSA database, the authors identified 681 men with serial PSA measurements. They analyzed these data to evaluate the relationship between PSAV, PSADT, and the presence of high-risk disease. Their findings are as follows: Within the period of 5 years prior to diagnosis, PSAV was significantly higher among men with high-risk or fatal prostate cancer than men without it. By contrast, PSADT was not significantly associated with high-risk or fatal disease. They conclude that, “These data suggest that PSAV is more useful than PSADT in the pretreatment setting to help identify those men with life-threatening disease.” The “New” Prostate Cancer InfoLink would remind readers that there is an ongoing discussion within the urology community about whether the addition of PSAV data to other available data actually improves the clinical prediction of high-riosk disease.

Another study, by Martin et al., has examined whether the proportion of men with a PSAV >2 ng/mL per year has changed significantly during the PSA era. The authors evaluated men from a prospective prostate cancer screening study who underwent radical prostatectomy between 1989 and 2002. They compared the men who were treated during three specific time periods: before 1995, from 1995 to 1998, and after 1998. Of 1,095 men in their database, 262 (24 percent) had a PSAV >2 ng/mL per year. There was a statistically significant reduction in the proportion of men presenting with a PSAV > 2 ng/mL per year over the study period. Specifically, 35 percent of men presented with a PSAV > 2 ng/mL per year in the early period compared with only 22 and 12 percent in the middle and late periods, respectively (P < 0.001). There also was a significantly greater proportion of men with morwe than two PSA values obtained before diagnosis (P < 0.001). The authors conclude that, “Men who were screened serially with PSA were less likely to present with a PSAV >2 ng/mL per year.” The go on to state that, “This association lends support to the hypothesis that serial PSA-based screening may lead to a decrease in prostate cancer-specific mortality.”

Filed under: Management, Treatment

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