Research and articles
On this page is described some important contemporary reports on research and studies relating to prostate cancer that we think would be of particular interest to members of the group. This list is being added to over time.
TOPIC
RESEARCH STUDY OR ARTICLE
PSA TESTING, PSA SCREENING
"No PSA Screening Would Triple Metastatic Prostate Cancer Cases at Diagnosis": CancerNetwork article dated 6 August 2012 discussing modelling undertaken by Prof. Edward M Messing et al at Rochester Medical Center. The article can be read online here. The text of that article plus an abstract of the study referred to can be downloaded as a 123 KB PDF file from our site here.
European Randomized Study of Screening for Prostate Cancer (ERSPC) study's 11-year follow-up analysis on PSA screening. In a press release dated 15 March 2012 the ERSPC indicated that one of the conclusions from the recently completed 11-year follow up study on PSA screening was that "...a man who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%." In other summary reports of the ERSPC study a different statistic is often reported - namely a 21% reduction in risk. The 29% statistic related to men in the screening group who "... complied with regular screening", whereas the 21% relates to the reduction of risk amongst ALL men in the screening group, whether or not they complied. An interesting aspect about the study is that according to a press release from another source, the reduction in risk occurred in only two of the eight countries participating in the study (Sweden and the Netherlands) - it would be of interest to determine what factors applied in those countries but not in the others.
In the Financial Review of 25 August 2011 there is an article by Jill Margot reporting the apparent availability of a new type of analysis that is claimed to improve PSA’s diagnostic value. This is referred to as “Phi” - the Prostate Health Index. The article claims that the Phi index enhances the diagnostic accuracy of the level of total PSA and the ratio of free to total PSA. An analysis is made for an immature form of PSA in the blood. This information is then combined with data for free PSA and total PSA to estimate the likelihood of cancer being present. An image of the article as a 1.7 MB file in PDF format is downloadable from here.
Swedish prostate-cancer PSA screening study reported in The Lancet Oncology, Volume 11, Issue 8, pp 725 - 732, August 2010. This article by Prof Jonas Hugosson MD et al reports the results after 14 years of tracking of 9952 residents of Goteborg who were invited to participate in PSA testing every two years and another 9952 residents that comprised a control group. Of the 9952 in the screening group, 7578 actually attended the screening program. After 14 years, the numbers who had died from prostate cancer were 44 in the screening group, 27 of the attendees and 78 in the control group. Thus, the relative risk of men in the screening group dying from prostate cancer was 56% of that for the men in the control group. For the subset of men in the screening group who actually attended the program the relative risk of dying from prostate cancer was only 44% of that for the men in the control group. A major conclusion of the authors of the study is that “...a screening programme will decrease prostate-cancer mortality by as much as half over 14 years’ follow up.” A summary of the Lancet Oncology article is on this page. One interesting detailed discussion of the study can be found on Prostate Cancer Infolink and there are other discussions on the web.
Re-analysis of some data from the ERSPC PSA screening study. This reanalysis of data from the ERSPC (European Randomised Study of Screening for Prostate Cancer) study is reported by M J Roobol et al in the 30 July 2009 European Urology Journal pp 584-591. The ERSPC study findings reported initially in March 2009 indicated that PSA screening may reduce prostate cancer deaths by 20%. Roobol et al indicate that the 20% estimate “...is influenced by two types of noncompliance: nonattendance in men who are randomised to the intervention arm and contamination (ie, the use of [PSA] testing in men randomised to the control arm).” Using data from the Rotterdam arm of the ERSPC, the authors concluded that: “After correction for both nonattendance and contamination, the mortality reduction increased by 50%, giving a PCa (prostate cancer) mortality reduction of 31–33% attributable to attending screening. This estimate represents the reduction of the risk of dying from PCa comparing men who accept an invitation to undergo PSA-based screening as carried out in ERSPC as compared with men who were not tested.” A copy of the full article can be read and/or downloaded as a 1.1 MB PDF file by going here and doing a Search for ‘Screening adjusted for nonattendance and contamination in the European Randomised Study of Screening for Prostate Cancer’ (without the quotes).
European Randomized Study of Screening for Prostate Cancer (ERSPC) study's 11-year follow-up analysis on PSA screening. In a press release dated 15 March 2012 the ERSPC indicated that one of the conclusions from the recently completed 11-year follow up study on PSA screening was that "...a man who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%." In other summary reports of the ERSPC study a different statistic is often reported - namely a 21% reduction in risk. The 29% statistic related to men in the screening group who "... complied with regular screening", whereas the 21% relates to the reduction of risk amongst ALL men in the screening group, whether or not they complied. An interesting aspect about the study is that according to a press release from another source, the reduction in risk occurred in only two of the eight countries participating in the study (Sweden and the Netherlands) - it would be of interest to determine what factors applied in those countries but not in the others.
In the Financial Review of 25 August 2011 there is an article by Jill Margot reporting the apparent availability of a new type of analysis that is claimed to improve PSA’s diagnostic value. This is referred to as “Phi” - the Prostate Health Index. The article claims that the Phi index enhances the diagnostic accuracy of the level of total PSA and the ratio of free to total PSA. An analysis is made for an immature form of PSA in the blood. This information is then combined with data for free PSA and total PSA to estimate the likelihood of cancer being present. An image of the article as a 1.7 MB file in PDF format is downloadable from here.
Swedish prostate-cancer PSA screening study reported in The Lancet Oncology, Volume 11, Issue 8, pp 725 - 732, August 2010. This article by Prof Jonas Hugosson MD et al reports the results after 14 years of tracking of 9952 residents of Goteborg who were invited to participate in PSA testing every two years and another 9952 residents that comprised a control group. Of the 9952 in the screening group, 7578 actually attended the screening program. After 14 years, the numbers who had died from prostate cancer were 44 in the screening group, 27 of the attendees and 78 in the control group. Thus, the relative risk of men in the screening group dying from prostate cancer was 56% of that for the men in the control group. For the subset of men in the screening group who actually attended the program the relative risk of dying from prostate cancer was only 44% of that for the men in the control group. A major conclusion of the authors of the study is that “...a screening programme will decrease prostate-cancer mortality by as much as half over 14 years’ follow up.” A summary of the Lancet Oncology article is on this page. One interesting detailed discussion of the study can be found on Prostate Cancer Infolink and there are other discussions on the web.
Re-analysis of some data from the ERSPC PSA screening study. This reanalysis of data from the ERSPC (European Randomised Study of Screening for Prostate Cancer) study is reported by M J Roobol et al in the 30 July 2009 European Urology Journal pp 584-591. The ERSPC study findings reported initially in March 2009 indicated that PSA screening may reduce prostate cancer deaths by 20%. Roobol et al indicate that the 20% estimate “...is influenced by two types of noncompliance: nonattendance in men who are randomised to the intervention arm and contamination (ie, the use of [PSA] testing in men randomised to the control arm).” Using data from the Rotterdam arm of the ERSPC, the authors concluded that: “After correction for both nonattendance and contamination, the mortality reduction increased by 50%, giving a PCa (prostate cancer) mortality reduction of 31–33% attributable to attending screening. This estimate represents the reduction of the risk of dying from PCa comparing men who accept an invitation to undergo PSA-based screening as carried out in ERSPC as compared with men who were not tested.” A copy of the full article can be read and/or downloaded as a 1.1 MB PDF file by going here and doing a Search for ‘Screening adjusted for nonattendance and contamination in the European Randomised Study of Screening for Prostate Cancer’ (without the quotes).
DIAGNOSIS OF PCa, ASSAYING SEVERITY, PREDICTING SEVERITY
Nomogram tool updated for predicting prostate cancer severity. Author: Nick Mulcahy. Medscape Urology News, 9 January 2013 Extracts from the article: An update of the staging nomogram known as the "Partin tables," which predicts the severity of prostate cancer and helps clinicians and patients make treatment decisions, has been published in the January 3 issue of the British Journal of Urology International... The tool uses commonly available preoperative data - serum prostate-specific antigen (PSA) level, clinical stage, and biopsy Gleason score - to accurately predict pathologic stage, which can only be fully assessed once the prostate is surgically removed...The update is based on a study of more than 5600 men treated at Johns Hopkins from 2006 to 2011. Earlier versions of the nomogram were also based on patients at the institution; this single-center data pool is a limitation of the tool...By inputting the PSA, Gleason score, and clinical stage into the updated Partin tables and clicking the Find Results button, an individual can see the percentage chance that the cancer is confined to the prostate, has migrated to the edge of the gland, has invaded the seminal vesicles, or has spread to the lymph nodes. Web link: http://tinyurl.com/afumo2c (The nomogram tool can be accessed here: http://tinyurl.com/dme35x The term "clinical stages" is explained on this page of our web site. Ed.)
Article cited in Feb. 17 2011 Cancernetwork.com entitled Four-Gene Signature Predicts Aggressive Prostate Cancer. The article summarises a study by Lynda Chin that is reported in Nature online on February 2 2011, providing this summary: “... researchers describe a four-gene signature that was more accurate than the standard Gleason score test in predicting which patients would die from metastatic spread of their prostate cancer. The Gleason score is about 60% to 70% accurate in predicting whether a man’s prostate cancer will become aggressive. In the Nature study, the four-gene signature alone was 83% accurate in making this prediction, and 92% accurate when combined with the Gleason score.”
Article by Azvolinsky, A: New prognostic signature for prostate cancer may help in treatment decisions. cancernetwork.com 15 February 2011. The article states that “Researchers at the Queen Mary U. of London and a team of collaborators have identified a genetic signature among prostate tumors that may help determine the best course of treatment for patients. The results of the study will be published in the March 2011 issue of Lancet Oncology.... A molecular diagnostics company, Myriad Genetics, based in Salt Lake City, Utah already has a commercial diagnostics test that tests the level of 46 CCP genes that was utilized in the University of London study. If these published results are confirmed in other trials such as adjuvant radiation, androgen deprivation, and novel systemic treatments, the test could soon be commonly used to estimate the risk of prostate cancer outcome and reoccurrence.”
Article cited in Feb. 17 2011 Cancernetwork.com entitled Four-Gene Signature Predicts Aggressive Prostate Cancer. The article summarises a study by Lynda Chin that is reported in Nature online on February 2 2011, providing this summary: “... researchers describe a four-gene signature that was more accurate than the standard Gleason score test in predicting which patients would die from metastatic spread of their prostate cancer. The Gleason score is about 60% to 70% accurate in predicting whether a man’s prostate cancer will become aggressive. In the Nature study, the four-gene signature alone was 83% accurate in making this prediction, and 92% accurate when combined with the Gleason score.”
Article by Azvolinsky, A: New prognostic signature for prostate cancer may help in treatment decisions. cancernetwork.com 15 February 2011. The article states that “Researchers at the Queen Mary U. of London and a team of collaborators have identified a genetic signature among prostate tumors that may help determine the best course of treatment for patients. The results of the study will be published in the March 2011 issue of Lancet Oncology.... A molecular diagnostics company, Myriad Genetics, based in Salt Lake City, Utah already has a commercial diagnostics test that tests the level of 46 CCP genes that was utilized in the University of London study. If these published results are confirmed in other trials such as adjuvant radiation, androgen deprivation, and novel systemic treatments, the test could soon be commonly used to estimate the risk of prostate cancer outcome and reoccurrence.”
ACTIVE SURVEILLANCE, OBSERVATION
Time for active surveillance of intermediate-risk disease? Author: Hashim U. Ahmed. Nat. Rev. Urol. 10, 6–8 (2013); published online 13 November 2012; doi:10.1038/nrurol.2012.213 Author's abstract: Active surveillance has become increasingly popular as a management option for localized prostate cancer. Although widely viewed as a means to enable men with low-risk prostate cancer to avoid or defer the effects of whole-gland radical therapy, two new studies demonstrate that it might be a safe approach in intermediate-risk disease. Web link: http://tinyurl.com/b3ga2s5
Prostate Cancer Intervention Versus Observation Trial (PIVOT) results. This study was conducted by Timothy J Wilt et al and an abstract of the study is reported here: http://tinyurl.com/cshj8ol In the period 1994 to 2004, 731 men with localised prostate cancer were assigned randomly to two groups: radical prostatectomy and observation. Prostate-cancer-specific and all-causes deaths amongst the two groups was assessed in 2010. This article by Dr. Allan S Brett provides an informative analysis of the results: http://tinyurl.com/8f8bozh Brett notes that: "At median follow-up of 10 years, neither all-cause mortality nor prostate cancer–specific mortality was significantly lower in the prostatectomy group than in the observation group. However, among men with PSA levels of more than 10 ng/mL, mortality was lower with prostatectomy (see Table). Subgroups with higher-risk cancers (defined by criteria incorporating PSA levels, Gleason scores, and tumor staging) also showed trends toward lower mortality with surgery. Bone metastases occurred in 4.7% of prostatectomy patients and in 10.6% of observation patients..." A copy of that article including the very illuminating table can also be downloaded as a 98 KB PDF file from our web site here.
Prostate Cancer Intervention Versus Observation Trial (PIVOT) results. This study was conducted by Timothy J Wilt et al and an abstract of the study is reported here: http://tinyurl.com/cshj8ol In the period 1994 to 2004, 731 men with localised prostate cancer were assigned randomly to two groups: radical prostatectomy and observation. Prostate-cancer-specific and all-causes deaths amongst the two groups was assessed in 2010. This article by Dr. Allan S Brett provides an informative analysis of the results: http://tinyurl.com/8f8bozh Brett notes that: "At median follow-up of 10 years, neither all-cause mortality nor prostate cancer–specific mortality was significantly lower in the prostatectomy group than in the observation group. However, among men with PSA levels of more than 10 ng/mL, mortality was lower with prostatectomy (see Table). Subgroups with higher-risk cancers (defined by criteria incorporating PSA levels, Gleason scores, and tumor staging) also showed trends toward lower mortality with surgery. Bone metastases occurred in 4.7% of prostatectomy patients and in 10.6% of observation patients..." A copy of that article including the very illuminating table can also be downloaded as a 98 KB PDF file from our web site here.
RADICAL PROSTATECTOMY
Article by Menon, M et al: Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1,384 patients with a median 5-year follow-up. European Urology 58(6) pp e53-e62 December 2010. The authors provide this ‘take home message’: ‘We present biochemical recurrence–free survival (BCRFS) outcomes for 1384 men who underwent robot-assisted radical prostatectomy (RARP) between 2001 and 2005, with the longest follow-up to date for this surgical approach. With a 5-yr actuarial BCRFS of 86.6%, RARP appears to confer effective 5-yr prostate cancer control.’ Viewable and downloadable as a 367 KB PDF file from here.
Article by Barbashi G I and Glied S A on health care costs of robot-assisted laparoscopic surgery reported in the New England Journal of Medicine 363:701-704, August 19 2010. In reaching their conclusions the authors note that: ‘To date, there have been no large-scale randomized trials of robot-assisted surgery, and the limited observational evidence fails to show that the long-term outcomes of robot-assisted surgery are superior to those of conventional procedures.’ and ‘ Various nonsurgical treatment alternatives for localized prostate cancer exist, with similar long-term outcomes and varying side effects, such as incontinence and impotence. Existing analyses suggest that as compared with open surgery, robot-assisted surgery does not diminish the frequency of these adverse effects.’ and ‘...the substantial short-term benefits in terms of postoperative recovery ... associated with robot-assisted procedures...’
Study on the comparative effectiveness of minimally-invasive radical prostatectomy (MIRP) Vs open retropubic radical prostatectomy (RRP) by Hu J C et al reported in JAMA 2009 Oct. 14; 302(14) pp 1557-64. An abstract of the article is here. It indicates that the authors observed that MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days), lower rates of blood transfusions (2.7% vs 20.8%), postoperative respiratory complications (4.3% vs 6.6%), miscellaneous surgical complications (4.3% vs 5.6%), and anastomotic stricture (5.8% vs 14.0%). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years) and erectile dysfunction (26.8 vs 19.2 per 100 person-years). Rates of use of additional cancer therapies did not differ by surgical procedure.
Article by Barbashi G I and Glied S A on health care costs of robot-assisted laparoscopic surgery reported in the New England Journal of Medicine 363:701-704, August 19 2010. In reaching their conclusions the authors note that: ‘To date, there have been no large-scale randomized trials of robot-assisted surgery, and the limited observational evidence fails to show that the long-term outcomes of robot-assisted surgery are superior to those of conventional procedures.’ and ‘ Various nonsurgical treatment alternatives for localized prostate cancer exist, with similar long-term outcomes and varying side effects, such as incontinence and impotence. Existing analyses suggest that as compared with open surgery, robot-assisted surgery does not diminish the frequency of these adverse effects.’ and ‘...the substantial short-term benefits in terms of postoperative recovery ... associated with robot-assisted procedures...’
Study on the comparative effectiveness of minimally-invasive radical prostatectomy (MIRP) Vs open retropubic radical prostatectomy (RRP) by Hu J C et al reported in JAMA 2009 Oct. 14; 302(14) pp 1557-64. An abstract of the article is here. It indicates that the authors observed that MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days), lower rates of blood transfusions (2.7% vs 20.8%), postoperative respiratory complications (4.3% vs 6.6%), miscellaneous surgical complications (4.3% vs 5.6%), and anastomotic stricture (5.8% vs 14.0%). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years) and erectile dysfunction (26.8 vs 19.2 per 100 person-years). Rates of use of additional cancer therapies did not differ by surgical procedure.
RADIOTHERAPY
Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Author: Michel Bolla et al. The Lancet, Volume 380, Issue 9858, Pages 2018 - 2027, 8 December 2012 doi:10.1016/S0140-6736(12)61253-7 Extract from the article: Background: We report the long-term results of a trial of immediate postoperative irradiation versus a wait-and-see policy in patients with prostate cancer extending beyond the prostate, to confirm whether previously reported progression-free survival was sustained. Interpretation: Results at median follow-up of 10·6 years show that conventional postoperative irradiation significantly improves biochemical progression-free survival and local control compared with a wait-and-see policy, supporting results at 5 year follow-up; however, improvements in clinical progression-free survival were not maintained. Exploratory analyses suggest that postoperative irradiation might improve clinical progression-free survival in patients younger than 70 years and in those with positive surgical margins, but could have a detrimental effect in patients aged 70 years or older. Web link: http://tinyurl.com/bsc5yzz
Article by Schieszer J: Should radiation therapy plus hormone therapy be the new standard of care for locally advanced prostate cancer? Oncology News International Vol. 19 No. 9 September 2, 2010. The author claims that while Androgen Deprivation Therapy (ADT) has become the primary treatment for men with locally advanced prostate cancer, emerging data suggest that ADT alone is not as effective as ADT plus External-beam Radiation Therapy (EBRT) and that recently, international researchers claim their data are strong enough to make continuous ADT plus EBRT the new standard of care. Viewable and downloadable as a 156 KB PDF file here.
Salvage External Beam Radiotherapy for Prostate Cancer After Radical Prostatectomy. Article in Oncology Vol 24 No. 1 July 2010. Authors: Radlow, A et al. A copy is downloadable as a 209 KB PDF file from here. The authors indicate that: “The treatment of prostate cancer that has recurred months or years after radical prostatectomy is an evolving field, and multiple consensus guidelines and prognostic features exist to help the clinician make a decision regarding treatment fields and likelihood of efficacy. Though there are multiple randomized trials supporting the use of ART (Adjuvant Radiation Therapy) in the immediate post-prostatectomy period for high-risk disease, similarly strong data are lacking in the salvage setting. However, the rate of serious complications has been low in patients undergoing SRT (Salvage Radio Therapy) , and there are multiple retrospective studies showing a subset of patients who are likely to benefit. Although there have been no studies that address the specific question of whether SRT is cost-effective, extrapolating on available data, we believe that SRT is cost-effective in selected patients who are likely to benefit based on MRI findings of local disease or the Stephenson nomogram.” (The Stephenson nomogram referred in the article is here and is implemented as one of the Sloan Kettering nomogram predictive tools that are explained on our page here.)
Article by Schieszer J: Should radiation therapy plus hormone therapy be the new standard of care for locally advanced prostate cancer? Oncology News International Vol. 19 No. 9 September 2, 2010. The author claims that while Androgen Deprivation Therapy (ADT) has become the primary treatment for men with locally advanced prostate cancer, emerging data suggest that ADT alone is not as effective as ADT plus External-beam Radiation Therapy (EBRT) and that recently, international researchers claim their data are strong enough to make continuous ADT plus EBRT the new standard of care. Viewable and downloadable as a 156 KB PDF file here.
Salvage External Beam Radiotherapy for Prostate Cancer After Radical Prostatectomy. Article in Oncology Vol 24 No. 1 July 2010. Authors: Radlow, A et al. A copy is downloadable as a 209 KB PDF file from here. The authors indicate that: “The treatment of prostate cancer that has recurred months or years after radical prostatectomy is an evolving field, and multiple consensus guidelines and prognostic features exist to help the clinician make a decision regarding treatment fields and likelihood of efficacy. Though there are multiple randomized trials supporting the use of ART (Adjuvant Radiation Therapy) in the immediate post-prostatectomy period for high-risk disease, similarly strong data are lacking in the salvage setting. However, the rate of serious complications has been low in patients undergoing SRT (Salvage Radio Therapy) , and there are multiple retrospective studies showing a subset of patients who are likely to benefit. Although there have been no studies that address the specific question of whether SRT is cost-effective, extrapolating on available data, we believe that SRT is cost-effective in selected patients who are likely to benefit based on MRI findings of local disease or the Stephenson nomogram.” (The Stephenson nomogram referred in the article is here and is implemented as one of the Sloan Kettering nomogram predictive tools that are explained on our page here.)
TREATMENT OF
METASTATIC PCa, CASTRATE- RESISTANT PCa
METASTATIC PCa, CASTRATE- RESISTANT PCa
The changing landscape in the treatment of metastatic castration-resistant prostate cancer. Author: Joelle El-Amm et al. Ther. Adv. Med. Oncol. 2013;5(1):25-40. In the author's words, "This review describes the clinical trials that brought about the drug approvals of various agents and offers some insights regarding a rational approach to optimal treatment sequencing for these drugs since national guidelines are currently lacking."..."The past few years have brought increasing advances in the therapeutic management of metastatic castration-resistant prostate cancer with the approval of several agents, including vaccine therapy with sipuleucel-T, second-line chemotherapy with cabazitaxel, the bone-targeted pharmaceutical denosumab, and the novel antiandrogen therapy abiraterone acetate. There are ongoing developments with other agents in the pipeline such as MDV3100 and alpharadin that have shown promising results. " Web link: http://tinyurl.com/c6jtd2a
New Agents for the Management of Castration-Resistant Prostate Cancer. Author: Robert J Cersosimo. The Annals of Pharmacotherapy. 2012;46(11):1518-1528. Author's abstract: Objective: To review the activity of 3 new agents approved for the management of advanced castration-resistant prostate cancer (CRPC): sipuleucel-T, cabazitaxel, and abiraterone acetate. Conclusions: The advent of new agents for the management of advanced CRPC has increased the choices for patients whose options were limited. Additional experience will determine the optimal sequencing of these agents, their roles in combination therapy, and their activity in patients with earlier disease. Web link: http://tinyurl.com/bn8hvpg
Maximizing Survival in Metastatic Castrate-resistant Prostate Cancer. Author: Alison Birtle. Medscape Urology News: Expert Rev. Anticancer Ther. 2013;13(1):89-99. Extract from the article: Recently, licensed and emerging treatments for metastatic castrate-resistant prostate cancer are transforming the prognosis for men whose disease has already progressed during or after docetaxel-based chemotherapy. Two agents (cabazitaxel and abiraterone) are already accessible to prescribers, having shown survival benefits versus their comparators in randomized controlled trials, and other agents are showing promising results. A future in which metastatic castrate-resistant prostate cancer can be managed as a 'chronic disease' looks tantalizingly close. The challenge for clinicians will be to use these treatments rationally, in a way that optimizes each individual patient's chances of prolonged survival. Web link: http://tinyurl.com/b8g2yt8
Abiraterone in Metastatic Prostate Cancer without Previous Chemotherapy. Authors: Charles J Ryan et al. New Engl J Med 2013; 368:138-148 January 10, 2013DOI: 10.1056/NEJMoa1209096 Extract from the article: Background: Abiraterone acetate, an androgen biosynthesis inhibitor, improves overall survival in patients with metastatic castration-resistant prostate cancer after chemotherapy. We evaluated this agent in patients who had not received previous chemotherapy. Conclusions: Abiraterone improved radiographic progression-free survival, showed a trend toward improved overall survival, and significantly delayed clinical decline and initiation of chemotherapy in patients with metastatic castration-resistant prostate cancer. Web link: http://tinyurl.com/avyayp5
FDA approves use of prostate cancer pill (abiraterone) before chemo. Author: Kate Johnson. Medscape Urology News, Dec. 11 2012 Extract from the article: The US Food and Drug Administration (FDA) has approved the expanded use of abiraterone acetate (Zytiga, Janssen Biotech Inc) to first-line therapy for metastatic castration-resistant prostate cancer (mCRPC). The drug, which decreases testosterone production, was approved in April 2011 as a second-line treatment after docetaxel chemotherapy in the same population. This expanded approval "demonstrates the benefit of evaluating a drug in an earlier disease setting and provides patients and healthcare providers the option of using [abiraterone] earlier in the course of treatment," Richard Pazdur, MD, director of the Office of Oncology Drug Products in the FDA Center for Drug Evaluation and Research, stated in an FDA news release. The expanded use of abiraterone was approved by the FDA's priority review program on the basis of a randomized double-blind study, which was published online December 10 in the New England Journal of Medicine. (That is the Ryan et al study referred to above - Ed.) It comes on the heels of a recommendation made last month by the Committee for Medicinal Products for Human Use at the European Medicines Agency, which usually means an approval in Europe. Web link: http://tinyurl.com/arvl486
Abiraterone benefit extends to bone-related symptoms. Author: Sarah Payton. Nature Reviews Urology 10, 1 (January 2013) | doi:10.1038/nrurol.2012.232 Extract from the article: Abiraterone acetate not only improves survival but also provides pain relief and delays the occurrence of skeletal-related events, compared with placebo, in patients with metastatic castration-resistant prostate cancer (CRPC), according to new analysis of the COU-AA-301 trial published in The Lancet Oncology. Web link: http://tinyurl.com/byhjb4k
Increased Survival with Enzalutamide for castration-resistance in prostate cancer after chemotherapy: The approval by the US Food and Drug Administration of Enzalutamide (formerly MDV3100) for men with metastatic prostate cancer was reported in this 31 August 2012 web article by the Memorial Sloan-Kettering Cancer Center: http://tinyurl.com/8e46aj8 The article indicates that the AFFIRM trial that was conducted amongst men who had castration-resistant prostate cancer after chemotherapy, led to FDA's approval. The trial was undertaken by Dr. Howard I Scher et al. A summary of their study is reported in this article: http://tinyurl.com/8gc4e78 A copy of that article can also be downloaded as a 41 KB PDF file from our web site here.
Alpharadin drug treatment for castration-resistant prostate cancer and bone metastases. In a Cancernetwork web article written by Anna Azvolinsky dated 29 September 2011, the results of a successful trial of a new drug amongst men with symptomatic, castration-resistant prostate cancer and bone metastases was reported. The drug is Alpharadin (Radium-223 chloride). In the article it is stated that: “Radium-223, an alpha particle given intravenously, has been shown to improve overall survival in men with castrate-resistant prostate cancer ... with a 30% risk reduction of death... The positive results from the phase III, randomized ALSYMPCA (ALpharadin in SYMPtomatic prostate CAncer) study were reported ... at the European Multidisciplinary Cancer Congress in Stockholm, Sweden. Dr Chris Parker of the Royal Marsden Hospital in Sutton, UK presented data showing that the radium-223 combined with best standard of care arm showed a 14 month medial overall survival, compared to 11.2 months for the placebo plus best standard of care arm." Other information about the study is reported in an Internal Medicine News Digital Network web article dated 26 September 2011 written by Patrice Wendling. A copy of the Avolinsky article can be downloaded from here as a 102 KB PDF file and the Wendling article from here as a 131 KB PDF file.
New Agents for the Management of Castration-Resistant Prostate Cancer. Author: Robert J Cersosimo. The Annals of Pharmacotherapy. 2012;46(11):1518-1528. Author's abstract: Objective: To review the activity of 3 new agents approved for the management of advanced castration-resistant prostate cancer (CRPC): sipuleucel-T, cabazitaxel, and abiraterone acetate. Conclusions: The advent of new agents for the management of advanced CRPC has increased the choices for patients whose options were limited. Additional experience will determine the optimal sequencing of these agents, their roles in combination therapy, and their activity in patients with earlier disease. Web link: http://tinyurl.com/bn8hvpg
Maximizing Survival in Metastatic Castrate-resistant Prostate Cancer. Author: Alison Birtle. Medscape Urology News: Expert Rev. Anticancer Ther. 2013;13(1):89-99. Extract from the article: Recently, licensed and emerging treatments for metastatic castrate-resistant prostate cancer are transforming the prognosis for men whose disease has already progressed during or after docetaxel-based chemotherapy. Two agents (cabazitaxel and abiraterone) are already accessible to prescribers, having shown survival benefits versus their comparators in randomized controlled trials, and other agents are showing promising results. A future in which metastatic castrate-resistant prostate cancer can be managed as a 'chronic disease' looks tantalizingly close. The challenge for clinicians will be to use these treatments rationally, in a way that optimizes each individual patient's chances of prolonged survival. Web link: http://tinyurl.com/b8g2yt8
Abiraterone in Metastatic Prostate Cancer without Previous Chemotherapy. Authors: Charles J Ryan et al. New Engl J Med 2013; 368:138-148 January 10, 2013DOI: 10.1056/NEJMoa1209096 Extract from the article: Background: Abiraterone acetate, an androgen biosynthesis inhibitor, improves overall survival in patients with metastatic castration-resistant prostate cancer after chemotherapy. We evaluated this agent in patients who had not received previous chemotherapy. Conclusions: Abiraterone improved radiographic progression-free survival, showed a trend toward improved overall survival, and significantly delayed clinical decline and initiation of chemotherapy in patients with metastatic castration-resistant prostate cancer. Web link: http://tinyurl.com/avyayp5
FDA approves use of prostate cancer pill (abiraterone) before chemo. Author: Kate Johnson. Medscape Urology News, Dec. 11 2012 Extract from the article: The US Food and Drug Administration (FDA) has approved the expanded use of abiraterone acetate (Zytiga, Janssen Biotech Inc) to first-line therapy for metastatic castration-resistant prostate cancer (mCRPC). The drug, which decreases testosterone production, was approved in April 2011 as a second-line treatment after docetaxel chemotherapy in the same population. This expanded approval "demonstrates the benefit of evaluating a drug in an earlier disease setting and provides patients and healthcare providers the option of using [abiraterone] earlier in the course of treatment," Richard Pazdur, MD, director of the Office of Oncology Drug Products in the FDA Center for Drug Evaluation and Research, stated in an FDA news release. The expanded use of abiraterone was approved by the FDA's priority review program on the basis of a randomized double-blind study, which was published online December 10 in the New England Journal of Medicine. (That is the Ryan et al study referred to above - Ed.) It comes on the heels of a recommendation made last month by the Committee for Medicinal Products for Human Use at the European Medicines Agency, which usually means an approval in Europe. Web link: http://tinyurl.com/arvl486
Abiraterone benefit extends to bone-related symptoms. Author: Sarah Payton. Nature Reviews Urology 10, 1 (January 2013) | doi:10.1038/nrurol.2012.232 Extract from the article: Abiraterone acetate not only improves survival but also provides pain relief and delays the occurrence of skeletal-related events, compared with placebo, in patients with metastatic castration-resistant prostate cancer (CRPC), according to new analysis of the COU-AA-301 trial published in The Lancet Oncology. Web link: http://tinyurl.com/byhjb4k
Increased Survival with Enzalutamide for castration-resistance in prostate cancer after chemotherapy: The approval by the US Food and Drug Administration of Enzalutamide (formerly MDV3100) for men with metastatic prostate cancer was reported in this 31 August 2012 web article by the Memorial Sloan-Kettering Cancer Center: http://tinyurl.com/8e46aj8 The article indicates that the AFFIRM trial that was conducted amongst men who had castration-resistant prostate cancer after chemotherapy, led to FDA's approval. The trial was undertaken by Dr. Howard I Scher et al. A summary of their study is reported in this article: http://tinyurl.com/8gc4e78 A copy of that article can also be downloaded as a 41 KB PDF file from our web site here.
Alpharadin drug treatment for castration-resistant prostate cancer and bone metastases. In a Cancernetwork web article written by Anna Azvolinsky dated 29 September 2011, the results of a successful trial of a new drug amongst men with symptomatic, castration-resistant prostate cancer and bone metastases was reported. The drug is Alpharadin (Radium-223 chloride). In the article it is stated that: “Radium-223, an alpha particle given intravenously, has been shown to improve overall survival in men with castrate-resistant prostate cancer ... with a 30% risk reduction of death... The positive results from the phase III, randomized ALSYMPCA (ALpharadin in SYMPtomatic prostate CAncer) study were reported ... at the European Multidisciplinary Cancer Congress in Stockholm, Sweden. Dr Chris Parker of the Royal Marsden Hospital in Sutton, UK presented data showing that the radium-223 combined with best standard of care arm showed a 14 month medial overall survival, compared to 11.2 months for the placebo plus best standard of care arm." Other information about the study is reported in an Internal Medicine News Digital Network web article dated 26 September 2011 written by Patrice Wendling. A copy of the Avolinsky article can be downloaded from here as a 102 KB PDF file and the Wendling article from here as a 131 KB PDF file.
HORMONE THERAPY, ADT
Shorter ADT appears to be best for high-risk prostate cancer. Reporter: Charles Bankhead. Medpage Today 12 February 2013. This article reports a single phase 3 trial undertaken by a team led by Dr Abdenour Nabid, in which they compared the effectiveness of 18 months of adjuvant androgen deprivation therapy (ADT) with 36 months. The team concluded that ADT over 18 months was as effective as that for 36 months. Extracts from the article: "Men with node-negative high- risk prostate cancer lived just as long with a 50% shorter duration of androgen deprivation therapy (ADT) compared with standard duration therapy, results of a randomized clinical trial showed."… "After a median follow-up of 6.5 years, 76.2% of patients who were treated with pelvic radiotherapy and androgen blockade remained alive after 18 months of ADT versus 77% of the men whose hormonal treatment continued twice as long, reported Abdenour Nabid, MD, of Sherbrooke University Hospital in Quebec."…"The treatment groups also did not differ with respect to 5- and 10-year overall and disease- specific survival (DSS), said Nabid during a press briefing prior to the Genitourinary Cancers Symposium. 'In localized high-risk prostate cancer treated with radiotherapy and androgen blockade, androgen blockade duration can be safely reduced from 36 to 18 months.' he explained. ' Eighteen months of androgen blockade could represent the threshold effect, with no further benefit for our patients. For these patients, side-effect duration and treatment costs of androgen blockade are significantly reduced.' 'My hope is that the shorter duration can become the standard,' he added." Bankhead cautions that "This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal." Web link: http://tinyurl.com/agjf7kg A summary of the results reported in Nabid's paper are also reported in this Prostate Cancer Infolink article: http://tinyurl.com/agkfysd
Intermittent hormone therapy as good as continuous treatment for prostate cancer? In a Cancernetwork web article dated 11 September 2012 Anna Azvolinski reports the results of a study of the efficacy of intermittent androgen deprivation versus continuous therapy is reported: http://tinyurl.com/9fpobqn Azvolinsky states that: "Intermittent androgen deprivation was shown to be as efficacious as continuous therapy in terms of overall survival for men with prostate cancer whose prostate-specific antigen (PSA) levels are rising after initial or salvage radiotherapy." It is stated that no adverse effects for intermittent treatment were noted and that the study's authors claim that physical and overall health symptoms were slightly better in the intermittent-therapy group. The study is: Crook JM, O’Callaghan CJ, Duncan G, et al. Intermittent androgen suppression for rising PSA level after radiotherapy. NEJM 2012;367:895-903
The same view about the Crook study is expressed in a webcast by Dr Gerald Chodack who stated that: "The results [of the study by Crook et al] showed that intermittent therapy was not inferior to continuous therapy in terms of overall survival or prostate cancer survival. There were small differences in these 2 groups, but they were not significant. Advantages of intermittent therapy that were observed were fewer complaints of hot flashes, improved sexual drive, and fewer urinary complaints, although the authors did find that most of the men over 75 years of age did not regain their sexual function even when therapy was stopped." Chodack also concludes that the Crook study "... goes along with another well-done study on men with metastatic disease that also showed no significant difference in overall survival, although men on intermittent therapy in that study had a slightly higher risk for death from prostate cancer and a slightly lower risk for death from other causes." This other study was undertaken by N Mottet et al. The Chodack webcast and a transcript of it can be viewed here: http://tinyurl.com/9jypduk and a copy of the transcript can also be downloaded as a 74 KB PDF file from here.
Article by Schieszer J: Should radiation therapy plus hormone therapy be the new standard of care for locally advanced prostate cancer? Oncology News International Vol. 19 No. 9 September 2, 2010. The author claims that while Androgen Deprivation Therapy (ADT) has become the primary treatment for men with locally advanced prostate cancer, emerging data suggest that ADT alone is not as effective as ADT plus External-beam Radiation Therapy (EBRT) and that recently, international researchers claim their data are strong enough to make continuous ADT plus EBRT the new standard of care. Viewable and downloadable as a 156 KB PDF file here.
Article by Fang L C, Merrick G S and Wallner K E: Androgen Deprivation Therapy: A Survival Benefit or Detriment in Men With High-Risk Prostate Cancer? Oncology August 24, 2010 Vol. 24 No. 9. Viewable and downloadable as a 172 KB PDF file here. (This article is reviewed by O’Malley R, Poch M A and Mohler J - The Role, Timing, and Clinical Use of ADT in Prostate Cancer. Oncology August 24, 2010 Vol. 24 No. 9. Viewable and downloadable as a 16 KB PDF file here.)
Intermittent hormone therapy as good as continuous treatment for prostate cancer? In a Cancernetwork web article dated 11 September 2012 Anna Azvolinski reports the results of a study of the efficacy of intermittent androgen deprivation versus continuous therapy is reported: http://tinyurl.com/9fpobqn Azvolinsky states that: "Intermittent androgen deprivation was shown to be as efficacious as continuous therapy in terms of overall survival for men with prostate cancer whose prostate-specific antigen (PSA) levels are rising after initial or salvage radiotherapy." It is stated that no adverse effects for intermittent treatment were noted and that the study's authors claim that physical and overall health symptoms were slightly better in the intermittent-therapy group. The study is: Crook JM, O’Callaghan CJ, Duncan G, et al. Intermittent androgen suppression for rising PSA level after radiotherapy. NEJM 2012;367:895-903
The same view about the Crook study is expressed in a webcast by Dr Gerald Chodack who stated that: "The results [of the study by Crook et al] showed that intermittent therapy was not inferior to continuous therapy in terms of overall survival or prostate cancer survival. There were small differences in these 2 groups, but they were not significant. Advantages of intermittent therapy that were observed were fewer complaints of hot flashes, improved sexual drive, and fewer urinary complaints, although the authors did find that most of the men over 75 years of age did not regain their sexual function even when therapy was stopped." Chodack also concludes that the Crook study "... goes along with another well-done study on men with metastatic disease that also showed no significant difference in overall survival, although men on intermittent therapy in that study had a slightly higher risk for death from prostate cancer and a slightly lower risk for death from other causes." This other study was undertaken by N Mottet et al. The Chodack webcast and a transcript of it can be viewed here: http://tinyurl.com/9jypduk and a copy of the transcript can also be downloaded as a 74 KB PDF file from here.
Article by Schieszer J: Should radiation therapy plus hormone therapy be the new standard of care for locally advanced prostate cancer? Oncology News International Vol. 19 No. 9 September 2, 2010. The author claims that while Androgen Deprivation Therapy (ADT) has become the primary treatment for men with locally advanced prostate cancer, emerging data suggest that ADT alone is not as effective as ADT plus External-beam Radiation Therapy (EBRT) and that recently, international researchers claim their data are strong enough to make continuous ADT plus EBRT the new standard of care. Viewable and downloadable as a 156 KB PDF file here.
Article by Fang L C, Merrick G S and Wallner K E: Androgen Deprivation Therapy: A Survival Benefit or Detriment in Men With High-Risk Prostate Cancer? Oncology August 24, 2010 Vol. 24 No. 9. Viewable and downloadable as a 172 KB PDF file here. (This article is reviewed by O’Malley R, Poch M A and Mohler J - The Role, Timing, and Clinical Use of ADT in Prostate Cancer. Oncology August 24, 2010 Vol. 24 No. 9. Viewable and downloadable as a 16 KB PDF file here.)
CHEMOTHERAPY
Chemotherapy for Prostate Cancer - When Should a Urologist Refer a Patient to a Medical Oncologist? Author: N D Shore. Prostate Cancer Prostatic Dis. 2013;16(1):1-6. This article provides inter alia a comprehensive description of chemotherapy agents that may be used in treatment of castrate-resistant prostate cancer (CRPC). Extract from the article: "The last few years have seen considerable evolution in treatment options and therapeutic strategies for patients with castrate-resistant prostate cancer (CRPC). One major change was the expansion of chemotherapeutic options with the approval of cabazitaxel, representing the first chemotherapeutic therapy after docetaxel to demonstrate improved survival in patients with CRPC. A number of other noncytotoxic therapies have either recently been approved or are in advanced development for treating this patient population. Offering novel mechanisms of action, these new agents make considerably more expansive and complex the decisions regarding when to treat, which agents to use, and the order in which they are administered. A pivotal decision point for urologists who treat patients with advanced prostate cancer has been timing the patient's referral to an oncologist for chemotherapy. Although clinical guidelines regard chemotherapy as only appropriate for prostate cancer patients with symptomatic metastatic disease, increasing evidence points to the possibility that a subgroup of patients may benefit from an earlier introduction of chemotherapy. At the same time, additional treatment options that may either precede chemotherapy or follow initial chemotherapeutic failure mean that urologists must closely monitor their patients' health status to match specific clinical profiles with specific treatment options. With the increase in number and variety of therapeutic approaches, the role of the urologist has been expanded, in part, owing to the opportunity for urologists to administer treatments previously unavailable, and also owing to the growing importance of working cooperatively with oncologists and as a member of a multidisciplinary team." … "The way of the future in CRPC treatment points to the application of multiple agents, each with a particular efficacy at a particular stage of disease, administered to the same patient at various times with appropriate sequencing." Web link: http://tinyurl.com/b9aqbkg
FDA approves use of prostate cancer pill (abiraterone) before chemo. Author: Kate Johnson. Medscape Urology News, Dec. 11 2012 Extract from the article: The US Food and Drug Administration (FDA) has approved the expanded use of abiraterone acetate (Zytiga, Janssen Biotech Inc) to first-line therapy for metastatic castration-resistant prostate cancer (mCRPC). The drug, which decreases testosterone production, was approved in April 2011 as a second-line treatment after docetaxel chemotherapy in the same population. This expanded approval "demonstrates the benefit of evaluating a drug in an earlier disease setting and provides patients and healthcare providers the option of using [abiraterone] earlier in the course of treatment," Richard Pazdur, MD, director of the Office of Oncology Drug Products in the FDA Center for Drug Evaluation and Research, stated in an FDA news release. The expanded use of abiraterone was approved by the FDA's priority review program on the basis of a randomized double-blind study, which was published online December 10 in the New England Journal of Medicine. (That is the Ryan et al study referred to above - Ed.) It comes on the heels of a recommendation made last month by the Committee for Medicinal Products for Human Use at the European Medicines Agency, which usually means an approval in Europe. Web link: http://tinyurl.com/arvl486
Abiraterone benefit extends to bone-related symptoms. Author: Sarah Payton. Nature Reviews Urology 10, 1 (January 2013) | doi:10.1038/nrurol.2012.232 Extract from the article: Abiraterone acetate not only improves survival but also provides pain relief and delays the occurrence of skeletal-related events, compared with placebo, in patients with metastatic castration-resistant prostate cancer (CRPC), according to new analysis of the COU-AA-301 trial published in The Lancet Oncology. Web link: http://tinyurl.com/byhjb4k
FDA approves use of prostate cancer pill (abiraterone) before chemo. Author: Kate Johnson. Medscape Urology News, Dec. 11 2012 Extract from the article: The US Food and Drug Administration (FDA) has approved the expanded use of abiraterone acetate (Zytiga, Janssen Biotech Inc) to first-line therapy for metastatic castration-resistant prostate cancer (mCRPC). The drug, which decreases testosterone production, was approved in April 2011 as a second-line treatment after docetaxel chemotherapy in the same population. This expanded approval "demonstrates the benefit of evaluating a drug in an earlier disease setting and provides patients and healthcare providers the option of using [abiraterone] earlier in the course of treatment," Richard Pazdur, MD, director of the Office of Oncology Drug Products in the FDA Center for Drug Evaluation and Research, stated in an FDA news release. The expanded use of abiraterone was approved by the FDA's priority review program on the basis of a randomized double-blind study, which was published online December 10 in the New England Journal of Medicine. (That is the Ryan et al study referred to above - Ed.) It comes on the heels of a recommendation made last month by the Committee for Medicinal Products for Human Use at the European Medicines Agency, which usually means an approval in Europe. Web link: http://tinyurl.com/arvl486
Abiraterone benefit extends to bone-related symptoms. Author: Sarah Payton. Nature Reviews Urology 10, 1 (January 2013) | doi:10.1038/nrurol.2012.232 Extract from the article: Abiraterone acetate not only improves survival but also provides pain relief and delays the occurrence of skeletal-related events, compared with placebo, in patients with metastatic castration-resistant prostate cancer (CRPC), according to new analysis of the COU-AA-301 trial published in The Lancet Oncology. Web link: http://tinyurl.com/byhjb4k
COMPARISON OF TREATMENT METHODS
Surgery superior to radiotherapy in men with localised prostate cancer. In a press release of the European Association of Urology's 28th Annual UAE Congress dated 11 March 2013, a summary is provided of the content of a paper by Dr. Sooriakumaran et al reporting the results of a large scale observational study. The press release includes this content: "Surgery offers better survival benefit for men with localised prostate cancer, according to a large observational study, conducted by a group of researchers in Sweden and the Netherlands. The study won the second prize for best abstract in oncology at the 28th Annual EAU Congress which will open in Milan this Friday, 15 March. 'The current gold standard management of localised prostate cancer is radical therapy, either as surgery or radiation therapy. This study suggests that surgery is likely superior to radiation for the majority of men who have localized prostate cancer, especially the younger age group and those with no or few comorbidities,' said Dr. Prasanna Sooriakumaran, lead study author, of the Karolinska University Hospital in Stockholm. In their study, Sooriakumaran and colleagues compared the oncologic effectiveness of radical prostatectomy and radiotherapy in prostate cancer, and analysed the mortality outcomes in 34,515 patients treated with up to 15 years follow-up." The press release can be downloaded from here: http://tinyurl.com/cwpvzgh
Prostate Cancer Results Study Group (PCRSG) update. The PCRSG which is led by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle is conducting an ongoing "meta-analysis" of published research studies that report on the effectiveness of different treatments for prostate cancer. A 2009 report on the Center’s web site here provides a very readable description of the study. Dr Grimm has released presentations progressively showing the results of the ongoing analysis. The most recent presentation is dated 15 January 2013. This is entitled Comparing Treatment Results of Prostate Cancer - Prostate Cancer Results Study Group. It can be downloaded as a 6 MB file from our site here. If you would like to be added to the distribution list for future releases of the reports of the PCRSG, the Centre’s contact details are provided in that presentation. A shorter 3.6 MB version containing 17 slides and with some explanatory content has been prepared by our Group and can be downloaded from our site here.
Podcast entitled Men’s Health: Interesting new research into prostate disease and prostate cancer. ABC Radio National Health Report podcast 14 March 2011 presented by Dr Norman Swan. The radio broadcast can be listened to or downloaded from here. A copy of the transcript is here as a 140 KB PDF file. Of the people interviewed two are of particular interest: Dr Tom Pickles being interviewed about the results of an ongoing study of reports on the efficacy of different types of treatments for prostate cancer, and Prof. Pamela Russell being interviewed about work being undertaken on gene therapy for late stage prostate cancer. The ongoing study that Dr Pickles refers to in the interview is one lead by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle under the auspices of the ‘Prostate Cancer Results Study Group’ (PCRSG). This study is described in an entry above on this web page, together with links to the PCRSG's report slides.
Comparison of side effects for treating prostate cancer via radical prostatectomy and IMRT (Intensity-Modulated Radiotherapy). Author: Fran Lowry. Medscape Urology News, 30 January 2013 Extract from the article: Men (aged 55 to 74 at treatment - Ed.) with localized prostate cancer who elect to have prostatectomy or radiotherapy will experience problems with urinary, bowel, and sexual function in the long term, according to a new study published today in the New England Journal of Medicine... Data from the Prostate Cancer Outcomes Study (PCOS) show that in the short term, men who have had surgery will have more urinary incontinence and sexual dysfunction, and those who have had radiotherapy will have more bowel dysfunction, but by 15 years, dysfunction in all domains is not significantly different..."Whatever the reason, it could be aging, it could be the treatment, it could be secondary treatments, but in the long run, there are not a lot of differences between the 2 primary treatments for localized disease, whether they are surgery or radiation," senior author David F. Penson MD, told Medscape Medical News. The results from PCOS should give men with localized prostate cancer pause before they choose a treatment, Dr. Penson said. Web link: http://tinyurl.com/ccqn4dh (See abstract for the Penson study here: http://tinyurl.com/axqvyrc Note that the men in this study were aged between 55 and 74 at treatment and so would have been aged 70 to 89 at the 15-year follow-up date.)
Prostate Cancer Results Study Group (PCRSG) update. The PCRSG which is led by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle is conducting an ongoing "meta-analysis" of published research studies that report on the effectiveness of different treatments for prostate cancer. A 2009 report on the Center’s web site here provides a very readable description of the study. Dr Grimm has released presentations progressively showing the results of the ongoing analysis. The most recent presentation is dated 15 January 2013. This is entitled Comparing Treatment Results of Prostate Cancer - Prostate Cancer Results Study Group. It can be downloaded as a 6 MB file from our site here. If you would like to be added to the distribution list for future releases of the reports of the PCRSG, the Centre’s contact details are provided in that presentation. A shorter 3.6 MB version containing 17 slides and with some explanatory content has been prepared by our Group and can be downloaded from our site here.
Podcast entitled Men’s Health: Interesting new research into prostate disease and prostate cancer. ABC Radio National Health Report podcast 14 March 2011 presented by Dr Norman Swan. The radio broadcast can be listened to or downloaded from here. A copy of the transcript is here as a 140 KB PDF file. Of the people interviewed two are of particular interest: Dr Tom Pickles being interviewed about the results of an ongoing study of reports on the efficacy of different types of treatments for prostate cancer, and Prof. Pamela Russell being interviewed about work being undertaken on gene therapy for late stage prostate cancer. The ongoing study that Dr Pickles refers to in the interview is one lead by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle under the auspices of the ‘Prostate Cancer Results Study Group’ (PCRSG). This study is described in an entry above on this web page, together with links to the PCRSG's report slides.
Comparison of side effects for treating prostate cancer via radical prostatectomy and IMRT (Intensity-Modulated Radiotherapy). Author: Fran Lowry. Medscape Urology News, 30 January 2013 Extract from the article: Men (aged 55 to 74 at treatment - Ed.) with localized prostate cancer who elect to have prostatectomy or radiotherapy will experience problems with urinary, bowel, and sexual function in the long term, according to a new study published today in the New England Journal of Medicine... Data from the Prostate Cancer Outcomes Study (PCOS) show that in the short term, men who have had surgery will have more urinary incontinence and sexual dysfunction, and those who have had radiotherapy will have more bowel dysfunction, but by 15 years, dysfunction in all domains is not significantly different..."Whatever the reason, it could be aging, it could be the treatment, it could be secondary treatments, but in the long run, there are not a lot of differences between the 2 primary treatments for localized disease, whether they are surgery or radiation," senior author David F. Penson MD, told Medscape Medical News. The results from PCOS should give men with localized prostate cancer pause before they choose a treatment, Dr. Penson said. Web link: http://tinyurl.com/ccqn4dh (See abstract for the Penson study here: http://tinyurl.com/axqvyrc Note that the men in this study were aged between 55 and 74 at treatment and so would have been aged 70 to 89 at the 15-year follow-up date.)
URINARY INCONTINENCE
Caffeine Intake and its Association with Urinary Incontinence in United States Men: Results from National Health and Nutrition Examination Surveys 2005-2006 and 2007-2008
This study is by N J Davis et al reported in J Urol. 2012 Dec 28. An abstract of the study is here: http://tinyurl.com/cmcqw2d reporting that: "Caffeine consumption equivalent to approximately 2 cups of coffee daily (250 mg) is significantly associated with moderate to severe urinary incontinence in United States men. Our findings support the further study of caffeine modification in men with urinary incontinence."
This study is by N J Davis et al reported in J Urol. 2012 Dec 28. An abstract of the study is here: http://tinyurl.com/cmcqw2d reporting that: "Caffeine consumption equivalent to approximately 2 cups of coffee daily (250 mg) is significantly associated with moderate to severe urinary incontinence in United States men. Our findings support the further study of caffeine modification in men with urinary incontinence."
ERECTILE DYSFUNCTION
Treatment of erectile dysfunction and penile rehabilitation. This is a segment from Dr Norman Swan’s ABC radio program ‘The Health Report’ on 23 August 2010. Dr Swan interviewed Dr John Mulhall - Director of Sexual and Reproductive Medicine, Memorial Sloan-Kettering Cancer Center, New York. The original audio can be listened to here. A transcript of the program can be downloaded from here as a 111 KB PDF file. Dr Mulhall has created informative webcasts on the same subjects. Links are provided on this page of our web site.
Treatment of erectile dysfunction and penile rehabilitation. This is another segment from Dr Norman Swan’s ABC radio program ‘The Health Report’ on 23 August 2010. Dr Swan interviewed Dr John Mulhall - Director of Sexual and Reproductive Medicine, Memorial Sloan-Kettering Cancer Center, New York. The original audio can be listened to here. A transcript of the program can be downloaded from here as a 111 KB PDF file. Dr Mulhall has created informative webcasts on the same subjects. Links are provided on this page of our web site.
Treatment of erectile dysfunction and penile rehabilitation. This is another segment from Dr Norman Swan’s ABC radio program ‘The Health Report’ on 23 August 2010. Dr Swan interviewed Dr John Mulhall - Director of Sexual and Reproductive Medicine, Memorial Sloan-Kettering Cancer Center, New York. The original audio can be listened to here. A transcript of the program can be downloaded from here as a 111 KB PDF file. Dr Mulhall has created informative webcasts on the same subjects. Links are provided on this page of our web site.
QUALITY OF LIFE (QOL)
Study on the quality of life and satisfaction with outcomes among prostate cancer survivors by Sanda M G et al. reported in the New England Journal of Medicine 2008 March 20; 358:1250-1261. Downloadable as 213 KB PDF file from here.
RISK FACTORS AND MITIGATION OF RISK
Statins might NOT lower the risk of recurrence of prostate cancer after a radical prostatectomy. In an abstract reported in the September 2012 edition of the Journal of Urology, Alon Y Mass et al observe that the effect of statins on prostate cancer recurrence has been investigated in several studies with inconsistent results: http://tinyurl.com/8z2bsjf Mass and his colleagues report their investigation into whether or not statins were associated with biochemical recurrence of prostate cancer in a large cohort of men after radical prostatectomy and also report their meta-analysis of existing studies. The authors concluded that: "Our findings are consistent with the results of the meta-analysis, which indicated that preoperative statin use does not impact the overall risk of biochemical recurrence." A similar conclusion was reported in a 2 October 2012 Medscape Urology News article by Dr Will Boggs: http://tinyurl.com/9umwc7l He reports the results of a meta-analysis undertaken by a team led by Dr. Edward Messing. Boggs states that the Messing meta-analysis indicated that "... there was no significant difference in the risk of biochemical recurrence between statin users and nonusers...".
Aspirin may reduce the risk of prostate-cancer-specific mortality. In a 21 March 2012 article published by Cancer Research UK (see http://tinyurl.com/83kwcr4 ) reference is made to the results of three article published in early 2012 by Prof. Peter Rothwell et al. The studies indicate that taking low-dose aspirin regularly lowers the risk of developing cancer and also lowers the risk of cancer spreading. Prostate cancer is not mentioned specifically in the article. Unfortunately these abstracts do not provide any details: http://tinyurl.com/8rdxob2 , http://tinyurl.com/8p42t98 , http://tinyurl.com/8wnszy7 Readers would need to access the full articles to determine whether or not prostate cancer is referred to specifically. However, in a Cancernetwork web article dated 11 September 2012, Ian Ingram reports the results of a further study of aspirin, conducted by Assoc. Prof. Stanley L Liauw et al at the University of Chicago: http://tinyurl.com/8vn5j2d Ingram indicates that in the Liauw study, aspirin reduced the risk of prostate-cancer-specific mortality. However, he also indicates that Liauw et al state that "The optimal usage of aspirin, as well as the potential toxicity, should be addressed in a prospective study," and that "a randomized comparison would be valuable to corroborate this association and justify a routine recommendation of aspirin in patients with prostate cancer."
Two recent research studies have examined the beneficial effects of exercise in relation to reduction of risk of progression of prostate cancer and mortality. Two press releases summarise the research projects. The first is entitled “Exercise may lower risk of death for men with prostate cancer” and describes a research article authored by Stacey A Kenfield and others (January 2011). The second is entitled “Brisk walking may help men with prostate cancer” and describes a research article authored by Erin L Richman and others (May 2011). The press releases can be download from here and here.
An abstract of an article written by Corinne E Joshu et al reporting a relationship between smoking and prostate cancer recurrence after radical prostatectomy was reported on 18 May 2011 here: http://tinyurl.com/8tnyrtw The abstract for the Joshu article can also be downloaded from here on our web site. While the article reports the results of just one study, a number of other researchers have reported that smoking appears to be a risk factor for both prostate cancer incidence and recurrence after treatment. See for example a recent report in 2011 by J C Presti etal in which it was reported that "Smoking is associated with adverse pathologic features and a higher risk of biochemical recurrence in men undergoing radical prostatectomy." The abstract for this study can be accessed here: http://tinyurl.com/9fh6w24 and a copy of the extract can be downloaded from here on our web site. Reported in 2010 was a meta-analysis of 24 studies of the relationship between smoking and prostate cancer incidence and mortality, undertaken by Dr. Michael Huncharek et al. They concluded that "Observational cohort studies show an association of smoking with prostate cancer incidence and mortality. Ill-defined exposure categories in many cohort studies suggest that pooled data underestimate risk." This report can be accessed here: http://tinyurl.com/95nxng9 and can also be downloaded from here on our web site.
Diet and prostate cancer - a segment from Dr Norman Swan’s ABC radio program ‘The Health Report’ on 6 September 2010. Dr Swan interviewed Michael Pollak - Professor of Medicine and Oncology at McGill University, Montreal. The interview discusses recent research into the relationship between obesity, insulin and prostate cancer outcomes. The original audio can be listened to here. A transcript can be downloaded from here as a 53 KB PDF file.
Article by Brandt, A. et al entitled Age-Specific Risk of Incident Prostate Cancer and Risk of Death from Prostate Cancer Defined by the Number of Affected Family Members. The pre-print version of the article to be published in European Urology 58 2010 pp 275-280 can be downloaded as a 135 KB PDF file from here. The study concluded that there were “... vast increases in risk when multiple first-degree relatives are affected.” Presentation charts showing key findings can be downloaded as a 385 KB PDF file from here.
Article by Susman, E reporting studies that suggest that excess weight and smoking may influence risk of disease relapse after treatment for prostate cancer. Oncology NEWS International Vol. 19 No. 6 June 22 2010. Viewable and downloadable from here as a 61 KB PDF file.
Effect of dutasteride on the risk of prostate cancer. An article by G L Andriole el al in The New England Journal of Medicine, 2010 362:1192-1202. The authors concluded that “...among men at increased risk for prostate cancer and for benign prostatic hyperplasia, dutasteride reduced the risk of prostate cancers and precursor lesions and improved many outcomes related to benign prostatic hyperplasia. Dutasteride may be considered as a treatment option for men who are at increased risk for prostate cancer.” The article can be viewed here or downloaded as a 426 KB PDF file from here. Note that while use of Dutasteride for the treatment of benign prostatic hyperplasia (BPH) has been approved since 2002 by the USA’s FDA and Australia’s TGA (and from February 2011 was listed with a streamlined PBS authorisation code), in December 2010 the FDA rejected dutasteride as a drug for the indication of reducing the risk of prostate cancer (see article here).
Report of research by kConFab on the BRCA2 gene and prostate cancer risk. The research concluded that if a man comes from a family with multiple cases of breast or ovarian cancer, or knows there is a BRCA2 gene mutation running in their family, they may be at increased risk of developing prostate cancer. Press release can be downloaded from here as a 29 KB PDF file.
Aspirin may reduce the risk of prostate-cancer-specific mortality. In a 21 March 2012 article published by Cancer Research UK (see http://tinyurl.com/83kwcr4 ) reference is made to the results of three article published in early 2012 by Prof. Peter Rothwell et al. The studies indicate that taking low-dose aspirin regularly lowers the risk of developing cancer and also lowers the risk of cancer spreading. Prostate cancer is not mentioned specifically in the article. Unfortunately these abstracts do not provide any details: http://tinyurl.com/8rdxob2 , http://tinyurl.com/8p42t98 , http://tinyurl.com/8wnszy7 Readers would need to access the full articles to determine whether or not prostate cancer is referred to specifically. However, in a Cancernetwork web article dated 11 September 2012, Ian Ingram reports the results of a further study of aspirin, conducted by Assoc. Prof. Stanley L Liauw et al at the University of Chicago: http://tinyurl.com/8vn5j2d Ingram indicates that in the Liauw study, aspirin reduced the risk of prostate-cancer-specific mortality. However, he also indicates that Liauw et al state that "The optimal usage of aspirin, as well as the potential toxicity, should be addressed in a prospective study," and that "a randomized comparison would be valuable to corroborate this association and justify a routine recommendation of aspirin in patients with prostate cancer."
Two recent research studies have examined the beneficial effects of exercise in relation to reduction of risk of progression of prostate cancer and mortality. Two press releases summarise the research projects. The first is entitled “Exercise may lower risk of death for men with prostate cancer” and describes a research article authored by Stacey A Kenfield and others (January 2011). The second is entitled “Brisk walking may help men with prostate cancer” and describes a research article authored by Erin L Richman and others (May 2011). The press releases can be download from here and here.
An abstract of an article written by Corinne E Joshu et al reporting a relationship between smoking and prostate cancer recurrence after radical prostatectomy was reported on 18 May 2011 here: http://tinyurl.com/8tnyrtw The abstract for the Joshu article can also be downloaded from here on our web site. While the article reports the results of just one study, a number of other researchers have reported that smoking appears to be a risk factor for both prostate cancer incidence and recurrence after treatment. See for example a recent report in 2011 by J C Presti etal in which it was reported that "Smoking is associated with adverse pathologic features and a higher risk of biochemical recurrence in men undergoing radical prostatectomy." The abstract for this study can be accessed here: http://tinyurl.com/9fh6w24 and a copy of the extract can be downloaded from here on our web site. Reported in 2010 was a meta-analysis of 24 studies of the relationship between smoking and prostate cancer incidence and mortality, undertaken by Dr. Michael Huncharek et al. They concluded that "Observational cohort studies show an association of smoking with prostate cancer incidence and mortality. Ill-defined exposure categories in many cohort studies suggest that pooled data underestimate risk." This report can be accessed here: http://tinyurl.com/95nxng9 and can also be downloaded from here on our web site.
Diet and prostate cancer - a segment from Dr Norman Swan’s ABC radio program ‘The Health Report’ on 6 September 2010. Dr Swan interviewed Michael Pollak - Professor of Medicine and Oncology at McGill University, Montreal. The interview discusses recent research into the relationship between obesity, insulin and prostate cancer outcomes. The original audio can be listened to here. A transcript can be downloaded from here as a 53 KB PDF file.
Article by Brandt, A. et al entitled Age-Specific Risk of Incident Prostate Cancer and Risk of Death from Prostate Cancer Defined by the Number of Affected Family Members. The pre-print version of the article to be published in European Urology 58 2010 pp 275-280 can be downloaded as a 135 KB PDF file from here. The study concluded that there were “... vast increases in risk when multiple first-degree relatives are affected.” Presentation charts showing key findings can be downloaded as a 385 KB PDF file from here.
Article by Susman, E reporting studies that suggest that excess weight and smoking may influence risk of disease relapse after treatment for prostate cancer. Oncology NEWS International Vol. 19 No. 6 June 22 2010. Viewable and downloadable from here as a 61 KB PDF file.
Effect of dutasteride on the risk of prostate cancer. An article by G L Andriole el al in The New England Journal of Medicine, 2010 362:1192-1202. The authors concluded that “...among men at increased risk for prostate cancer and for benign prostatic hyperplasia, dutasteride reduced the risk of prostate cancers and precursor lesions and improved many outcomes related to benign prostatic hyperplasia. Dutasteride may be considered as a treatment option for men who are at increased risk for prostate cancer.” The article can be viewed here or downloaded as a 426 KB PDF file from here. Note that while use of Dutasteride for the treatment of benign prostatic hyperplasia (BPH) has been approved since 2002 by the USA’s FDA and Australia’s TGA (and from February 2011 was listed with a streamlined PBS authorisation code), in December 2010 the FDA rejected dutasteride as a drug for the indication of reducing the risk of prostate cancer (see article here).
Report of research by kConFab on the BRCA2 gene and prostate cancer risk. The research concluded that if a man comes from a family with multiple cases of breast or ovarian cancer, or knows there is a BRCA2 gene mutation running in their family, they may be at increased risk of developing prostate cancer. Press release can be downloaded from here as a 29 KB PDF file.
BPH
The link between benign prostatic hyperplasia (BPH) and prostate cancer. Authors: David D. Ørsted, Stig E. Bojesen. Nature Reviews Urology 10, 49-54 (January 2013) doi:10.1038/nrurol.2012.192 Author's abstract: Benign prostatic hyperplasia (BPH) and prostate cancer are among the most common diseases of the prostate gland and represent significant burdens for patients and health-care systems in many countries. The two diseases share traits such as hormone-dependent growth and response to antiandrogen therapy. Furthermore, risk factors such as prostate inflammation and metabolic disruption have key roles in the development of both diseases. Despite these commonalities, BPH and prostate cancer exhibit important differences in terms of histology and localization. Although large-scale epidemiological studies have shown that men with BPH have an increased risk of prostate cancer and prostate-cancer-related mortality, it remains unclear whether this association reflects a causal link, shared risk factors or pathophysiological mechanisms, or detection bias upon statistical analysis. Establishing BPH as a causal factor for prostate cancer development could improve the accuracy of prognostication and expedite intervention, potentially reducing the number of men who die from prostate cancer. Web link: http://tinyurl.com/aar49mp
No reduction in Quality of Life for long-term use of Finasteride. The 5-alpha-reductase inhibitor Finasteride has been used for the alleviation of benign prostatic hypertrophy (BPH). In a 12 September 2012 article by Megan Brooks, the results of a 7-year Prostate Cancer Prevention Trial (PCPT) are reported: http://tinyurl.com/97cvttg The trial was undertaken by a team led by Dr Carol M Moinpour of the Fred Hutchinson Cancer Research Center in Seattle. The Brooks' article indicated that there was a "... 25% reduction in the prevalence of prostate cancer and about a 40% reduction in the occurrence of symptomatic benign prostatic hypertrophy (BPH)" and "... no statistically significant affect on these three health-related quality of life domains": physical functioning, mental health and vitality.
Effect of dutasteride on the risk of prostate cancer. An article by G L Andriole el al in The New England Journal of Medicine, 2010 362:1192-1202. The authors concluded that “...among men at increased risk for prostate cancer and for benign prostatic hyperplasia, dutasteride reduced the risk of prostate cancers and precursor lesions and improved many outcomes related to benign prostatic hyperplasia. Dutasteride may be considered as a treatment option for men who are at increased risk for prostate cancer.” The article can be viewed here or downloaded as a 426 KB PDF file from here. Note that while use of Dutasteride for the treatment of benign prostatic hyperplasia (BPH) has been approved since 2002 by the USA’s FDA and Australia’s TGA (and from February 2011 was listed with a streamlined PBS authorisation code), in December 2010 the FDA rejected dutasteride as a drug for the indication of reducing the risk of prostate cancer (see article here).
No reduction in Quality of Life for long-term use of Finasteride. The 5-alpha-reductase inhibitor Finasteride has been used for the alleviation of benign prostatic hypertrophy (BPH). In a 12 September 2012 article by Megan Brooks, the results of a 7-year Prostate Cancer Prevention Trial (PCPT) are reported: http://tinyurl.com/97cvttg The trial was undertaken by a team led by Dr Carol M Moinpour of the Fred Hutchinson Cancer Research Center in Seattle. The Brooks' article indicated that there was a "... 25% reduction in the prevalence of prostate cancer and about a 40% reduction in the occurrence of symptomatic benign prostatic hypertrophy (BPH)" and "... no statistically significant affect on these three health-related quality of life domains": physical functioning, mental health and vitality.
Effect of dutasteride on the risk of prostate cancer. An article by G L Andriole el al in The New England Journal of Medicine, 2010 362:1192-1202. The authors concluded that “...among men at increased risk for prostate cancer and for benign prostatic hyperplasia, dutasteride reduced the risk of prostate cancers and precursor lesions and improved many outcomes related to benign prostatic hyperplasia. Dutasteride may be considered as a treatment option for men who are at increased risk for prostate cancer.” The article can be viewed here or downloaded as a 426 KB PDF file from here. Note that while use of Dutasteride for the treatment of benign prostatic hyperplasia (BPH) has been approved since 2002 by the USA’s FDA and Australia’s TGA (and from February 2011 was listed with a streamlined PBS authorisation code), in December 2010 the FDA rejected dutasteride as a drug for the indication of reducing the risk of prostate cancer (see article here).