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Management of prostate cancer recurrence after definitive radiation therapy

The management of prostate cancer recurrence after definitive radiation therapy is shifting and there is no consensus regarding the optimal strategy. The major challenge is determining the anatomical site of relapse. In case of biochemical relapse, androgen deprivation therapy is a non-curative option commonly used, while patients with a local prostate cancer recurrence could be managed through a curative intent.

A recent study at  Maisonneuve-Rosemont Hospital, Montreal, Canada, has offered a new review of the treatment of patients in biochemical relapse after first-line radiation therapy. These patients have numerous options, but “best practices” for such patients are not well defined and long-term outcome data are relatively sparse. According to study conclusion, the biggest problem with such patients is being able to identify precisely where the recurrence has occurred — within the previously radiated area (local relapse) or somewhere else entirely (potentially micrometatstic disease). However, the authors state in their abstract that each clinical situation should be discussed in a multidisciplinary setting. Different options should be explained to the patient and decision should be taken after balancing treatment outcomes with life expectancy.

Androgen deprivation therapy can increase heart risk factors

According to a science advisory published in Circulation: Journal of the American Heart Association, (AHA), androgen deprivation therapy (ADT), commonly used in prostate cancer treatment, can worsen heart risk factors and may increase the risk of heart attack and/or cardiac death. However, the relationship between androgen deprivation therapy and heart attack or cardiac death has not been definitively established. [ continue to read ]

A positive surgical margin predicts the recurrence of prostate cancer

A research team has recently published data based on a series of 11,729 patients who underwent open radical retropublic prostatectomy at the Mayor Clinic in Rochester, Minnesota, between 1990 and 2006. Researchers goal was to better establish the impact of surgical margin status on clinical progression and mortality. The basic results of this careful analysis were as follows:

The authors note that their data show a distinct reduction in the frequency of positive surgical margins (at least in  their series) over the past 20 years. They conclude that the presence of a positive margin after radical prostatectomy does increase the probability of biochemical recurrence, local recurrence, and the delivery of salvage therapy. However, it does not reliably predict risk for systemic progression, cancer-specific death, or overall mortality.

Nitroglycerin may be able to delay the progression of prostate cancer

According to a group of researchers at Queen’s University in Kingston, Ontario, a very low dose of nitroglycerin may be able to delay the progression of prostate cancer in men with a rising PSA after standard first-line treatment with radiotherapy or surgery.

Treatment of prostate cancer using a very low dose of nitroglycerin may slow and even halt the progression of the disease without the severe side effects of current treatments, Queen’s University researchers have discovered. [ continue to read ]

Effect of androgen deprivation therapy on body composition in men with prostate cancer

Use of androgen deprivation therapy is associated with changes in body composition including increased fat and decreased lean mass. Limited information exists regarding the rate and extent of these changes.

A recent study at Queen’s University Belfast, Belfast, Northern Ireland, UK, evaluated the use of androgen deprivation therapy (ADT) in the treatment of prostate cancer. This systematic review was conducted to determine the effects of ADT on body composition in prostate cancer patients.

The study revealed that significant increases in fat and declines in lean mass were observed in prostate cancer patients treated with ADT. Lifestyle changes or suitable interventions to minimize the effect of ADT on body composition need to be investigated.

According to research team prostate cancer survivors should be made aware of the side effect of treatment on body composition. However, further work is required to determine what interventions can minimize the impact of ADT on body composition and therefore what evidence based advice they should be provided with. In general, though recommendation of a healthy diet and moderate exercise is reasonable.

Prostate cancer diagnosis may affect man’s mind

According to a new study published online February 2 in the Journal of the National Cancer Institute, being diagnosed with prostate cancer may increase a man’s risk of suicide or cardiovascular death, especially right after diagnosis.

According to the study, the elevated suicide risk was apparent before prostate-specific antigen (PSA) testing was common (1979) and when it was first introduced (1987), but not since PSA testing has been widespread (1993). The authors say this observation is most likely due to the potentially lower degree of stress associated with the diagnosis of indolent prostate cancer.

Daily fat intake and risk for prostate cancer

A research team at University of Nottingham Medical School, UK, has published data from a population-based, case-control study with 512 patients under 60 years of age and 838 controls, conducted in the United Kingdom between 1999 and 2004.

Collected data suggest that daily fat intake is significantly associated with risk for early onset prostate cancer. The authors argue that dietary fat intake is a modifiable risk factor for prostate cancer, particularly in younger men. Subset data in this study confirmed this risk for daily intake of saturated fatty acids (SFAs), mono-unsaturated fatty acids (MUFAs), and poly-unsaturated fatty acids (PUFAs), as well as for total dietary fat intake.

Prostate Cancer Detection: Estimating The Screening Benefit

The European Randomized Study of Screening for Prostate Cancer (ERSPC) has demonstrated that screening has the potential for reducing mortality from prostate cancer (PC).

In contrast, The Prostate, Lung, Colorectal and Ovarian (PLCO) trial showed no difference in PC mortality after comparing the number of men who died from PC in a screened population with that in a control population where screening was not recommended or performed on a systematic basis.

China study: PSA screening is effective for early detection of prostate cancer

As previous studies have suggested that implementation of PSA screening in China is of crucial importance, a recent study at Nanjing Medical University, China, compared clinical and pathological characteristics of screen-detected and clinically diagnosed prostate cancers and evaluated the effectiveness of PSA screening for early detection of prostate cancer in Nanjing.

The study concluded that PSA screening is effective for early detection of prostate cancer in Chinese elderly men. Favorable PSA levels, Gleason scores, clinical stages, and chances for radical prostatectomy are associated with PSA screening. Further studies are needed to evaluate the effect of screening on treatment outcomes and mortality of prostate cancer in Chinese.

Of course, if prostate cancer screening becomes commonplace in China, the world’s most populous nation will also have to face up to the question of the most appropriate way to manage men with early-stage, screen-detected prostate cancer.

New scan may help find aggressive prostate tumors

According to recent report of Leo L. Cheng, an assistant professor of radiology and pathology at Harvard Medical School and a researcher at Massachusetts General Hospital, a new imaging technology promises to achieve the long-sought goal of singling out prostate cancers that are life-threatening and require the most aggressive treatment, researchers report.

The new study used magnetic resonance spectroscopy on five cancerous prostate glands removed from men with the diagnosis. The results of the scans were compared with those of the standard technique, which judges a cancer by the degree of disorder produced by the malignancy. Five of seven regions identified as cancerous by that method scored high on a magnetic resonance spectroscopy malignancy index. The other two regions were near the outer edges of the glands, where exposure to air made the magnetic resonance results less clear.

Magnetic resonance spectroscopy, which provides information about the metabolic chemistry of suspected cancerous tissue, gave good results in a small trial in which its readings were compared with those of current measures of prostate cancer danger, according to a report published Jan. 27 in Science Translational Medicine.