Over the last few months, a number of studies have been published with new information about diagnosis and treatment of prostate cancer, which affects about one in six men at some time during their life.
Those studies include ‘Mortality Results from a Randomized Prostate-Cancer Screening Trial,’ published in the March 26 issue of the New England Journal of Medicine. Dr. Gerald Andriole Jr., chief of urologic surgery and director of the Prostate Study Center at Barnes-Jewish Hospital, is lead author.
The study marks the first report from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial on prostate-cancer mortality, and followed 76,693 men at 10 American study centers from 1993 through 2001. Researchers concluded that “after seven to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups,” one of which was screened using prostate-specific–antigen (PSA) testing for six years and digital rectal examinations for four years, while the control group received less aggressive testing.
“The bottom line is that if a patient is elderly or has other serious health problems and is not expected to live for more than a decade, then PSA testing is unnecessary,” Andriole says. “PSA testing, however, can still tell us a lot about the prostate, so it’s probably worthwhile in men who are expected to live more than 10 years. But we expect to develop better screening tools in the next few years.”
Andriole is looking to new genetic research that will allow physicians to identify gene markers specific to aggressive forms of prostate cancer. “Recognizing the specific genetic signature of the cancer will help determine the best treatment course,” he says. “We’re inching up on this by accumulating and analyzing prostate cancer cases from the past 15 years.”
The value of PSA testing remains murky. According to the American Urological Association Foundation, “The benefits of regular screening and early detection should not be discounted in the overall population. The decision to screen for prostate cancer with PSA and digital rectal examination should incorporate other known risk factors, including family history of prostate cancer, age, ethnicity/race, and whether or not the individual has had a previous negative prostate biopsy.” Current screening recommendations call for annual PSA testing at age 50 or earlier, however, the American Urological Association is expected to issue updated guidelines soon.
Dr. Luis Anglo, a urologist with Metropolitan Urological Specialists, notes that “there is no question that PSA is an excellent method of detecting prostate cancer. So far, it is by far the best tool we have, along with a prostate exam.”
Other studies have looked at prostate cancer treatment, questioning the value of radiation therapy following prostate removal. One report, published in the March issue of BJU International, a British urology journal, states that “follow-up radiotherapy after radical prostatectomy (prostate removal) does not improve overall or cancer-specific survival.” However, an article in the March issue of the Journal of Urology reports that “radiation therapy 18 weeks after radical prostatectomy (in locally advanced disease), significantly reduces the risk of recurrence, metastasis and the need for hormonal deprivation, and significantly increases survival.”
Such conflicting reports pose a problem for patients and physicians alike, Anglo says. “Both of us are faced with conflicting information. Hence the need to discuss this with the patient, looking at their individual situation, and try to come to a decision that best suits the clinical picture and the patient’s desires.”
Prostate cancer treatment also has advanced recently. One new procedure, known as a “male lumpectomy,” removes only the cancerous portion of the prostate instead of the entire gland. And the U.S. Food and Drug Administration recently approved the injectable drug Degarelix, the first new drug in several years for prostate cancer.
“I have begun selecting patients to receive injections of Degarelix,” says Richard Hess, R.N., a clinical nurse in the Saint Louis University Department of Urologic Surgery. “It should be a safer drug for patients that have bone metastasis at the time of diagnosis,” he adds.
“Try not to become confused by the media or personal opinions when it comes to prostate health,” Hess advises. “Early diagnosis is key for good outcome, and each individual should make their own treatment decisions.”