Consider Source of Localized
Prostate Cancer Recommendations
Localized prostate cancer needs a balanced view of treatment
options from both urologists and radiologists, researchers said
here. Most younger Medicare-age patients who saw only a
urologist before deciding on treatment opted for radical prostatectomy
(RP), said urologist Thomas L. Jang, MD, of Memorial Sloan-Kettering
Cancer Center in New York, and radiation oncology colleagues, at the
American Society of Clinical Oncology meeting.
Older men over whelmingly
chose primary androgen deprivation therapy (ADT) or watchful waiting
(WW), the investigators found in a review of data on 85,000 men in
National Cancer Institute's Medicare-linked Surveillance, Epidemiology
and End Results (SEER) database. In contrast, patients of all ages favored
radiation therapy (RI) if they had pretreatment visits with a urologist
and a radiation oncologist.
Although many men have a RP without seeing
a radiation oncologist, "urologists exercise discretion," said
Dr. Jang.
"They rarely perform RP on men who have a limited life expectancy
based on advanced age." Noting that most patients opt for
RI if they have a radiation oncology consult, he emphasized that
"it is essential that men have access to balanced information."
None
of the principal treatment options for prostate cancer has clearly demonstrated
superiority over the others, Dr. Jang noted. As a result, most patients
decide on treatment on the basis of physician recommendations and perceived
tolerance for different types of adverse effects. Within that decision-making
environment, prostate cancer patients should get an unbiased,
balanced perspective.
NEW FINDING
Radical Prostatectomy Edges Out
Watchful Waiting
Overall mortality (death from any
cause) was lower in men with
prostate cancer who underwent
radical prostatectomy compared
to those who had no treatment or
deferred treatment (called watchful waiting), a new study finds.
In the study, researchers randomly assigned 695 men with early prostate
cancer to either radical prostatectomy or watchful waiting.
Preliminary findings, reported in
2002, indicated that surgery reduced deaths due to prostate
cancer, but it was too early to
determine whether surgery reduced overall mortality. In the current
10-year follow-up, however, radical prostatectomy edged out
watchful waiting, reducing overall
mortality by 26%. Men who underwent surgery also had a 44%
lower risk of death due to prostate
cancer, a 40% reduction in risk of
distant metastasis, and a 67%
reduction in risk of local prostate
cancer progression.
In terms of absolute numbers of
deaths, the reduction in overall
mortality was modest. But the significantly higher incidence of local
progression and distant metastasis
in the watchful waiting group was
associated with patient anxiety
and oftentimes the need for hormonal therapy and radiation to
ease bone pain. A higher incidence
of metastasis in the watchful waiting group also suggests that the mortality
advantage of the surgery group may increase with time.
NEW ENGLAND JOURNAL OF MEDICINE
Volume 352, Page 1977
May 12, 2005
|
PROSTATE CANCER
PATIENT
SUPPORT
1 800 80 Us TOO
NEW RESEARCH
Regular Vigorous Activity May Slow
Cancer Progression in Older Men
Older men who regularly engage in
vigorous exercise are less likely to
have high-grade, advanced, or
fatal prostate cancer, according to
a new report from the Health Professionals Follow-Up Study.
In the study, which followed
47,620 male health professionals
from 1986-2000, the researchers
identified 2,892 cases of prostate
cancer. Detailed lifestyle information, including physical activity
level, had been collected on the
participants, enabling the researchers to correlate prostate
cancer risk with exercise habits. A
link between the 2 factors was not
found in the group overall. But
among men ages 65 and older,
regular vigorous exercise reduced
the risk of advanced prostate cancer by nearly 70%. The reduction
was similar for fatal prostate cancer. Tumor grade was also lower
in the men who exercised. The
amount of physical activity required to achieve this risk reduction
was about 3 hours per week.
Although it is not entirely clear
how vigorous exercise reduces the
risk of prostate cancer progression, the researchers speculated
that it may affect hormones that
spur prostate cancer growth.
These include insulin-like growth
factor-1, insulin, leptin, and testosterone. The failure to find a risk
reduction in younger men may be related to the greater influence of genetic
risk factors and high testosterone levels in this age group.
ARCHIVES
OF INTERNAL MEDICINE
Volume 165, Page 1005
May 9, 2005
High-Dose Radiation Reduces Risk
of Recurrence Among Men with
Localized Prostate Cancer
High-dose radiation therapy may
be superior to conventional-dose
therapy in reducing the risk of cancer recurrence among men with
cancer confined to the prostate.
Refinements to conventional radiation therapy, known collectively as
"3-dimensional conformal therapy,"
now offer the option of delivering
higher, better-targeted radiation
doses with less risk of damage to
healthy tissue. In a new study,
researchers tested the effects of
increasing the radiation dose from
the standard 70.2 grays (Gy) to
79.2 Gy in 393 prostate cancer
patients.
After 5 years, 80% of the men
treated with high-dose radiation,
compared to 61% of the men
treated with conventional-dose
radiation, were free from biochemical failure–an increasing prostate-specific
antigen (PSA) level, which indicates cancer recurrence. This
represents an overall risk reduction
of 49% among men who received
the high-dose therapy.
To date, the researchers have
detected no difference in overall
survival between the 2 groups. The
occurrence of serious urinary or
rectal side effects was higher in the
high-dose group. But the overall
incidence of serious radiation-related side effects was low: 2%
among men in the high-dose group and 1% among men in the
conventional-dose group.
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Volume 294, Page 1233
September 14, 2005 |