Radiation + Hormone Therapy = New Standard? Men with Locally advanced prostate cancer - that is, men whose cancer has spread beyond the wall of the prostate gland - respond better to a combination or radiation plus long - term hormone therapy than men who receive hormone therapy alone, according to results from a large phase ifi study by Swedish researchers. In fact, the combination treatment cut the men's risk of death in half. What's more, at 10 years, the recurrence of prostate cancer, as determined by a positive test for prostate specific antigen (PSA), was nearly 3 times higher in the group that had only the hormone therapy (75%) than in the group that had both hormone therapy and radiation (26%). While the findings strongly suggest men who are candidates for this type of treatment consider a combined approach, men in the combined therapy group did report more urinary, rectal, and sexual problems after 5 years than men taking just the hormone therapy. Men who have preexisting problems in these areas should talk to their doctors before considering radiation. For more information, see the American Cancer Society's Detailed Guide: Prostate Cancer, available on cancer.org, especially the section: "How is Prostate Cancer Treated?" AGENT ORANGE INCREASES AGGRESSIVENESS OF RECURRENT PROSTATE CANCER Veterans exposed to Agent Orange are at increased risk of aggressive recurrence of prostate cancer, researchers report. A study of 1,495 veterans who underwent radical prostatectomy to remove their cancerous prostates showed that the 206 exposed to Agent Orange had nearly a 50 percent increased risk of their cancer recurring despite the fact that their cancer seemed relatively nonaggressive at the time of surgery. Increasing evidence is emerging that exposure to Agent Orange, a defoliant used during the Vietnam War, increases risk for a variety of health problems, including prostate cancer, although the exact mechanism is unclear. Dr. Martha Terris, chief of urology at the Charlie Norwood VA Medical Center in Augusta, GA and professor of urology at the Medical College of Georgia School of Medicine Terris was the corresponding author on the study published in the May 2009 issue of BJUlnternational. Dr. Terris led a separate study of 1,653 veterans at VA medical centers in Augusta, GA, Los Angeles, CA, Palo Alto, CA and six affiliated medical schools between 1990 and 2006 that also showed higher recurrence rates and more aggressive recurring cancers with Agent Orange exposure. This study included new patients as well as many of her original study patients after longer follow-up. Dr. Sagar R. Shah, MCG urology resident, presented the findings at the 2007 annual meeting of the American Urological Association. Plenty of questions remain, such as what happens to patients whose primary treatment is standard radiation or brachytherapy, where rice-size radiation pellets are implanted in the prostate, rather than surgery, Dr. Terris said. "There is something about the biology of these cancers associated with prior Agent Orange exposure that is causing them to be more aggressive. We need to get the word out," Terris added. Science Daily News, 20 April 2009 |
ABIRATERONE SHOWS ACTIVITY IN HORMONEREFRACTORY PROSTATE CANCER (HRPC) A majority of patients with HRPC had at least a 50% decrease in PSA levels when treated with the enzyme inhibitor abiraterone acetate, according to data from a small clinical trial. Administered orally, abiraterone acetate inhibits the steroidal enzyme 17ahydroxylase/C 17,20 lyase (CYP 17), a cytochrome p450 complex involved in testosterone synthesis. In preliminary clinical trials, the agent demonstrated activity as second-line therapy for patients with HRPC. Dr. Ryan reported findings from a phase II study involving men with chemotherapy-naive HRPC and no prior exposure to ketoconazole at the 2009 ASCO Genitourinary Cancers Symposium.' Patients received abiraterone acetate plus prednisone daily, and they were evaluated for clinical and PSA response every 28 days. During treatment for a median of 10.5 months, 24 patients had at least a 30% decline in PSA levels from baseline, 22 had declines of 50% or more and eight had reductions greater than 90%. Adverse events were generally mild and transient. One patient had grade 3 treatmentrelated hypertension. "The results are consistent with what was observed in previous clinical studies," said Dr. Ryan. "Abiraterone has consistently demonstrated activity in castration-resistant prostate cancer. The drug also has been generally well tolerated." Adverse events were mild and transient. One patient had grade 3 treatment-related hypertension. Having demonstrated single-agent activity, abiraterone acetate will be evaluated in combination with other therapies in future trials. One or more investigators in the study had financial disclosures from Cougar Biotechnology, the study supporter, and investigators included Cougar Biotechnology employees. I. Ryan CJ, et al, Abstract 159, presentedat the 2009 ASCO GU symposium,
2628 February 2009. PROSTATE CANCER MORTALITY LOWER IN STATIN USERS Stephen Marcella, MD, of the University of Medicine and Dentistry of New Jersey School of Public Health in Piscataway, reported that prostate cancer mortality risk declined by 50% in men taking statins for reasons unrelated to cancer at the 2009 ASCO GU meeting.' Investigators examined data from the New Jersey Cancer Registry and identified 380 patients who died of prostate cancer during 1999 to 2001. These men were compared against 380 randomly selected matched controls with respect to age, race, education, comorbid conditions and statin exposure from 1989 forward. Pre-specified analyses included effects of highversus low-potency statins and hydrophilic versus lipophilic statins. The mean age of the entire study population was about 66 years. Significantly more patients in the control group had a history of statin use (71% vs. 17%) whereas significantly more cancer patients had received antihypertensive therapy (76% vs. 53%) and other types of cardiac medications (42% vs. 28%). All differences were significant at P <0.0001. Unadjusted results revealed a prostate cancer mortality odds ratio of 0.49 for statin users vs. nonusers (P <0,0001). Adjustment for demographic and clinical variables such as use of antihypertensive medications, further reduced the odds ratio to 0.37 (P <0.0001). The benefit was greatest in men taking high-potency statins (e.g., atorvastatin (Lipitor®) and rosuvastatin (Crestor®), as well as lipophilic statins (e.g., atorvastatin and fluvastatin (Lescol®). Several recent studies suggest that statins decreases the risk of advanced or metastatic prostate cancer, Dr. Marcella said. "We actually looked at prostate cancer death, and we verified in every case that the patient died of prostate cancer." I. Marcella S, Rhoads G, Abstract 26, presented at the 2009 ASCO GU
Symposium, 26 February 2009 |
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