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Prostate knowledge base with publications, presentations, videos and more.
Physician variation in management of low-risk prostate cancer: a population-based cohort study
Hoffman KE, Niu J, Shen Y, Jiang J, Davis JW, Kim J, Kuban DA, Perkins GH, Shah JB, Smith GL, Volk RJ, Buchholz TA, Giordano SH, Smith BD.
11/17/2014Comment from Henk van der Poel: Do we give impartial advice? Or who is unbiased? Early analyses showed a preferential treatment advice dependent on the main treatment modality provided by a specific physician. Urologist were more likely to provide prostatectomy, whereas radiation oncologist preferentially used radiotherapy and men consulting a medical oncologist were more likely to receive an initial active surveillance management of low and intermediate risk prostate cancer. In a large cohort of patients (12.000) with low risk prostate cancer diagnosed over the age of 65 year treatment was analyzed. The majority of men (80%) with low risk disease received treatment. Men seen by urologists only, a urologist with more years after training and urologists that treat non-low-risk prostate cancer were all significantly more likely to undergo treatment as opposed to an (active) surveillance approach. In men visiting the radiation oncologist upfront treatment was even higher than for urologists: over 90%. Between 2006 and 2009 an increasing rate of observation was noted (from 17.5% to 25.1%) indicating that the field is continuously shifting and data from 8 years ago may and should not affect nowadays decision-making on the topic of active surveillance. With an increase in life-expectancy data from the SPCG-4 trial, in some cases even before the PSA era should be interpreted with caution. Although active surveillance adaptation will continue to improve, with longer follow up the “progression” rate leading to active treatment in men initially managed conservatively is shown to exceed 50%. Finally, although urologists seem to advice active treatment in many men with low risk prostate cancer, they don’t stand alone. Also radiation oncologists tend to shy away form active surveillance and perform active treatment in over 90% over referred men with low risk prostate cancer.Updated Interim Efficacy Analysis and Long-term Safety of Abiraterone Acetate in Metastatic Castration-resistant Prostate Cancer Patients Without Prior Chemotherapy (COU-AA-302)
11/17/2014Comment by Henk van der Poel: Although abiraterone has so far been used in several clinical studies, longer term toxicity data are not widely available. An update from the COU-AA-302 study of abiraterone and prednisone in men with CRPC prior to docetaxel showed that docetaxel chemotherapy was postponed by a median of almost 10 months on the abiraterone plus prednisone versus prednisone-only arm. The main toxicity in the abiraterone arm was transaminase elevations grade 3 and 4 in 3-6% of men compared to 1% in the prednisone arm. Cardiac toxicity leading to treatment discontinuation was extremely rare (<1%) and did not decrease after longer intervals of abiraterone use (>2 years).Plasma vitamin D and prostate cancer risk: results from the Selenium and Vitamin E Cancer Prevention Trial
Kristal AR, Till C, Song X, Tangen CM, Goodman PJ, Neuhauser ML, Schenk JM, Thompson IM, Meyskens FL Jr, Goodman GE, Minasian LM, Parnes HL, Klein EA.
10/21/2014Comment from Henk van der Poel: Both low and high Vit D plasma levels found to increase prostate cancer risk in the SELECT trial population. Vit D supplementation may increase PCA risk.
In the PCPT trial elevated serum vit D levels were also associated with increased incidence of Gleason 2-6 but with a reduced risk of Gleason 8-10 cancers in both the placebo and finasteride study arm.
It is suggested that this apparent contradiction is caused by selection bias in the SELECT trial population (Schwartz cancer epidemiol biom prev 23:1447, 2014) and that indeed vit D may decrease the incidence of higher risk prostate cancer as suggested by the PCPT findings.
More Extensive Pelvic Lymph Node Dissection Improves Survival in Patients with Node-positive Prostate Cancer
09/24/2014Comment from Henk van der Poel: Removing more than 14 nodes improved cancer specific survival at 10 years after prostatectomy by more than 15% in this retrospective series.Limited evidence for the use of imaging to detect prostate cancer: A systematic review
09/24/2014Comment from Henk van der Poel:
Imaging options for prostate cancer detection are limited. In 4852 identified studies, only 6 studies were included in the systematic review. Imaging currently does not aid in prostate cancer detection.Prediction of Outcome Following Early Salvage Radiotherapy Among Patients with Biochemical Recurrence After Radical Prostatectomy
09/24/2014Comment from Henk van der Poel:
Does good biochemical outcome after salvage radiotherapy reflects good patient selection or poor surgical performance? Interestingly, Briganti et al report biochemical recurrence-free rates at 5 years over 70% for early salvage radiotherapy, i.e. radiotherapy to the prostatic fossa before the postoperative PSA is 0.5ng/ml and with an unmeasurable PSA at nadir. The fact that men with positive surgical margins had less benefit from radiotherapy is remarkable. Their nomogram predicts biochemical recurrence in around 50% of men with extra capsular growing, R1-resected, Gleason 8-10 disease after early salvage radiotherapy. Clearly they show that the level of PSA to start salvage radiotherapy is dependent on tumor characteristics. Patients with higher Gleason graded tumors have more to lose while waiting till PSA is 0.5ng/ml before radiotherapy is applied compared to men with a Gleason 6 cancer. Whether this reflects rapid metastases in this group, increased radio resistance or a larger tumor volume at lower PSA values remains to be determined.
Proper selection of patients will increase the efficacy of salvage radiotherapy. But then again, the fact that men with positive surgical margins fare worse compared to margin negative disease shows that salvage radiotherapy may not be sufficient to compensate for poor surgery.The use of exome genotyping to predict pathological Gleason score upgrade after radical prostatectomy in low-risk prostate cancer patients.
Oh JJ, Park S, Lee SE, Hong SK, Lee S, Choe G, Yoon S, Byun SS.
09/09/2014Comment from Henk van der Poel:
Besides clinical parameters upgrading of Gleason 6 prostate cancer on biopsy was predicted by a single SNP. Adding SNP genotype data to clinical parameters improved prediction by an absolute 4.5%.Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer
Gondo T, Hricak H, Sala E, Zheng J, Moskowitz CS, Bernstein M, Eastham JA, Vargas HA.
09/09/2014Comment from Henk van der Poel:
Multiparameter MRI may prevent unnecessary treatment in clinical Gleason 7 prostate cancer.Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial
Cormie P, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, Chambers SK, Newton RU.
09/09/2014Comment from Henk van der Poel:
Three months, twice weekly 60 minutes of physical exercising to 70% of heart rate target intensity prevented significantly reduced the adverse effects of androgren ablation on body mass composition and parameters of physical function but not bone mineral density and blood biomarkers.The impact of a BRCA2 mutation on mortality from screen-detected prostate cancer.
Akbari MR, Wallis CJ, Toi A, Trachtenberg J, Sun P, Narod SA, Nam RK.
09/09/2014Comment from Henk van der Poel:
BRCA2 carriers not only have an increased risk of prostate cancer but also worse prognosis when detected in a screening program.
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Prostate Cancer News from ASCO 2014
Commentaries from Susanne Osanto on a selection of presentations within Prostate Cancer from this year’s ASCO meeting.
Latest Updates from the Advance Prostate Cancer Resource Centre
EAU 2017 Scientific Programme and Sessions
View the Scientific Programme and Sessions of the 2017 EAU Annual Congress, Munich, Germany.