Research presented during the 102nd Annual Scientific Meeting of the American Urological Association provided further evidence supporting regular prostate-cancer screening and offered new insights into disease progression. Prostate cancer is the third-leading cause of cancer deaths among American men and is most treatable when caught in its earliest stages. Research presented during the 102nd Annual Scientific Meeting of the American Urological Association in Anaheim, Ca. provided further evidence supporting regular prostate-cancer screening and offered new insights into disease progression and the hormonal treatment of recurrent disease.

A single PSA measurement in middle age predicts diagnosis of advanced prostate cancer up to 25 years later in an unscreened population (Abstract 1876)

Almost all advanced cancers could be found early by intense screening of at-risk patients, according to researchers from New York and Malmo, Sweden, who analyzed samples taken from a population-based cohort of 21,277 men in Malmo, Sweden between 1974 and 1986 to determine whether initial PSA plasma levels correlated with future diagnosis of advanced disease.

Of the 21,277 cases, 498 men actually developed prostate cancer, and 161 suffered from advanced disease (greater than T3 or metastasis). Association between PSA levels and eventual development advanced disease was determined using conditional logistical regression. In men with a total PSA of .5, .75, 1., 1.5 and 2 ng/ml, the probability of being diagnosed with advanced disease by age 75 was two per cent, three per cent, four per cent, seven per cent and 12 per cent, respectively. Risk was highly concentrated, with 89 per cent of advanced cancers occuring in men with the top ten per cent of PSA levels.

Clinical and pathological features of screen vs. non-screen detected prostate cancers: is there a difference? (Abstract 851)

Pathological stage and surgical margins are important predictors of prostate cancer recurrence after radical prostatectomy.

Cancers detected in a PSA-screening population from Tyrol, Austria, had a statistically significant lower rate of extracapsular extension and positive surgical margins than those found in a non-screened population despite similar preoperative PSA levels. Researchers evaluated 997 radical prostatectomy patients from Innsbruck undergoing surgery between February 1999 through March 2006. Within that group, 806 were participants in the PSA screening Tyrol Prostate Cancer Demonstration Project and 191 represented the non-screening group. Preoperative total PSA, age, pathological characteristics and prostate volume were analyzed. Screen-detected cancers were significantly more likely to be organ confined at the time of treatment with radical prostatectomy.

Baseline characteristics and predictors of progression in an active surveillance cohort: the UCSF experience (Abstract 611)

Active surveillance with delayed intervention is a viable option for well-selected patients with favorable risk prostate cancer. But is there a single characteristic that could help determine which of these patients are likely to progress? What is the best predictor of subsequent intervention with treatment? To determine the best predictor of secondary treatment, researchers from the University of California, San Francisco (UCSF), examined demographic and clinical characteristics of men electing active surveillance.

The researchers led by Peter R. Carroll, M.D., characterized disease progression in a subset of men with low-risk disease enrolled in an active surveillance protocol at UCSF. Patients received repeat prostate needle biopsies at 12-24 month intervals, trans-rectal ultrasound (TRUS) every six-12 months and PSA measurements every three months to track progression. Researchers defined progression as a change in PSA of greater than 0.75 ng/ml per year, increase in lesion size (as determined by TRUS) or change in Gleason sum. Of those three predictors, change in tumor grade was the most significant predictor of delayed intervention, with 35 per cent of the subjects experiencing an increase in Gleason score on surveillance. There were no baseline demographic or clinical characteristics that could accurately predict disease progression in this population.

Outcomes of men managed with watchful waiting in the PSA follow-up study (Abstract 610)

There are many questions surrounding watchful waiting/active surveillance as an initial treatment for prostate cancer and whether outcomes vary from patients who elect a more aggressive treatment sooner after diagnosis. Researchers from Northwestern University, led by William Catalona, M.D., reviewed a large, community-based cohort of men with screen-detected prostate cancer electing watchful waiting as initial management for their disease.

A group of 347 men selecting watchful waiting as their initial treatment were followed with biannual PSA tests. Of this group, 36 per cent showed evidence of biochemical progression and/or underwent secondary treatment. Overall mortality was 30 per cent and disease-specific mortality was eight per cent. There were no deaths in the group electing secondary treatment while eight died in the non-treatment group.

Intermittent androgen deprivation in patients with PSA-relapse after radical prostatectomy (Abstract 600)

In men with PSA relapse following prostatectomy, androgen deprivation is commonly used to slow tumor progression. However, reducing androgen (namely testosterone) levels can seriously impact quality of life for patients undergoing this treatment. Researchers from Germany presented data comparing the use of continuous androgen deprivation (CAD) therapy to intermittent androgen deprivation (IAD) therapy in these patients to compare both efficacy and patient tolerability between these two forms of hormonal treatment.

No statistically significant difference was seen in androgen-independent disease progression between the two groups. However, patients treated with IAD had an improved quality of life and fewer hot flashes than the CAD group indicating that IAD may be a more attractive treatment option for patients with PSA relapse after primary treatment.


Source: American Urological Association