Late Breaking Developments In Transitional Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 10 Dec 2007 - 0:00 PDT

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UroToday.com - Three late breaking development papers were presented in the field of prostate cancer.

"Predicting the need for treatment among men with low grade, low stage prostatic cancer enrolled in a program of expectant management with curative intent"

Dr. Danil Markarove said that some CaP have a long natural history. These are with a Gleason score <7, <3 cores involved and <50% with cancer and a PSAD <0.1. They studied these patients on expectant management and delayed intervention with curative intent. They sought to identify variables that would select the truly indolent tumors from aggressive one. 75 patients with these entry criteria and 2 followup biopsies were reviewed. A nuclear morphometric model evaluated pathologic features on the biopsies and was compare to clinicopathologic criteria. The model had an AUC of 87% vs. 68% for clinicopathologic prediction. He summarized that nuclear morphometric modeling may be useful in preventing overtreatment of indolent CaP. Prospective validation is needed.

"Treatment outcome of immediate versus delayed hormone therapy in patients with lymph node metastases following radical prostatectomy"

Dr. Yves Fradet presented the level 1 evidence for adjuvant ADT for node positive CaP (the Messing trial). He sought to determine the relative benefits of early 1 year of ADT, early continuous ADT or delayed ADT until PSA failure. There were 50-80 patients per group. The adjuvant 1 year group and delayed ADT groups with stage N1 CaP were similar at 5 years. For stage N2 patients, the 5-year outcomes were also the same. While the risk of death from CaP is similar, the risk of death by other causes is greater in those receiving continuous ADT. This suggests long-term ADT is potentially linked to death from other causes.

"Image guided laser thermotherapy for focal ablation of prostate cancer"

Dr. John Trachtenberg reported on the GTx program that would treat low risk CaP with focal therapy to preserve QOL in addition to treating the tumor. Due to the multifocality of CaP, sequential therapy could then be performed. There is usually a predominant focus of tumor, and in patients with extra-capsular extension the predominant focus is the source in 86%. The predominant tumor site is identified by MRI and fused to US imaging in the OR to insert fibers for laser ablation. Real time monitoring of the ablation is performed. Microvessel ablation and real time coagulation assisted in the treatment monitoring. Six of 12 patients on an IRB approved protocol have been accrued to date, with preliminary data as follows. The mean volume of the treated lesions was 0.35cc and the mean ablation volume was 2.4cc. Further reports will be presented after accrual is complete. The imaging technology presented is very exciting. The focal therapy would likely be coupled with programs in chemoprevention and active surveillance.

Presented at the 8th Annual Meeting of the Society of Urologic Oncology (SUO) - November 29 - December 1, 2007. Natcher Conference Center, National Institutes of Health - Bethesda, Maryland.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD

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