New research supports early testing for prostate cancer

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 today 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 therapy of recurrent disease. A special session for media highlighting this research was held on May 20 at 9:00 a.m. PDT and was moderated by AUA spokesman Christopher L. Amling, M.D.

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, as per scientists 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 2 percent, 3 percent, 4 percent, 7 percent and 12 percent, respectively. Risk was highly concentrated, with 89 percent of advanced cancers occuring in men with the top 10 percent of PSA levels.

This abstract will be presented during Moderated Poster Session 59 on Wednesday, May 23 starting at 1:00 p.m.

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. Scientists reviewed 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 therapy with radical prostatectomy.

This abstract will be presented during Podium Session 29 on Monday, May 21 starting at 10:00 a.m.

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 therapy" To determine the best predictor of secondary therapy, scientists from the University of California, San Francisco (UCSF), examined demographic and clinical characteristics of men electing active surveillance.

The scientists 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 6-12 months and PSA measurements every three months to track progression. Scientists 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 percent 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.

This abstract will be presented during Podium Session 21 on Sunday, May 20 starting at 3:30 p.m.

OUTCOMES OF MEN MANAGED WITH WATCHFUL WAITING IN THE PSA FOLLOW-UP STUDY (Abstract 610)

There are a number of questions surrounding watchful waiting/active surveillance as an initial therapy for prostate cancer and whether outcomes vary from patients who elect a more aggressive therapy sooner after diagnosis. Scientists from Northwestern University, led by William Catalona, M.D., evaluated 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 therapy were followed with biannual PSA tests. Of this group, 36 percent showed evidence of biochemical progression and/or underwent secondary therapy. Overall mortality was 30 percent and disease-specific mortality was 8 percent. There were no deaths in the group electing secondary therapy while 8 died in the non-treatment group.

This abstract will be presented during Podium Session 21 on Sunday, May 20 starting at 3:30 p.m.

INTERMITTENT ANDROGEN DEPRIVATION IN PATIENTS WITH PSA-RELAPSE AFTER RADICAL PROSTATECTOMY FINAL RESULTS OF A EUROPEAN RANDOMIZED PROSPECTIVE PHASE III CLINICAL TRIAL (Abstract 600)

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

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 therapy option for patients with PSA relapse after primary therapy.

This abstract will be presented during Podium Session 20 on May 20 starting at 3:30 p.m.

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