Men Have Regret Years after Prostate Cancer Treatment

Excerpt:

“After years of introspection, about 15% of men with localized prostate cancer regretted the decisions they made regarding treatment, a survey of almost 1,000 patients showed.

“About twice as many men expressed regret after radical prostatectomy or radiation therapy as compared with active surveillance. The single biggest contributor to regret was treatment-associated sexual dysfunction, as reported in the Journal of Clinical Oncology.”

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Does Efficacy Require Toxicity, or Is It Time to Reconsider Presurgical Endocrine Therapy for Estrogen-Receptor-Positive Breast Cancer?

Excerpt:

“Neoadjuvant endocrine therapy – designed to reduce the size of breast tumors before surgical removal – appears to be as effective as neoadjuvant chemotherapy for patients with localized, estrogen-receptor (ER)-positive breast cancer with considerably fewer side effects. The study conducted by a Massachusetts General Hospital (MGH) Cancer Center research team appears in the current print issue of JAMA Oncology and was published online earlier this year.”

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HYPRO: Shorter RT Course No Better, Worse in Localized Prostate Cancer

Excerpt:

“A randomized phase III trial found that a hypofractionated radiotherapy (RT) regimen was not superior to, but generally equivalent to a conventional RT scheme in men with localized prostate cancer. The study joins a growing body of literature on hypofractionation in this malignancy, generally showing that the shorter courses are a reasonable option.

“A low α-β ratio for prostate cancer has generated interest in hypofractionation, as it could increase the tumor dose without increasing toxicities. ‘Moreover, hypofractionated radiotherapy is delivered in fewer fractions, improving patients’ convenience, hospital logistics, and possibly reducing healthcare costs,’ wrote study authors led by Luca Incrocci, MD, PhD, of Erasmus Medical Center Cancer Institute in Rotterdam, the Netherlands.

“A study was presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago that found a hypofractionated regimen of 60 Gy in 20 fractions was noninferior to conventional RT. Another, presented this past January at the ASCO Genitourinary Cancers Symposium, again found a 60 Gy/20 fractions regimen was noninferior to conventional RT and to another hypofractionated regimen of 57 Gy/19 fractions.”

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ASCO: Combo Tx Fails in Local High-Risk Prostate Ca

Excerpt:

“Neoadjuvant enzalutamide (ENZA) and abiraterone acetate (AA) plus 5 mg prednisone daily can be given safely for 6 months in men with localized high-risk prostate cancer prior to prostatectomy, a neoadjuvant study showed.

“However, the findings did not favor adding ENZA to augment AA plus leuprolide acetate (LHRHa) efficacy in localized high-risk prostate cancer, Eleni Efstathiou, MD, PhD, of the University of Texas MD Anderson Cancer Center, in Houston, said during a presentation at the American Society of Clinical Oncology.

“Pathologic downstaging (≤ pT2N0) occurred in 30% of patients treated with the combination therapy (AA+ENZA+ LHRHa) versus 52% of patients who received AA plus LHRHa alone (P=0.07), the study showed. Despite universal PSA depletion (≤ 0.1), a wide range of viable tumor was observed (volume 0-8.64 cc, cellularity 0-90%, and a tumor epithelial volume [TEV] 0-5.58 cc). TEV and stage were aligned.”

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Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”


Survival Rates for Patients with Prostate Cancer Better with Surgery Vrs Radiotherapy

“A rigorous evaluation of survival rates has shown that cancer patients with localised prostate cancer—the most common form of prostate cancer—have a better chance of survival if treated by surgery than by radiotherapy. These findings hold true even after accounting for type of radiation and the aggressiveness of cancer. This is the most robust analysis (meta-analysis) to date of published literature comparing surgery and radiotherapy for localised prostate cancer. The study is published in the peer-reviewed journal, European Urology.

“According to senior author, Dr Robert Nam (Odette Cancer Centre, Sunnybrook Research Institute, University of Toronto, Canada):

” ‘In the past, studies that have compared the success rates of or radiation have been confusing because of their methods. We have evaluated all the good-quality data comparing surgery and , and the results are pretty conclusive; in general, surgery results in better mortality rates than radiotherapy. Nevertheless, there are times when radiotherapy may be more appropriate than surgery, so it is important that a patient discusses treatment options with his clinician.’ “


FDA Approves Ablatherm HIFU Treatment for Prostate Cancer

“The FDA has fully approved the Ablatherm high-intensity focused ultrasound device for the nonsurgical and noninvasive treatment of localized prostate cancer, according to a press release from the device’s manufacturer.

“Ablatherm high-intensity focused ultrasound (EDAP TMS), or Ablatherm HIFU, is recommended for men with localized prostate cancer (stages T1-T2) who are not candidates for surgery, who prefer an alternative option or who failed radiotherapy treatment.

“The device targets the tumor via a computer-controlled rectal probe. Ultrasound waves are intended to destroy the prostate tissue while sparing surrounding organs. Data have indicated the device is effective for prostatic tissue ablation with a low occurrence of side effects, according to the press release.”


Men's Health Supplements Fail to Improve Prostate Cancer Outcomes

“Using men’s health supplements did not help prevent distant metastases, cancer-related death or adverse events among men undergoing definitive radiation therapy for localized prostate cancer, according to the results of a retrospective study presented at the ASTRO Annual Meeting.

“ ‘Around 50% of the patients we see are on any kind of supplement,’ Nicholas G. Zaorsky, MD, resident physician in radiation oncology at Fox Chase Cancer Center, told HemOnc Today. ‘At least 10% are on men’s health supplements. We wanted to understand whether these supplements actually made a difference in terms of outcomes or side effects.’

“The researchers defined men’s health supplements as supplements specifically labeled and marketed with the terms ‘men’s health’ or ‘prostate health.’ These supplements are frequently labeled as having potential anticancer benefits, although no associations have been proven, according to the researchers.”


ASCO 2015: Notable Reports on Prostate Cancer Treatment


This year’s American Society of Clinical Oncology (ASCO) annual meeting was short on any truly exciting developments in prostate cancer treatment. In stark contrast to other cancers, such as lung, breast, kidney, and melanoma, there were no reports of note on targeted and immunotherapies in prostate cancer. The two presentations summarized here offered new strategies in chemotherapy. Continue reading…