Genitourinary Cancers

Most men diagnosed with prostate cancer are more than 65 years of age. Therefore, a discussion of the issues surrounding the diagnosis, prevention, and treatment of prostate cancer in older men is, in many ways, a review of

Most men diagnosed with prostate cancer are more than 65 years of age. Therefore, a discussion of the issues surrounding the diagnosis, prevention, and treatment of prostate cancer in older men is, in many ways, a review of

ST. LOUIS-Three-dimensional (3D) conformal radiation therapy is being widely used for treatment of prostate cancer and has been successful at reducing rectal toxicities. "Conformal radiotherapy has allowed dose escalation with acceptable or even reduced rates of severe morbidity," Jeff M. Michalski, MD, reported. He added, however, that "we have to start paying attention to the low-grade morbidity. Grade 1 and grade 2 toxicity may predict development of severe late complications." Dr. Michalski is assistant professor of radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis.

DETROIT-Intrarectal topical application of amifostine (Ethyol), given as a "mini-enema," is extremely tolerable, produces no systemic toxicity, and may be an alternative to systemic administration for preventing rectal damage in patients undergoing radiotherapy for prostate cancer. Results of a phase I study were reported by Edgar Ben-Josef, MD. He is associate professor in the Department of Radiation Oncology at Wayne State University’s Karmanos Cancer Institute in Detroit.

SAN FRANCISCO-Atrasentan (ABT-627), an investigational endothelin-A receptor antagonist made by Abbott Laboratories, appears to delay clinical progression, PSA progression, and bone progression in hormone-refractory prostate cancer patients, according to phase II clinical trials presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO).

SAN FRANCISCO-Oral sodium clodronate appears to have delayed progression of bone metastasis from prostate cancer in a randomized clinical trial, although the results did not reach statistical significance. British investigator David Dearnaley, MD, presented the preliminary results on behalf of the Medical Research Council (MRC) Clinical Trials Unit at the 37th Annual Meeting of the American Society for Clinical Oncology (ASCO) in San Francisco.

Metastatic spinal disease is common in patients with prostate cancer. Spinal metastases may be asymptomatic (identified during staging) or cause pain and other neurologic signs and symptoms. In approximately 30% of prostate cancer patients,

Metastatic spinal disease is common in patients with prostate cancer. Spinal metastases may be asymptomatic (identified during staging) or cause pain and other neurologic signs and symptoms. In approximately 30% of prostate cancer patients,

Prostate cancer metastasis to the spine is an extremely difficult clinical problem to treat. However, it occurs commonly, and all clinicians-not only oncologists-should undertake to understand its pathogenesis, diagnosis,

ANAHEIM, California-In a study of advanced prostate cancer patients, use of the investigational bisphosphonate zoledronic acid (Zometa) led to significantly fewer skeletal-related events associated with bone metastases (including radiation therapy for pain relief) than did placebo, according to data presented at the Society of Urologic Oncology meeting, held in conjunction with the 96th Annual Meeting of the American Urological Association.

SAN FRANCISCO-High levels of a protein that normally prevents tumor growth may actually encourage angiogenesis and the spread of prostate cancer, according to a poster presented at the 40th Annual Meeting of the American Society for Cell Biology.

BETHESDA, Md-Rapid advances in managing prostate cancer over the last decade have created dilemmas for clinicians as they attempt to determine which treatment is best for each patient, said Patrick Walsh, MD, director, Department of Urology, Johns Hopkins University School of Medicine. Such dilemmas will not be resolved fast enough through randomized trials, he said.

Drs. Vaughn and Malkowicz have provided us with a succinct, thorough, evidence-based overview of the current role of chemotherapy in advanced bladder cancer. Their discussion highlights the veritable explosion of new chemotherapy agents

Drs. Vaughn and Malkowicz provide a fairly extensive and balanced review of chemotherapy for metastatic bladder cancer. They highlight the results obtained with some of the most commonly employed regimens that have been evaluated

BETHESDA, Md-Thalidomide (Thalomid) appears to inhibit angiogenesis (the recruitment of new blood vessels by the tumor). Clinically, thalidomide has been shown to lower PSA levels in some patients with androgen-independent prostate cancer. Using an LNCaP in vitro model, thalidomide has been shown to slightly increase the amount of PSA per cell number. "Some drugs appear to upregulate the expression of PSA and some downregulate it," William Dahut, MD, of the National Cancer Institute, said at an NCI conference on urologic oncology. This is clearly the case for carboxyamidotriazole (CAI) and TNP-470, both angiogenesis inhibitors, he said. CAI has been shown to downregulate PSA, whereas TNP-740 upregulated it.

Invasive bladder cancer is a chemotherapy-sensitive neoplasm. Historically, the development of cisplatin (Platinol)-based chemotherapy regimens has represented an important advance for patients with metastatic

NEW YORK-Expression of prostate-specific antigen (PSA) in the messenger RNA (mRNA) of pelvic lymph nodes appears to be a promising marker for occult micrometastases in patients with localized prostate cancer, said Anna C. Ferrari, MD, assistant professor, Medical Oncology Associates of the Derald R. Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York.

The report by Hanks and colleagues examines two controversial issues that are related to the treatment of prostate cancer with external-beam radiotherapy: (1) the outcome of younger vs older men, and (2) the relative risk of relapse with follow-up beyond 5 years. The findings of their study are important not only in addressing these points, but also because they shed light on another concern often raised by urologists.

In this issue of ONCOLOGY, Dr. Hanks further establishes his legacy by leading the charge for radiotherapy as the treatment of choice in men with clinically localized prostate cancer. Most urologists and some radiation oncologists tend to consider

A study was undertaken to evaluate the question of cure in "young" men with prostate cancer treated by external-beam radiation. Results in young men (£ 65 years) were compared to older men. Biochemical freedom from failure was examined to 10 years’ follow-up, and hazard functions for failure vs time were reported. Results show that prostate cancer patients are cured by external-beam radiation and that there is no difference in results for young or older men. Few failures occur after 5 years’ follow-up and the percentage cured is similar to that with prostatectomy, with much less morbidity. Appropriate dose is necessary to optimize outcome. [ONCOLOGY 15(5):563-574, 2001]

BETHESDA, Md-Prostate cancer researchers at the University of California, San Francisco (UCSF) are focusing on GM-CSF, dendritic cells, and anti-VEGF antibodies, Eric Small, MD, said at a conference sponsored by the National Cancer Institute and the Society of Urologic Oncology. Dr. Small is associate professor of medicine and of urology and co-director of the UCSF/Mt. Zion Urologic Oncology Program.

A new bill called the Men’s Health Act of 2001 aims to focus more attention on diagnosing and treating men with prostate cancer. Rep. Randy Cunningham’s (R-Calif) Men’s Health

BOSTON-Men are far more likely to be diagnosed with prostate cancer today than 2 decades ago, and they have more aggressive treatment options. Is their chance of dying of the disease dropping as a result? It is too early in the era of prostate-specific antigen (PSA) testing to tell, keynote speaker Michael J. Barry, MD, said at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology .

BOSTON-A combination of transurethral resection (TUR) and radiochemotherapy with cisplatin (Platinol) and fluorouracil (5-FU) produced the most promising results in a German study of bladder-sparing protocols for patients with invasive bladder cancer.

BOSTON-Investigators at Johns Hopkins University School of Medicine are testing a common cold virus as a vector for gene therapy against prostate cancer, Theodore L. DeWeese, MD, reported at the 42nd annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO). The therapy was found to be safe, and the technique showed signs of antitumor activity in a phase I trial.

Prostate cancer is now the most commonly diagnosed noncutaneous neoplasm in men.[1] While there are many questions of profound clinical significance related to the management of this neoplasm, few are as critical as those regarding the limitations of current imaging modalities for clinicians involved in the management of these patients. As such, the thorough, if somewhat depressing, overview of the current status of imaging in prostate cancer by El-Gabry et al provides timely insight into both where we are and where we need to go.

Various treatment options are available for adenocarcinoma of the prostate-the most common malignant neoplasm among men in the United States. To select an optimum management strategy, we must be able to identify an organ-confined disease (in which local therapy such as surgery or radiation may be beneficial) vs prostate cancer beyond the confines of the gland (for which other treatment approaches may be more appropriate). At present, no standard imaging modality can by itself reliably diagnose and/or stage adenocarcinoma of the prostate. Standard transrectal ultrasound, magnetic resonance imaging (MRI), computed tomography, bone scans, and plain x-ray are not sufficiently reliable when used alone. Fortunately, advances in imaging technology have led to the development of several promising modalities. These modalities include color and power Doppler ultrasonography, ultrasound contrast agents, intermittent and harmonic ultrasound imaging, MR contrast imaging, MRI with fat suppression, MRI spectroscopy, three-dimensional MRI spectroscopy, elastography, and radioimmunoscintigraphy. These newer imaging techniques appear to improve the yield of prostate cancer detection and staging, but are limited in availability and thus require further validation. This article reviews the status of current imaging modalities for prostate cancer and identifies emerging imaging technologies that may improve the diagnosis and staging of this disease. [ONCOLOGY 15(3):325-342, 2001]

BOSTON-One year after prostate cancer treatment, men who had radiation therapy were more likely to be able to maintain an erection than those who had radical prostatectomy, according to a study presented at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

NEW YORK-Among prostate cancer patients with biochemical evidence of relapse after radical surgery, exisulind, a selective apoptotic antineoplastic drug, had a significant impact on rising PSA levels in a double-blind, placebo-controlled study, according to a report at the Chemotherapy Foundation Symposium XVIII.

BOSTON-Raising 3D conformal radiation therapy doses for localized prostate cancer produced far less toxicity than expected in a nine-center cooperative study reported at the annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).