Radical Prostatectomy, Radiotherapy and Hormonal Therapy
Reports From Dr. Catalonas Follow-up Studies
screening is widely used as an aid to early detection of prostate cancer. Early detection increases the opportunity for long-term progression-free survival. Presently, the selection of treatment for early stage prostate cancer involves four choices: radical prostatectomy, brachytherapy, external beam radiation therapy and hormonal therapy.
Prostatitis Confounds the Use of PSA Velocity for Prostate Cancer Detection
Dr. Catalona’s research projects in prostate cancer involve a group of doctors and scientists in institutions across the U.S.
Intro: PSA Velocity (PSAV, the rate of the rise of PSA value) has been used as a way to predict detection of prostate cancer upon biopsy.
In our study, we found that prostatitis (infection in the prostate) can cause dramatic increases in PSA that can confound the use of PSA or PSAV for prostate cancer detection.
?: Is there a relationship between the prostate cancer detection rate in relation to the PSAV in the year prior to biopsy? And how does prostatitis affect the relationship of PSAV to prostate cancer detection?
Study: We examined statistics on 1,797 men in a community-based prostate cancer screening trial who had a benign digital rectal exam, a measurable PSAV and a first biopsy in the years 1989-2000.
We looked at the ranges of their PSA velocity, their diagnosis of prostate cancer on the first biopsy and the probability of prostate cancer detection during the following two years.
The results were not as we had expected. There was a general trend for decreasing cancer detection rates on initial and follow-up biopsies and a corresponding trend for increasing prostatitis with rising PSAV, especially when the PSAV rose over 2ng/ml.
Conclusion: Men with a benign DRE and a PSAV over 2 ng/nl in the year prior to an initial prostate biopsy have a lower risk of prostate cancer on that biopsy and within the next two years than men with a lower PSAV.
Dramatic increases in PSA over a year (increases in 2 and over) can be caused by prostatitis and not by prostate cancer.
Prostatitis should be ruled out with antibiotic treatment and repeat PSA measurements before a biopsy.
Scott E Eggener, New York, NY; Kimberly A Roehl, St Louis, MO; Christopher Griffin, Chicago, IL; Ofer Yossepowitch, New York, NY; William J Catalona, Chicago, IL
Effect of Laser Vaporization for BPH On Prostate Cancer Detection
Intro: The GreenLight laser (photoselective vaporization) and the Holmium laser (HoLAP) are two treatment options currently available for treatment of urinary obstruction from benign prostatic hyperplasia (BPH). These treatments have been successfully used as less invasive alternatives to the traditional transurethral resection of the prostate (TURP).
Unlike a TURP, in which the resected tissue is available for pathological examination, after vaporization it is not possible to determine whether prostate cancer was present.
?: Could laser vaporization of the prostate for BPH (enlarged prostate) compromise prostate cancer detection because the resected tissue is destroyed?
Study: 902 men with a history of negative prostate biopsies for an elevated PSA level or a suspicious DRE were followed for 4 1/2 years after the initial biopsy.
Subsequent cancer detection was studied to see if prostate vaporization would have compromised this cancer detection for these men.
Of the 902 men with at least two negative biopsy procedures, 242 (27%) were later diagnosed with prostate cancer, at a median of 35 months after the initially negative biopsy.
Conclusion: Patients who are considering the laser vaporization treatment should be counseled that their risk of coexistent prostate cancer is substantial, even despite a history of prior negative prostate biopsy.
Prostate needle biopsies should be performed routinely before laser vaporization in men with a PSA of 2.5 or more or findings suspicious for cancer on a DRE.
Also transurethral resection biopsies should be considered at the time of the laser vaporization procedure to provide further sampling of the transition zone.
Shilajit D Kundu, Chicago, IL; Kimberly A Roehl, Saint Louis, MO; Stacy Loeb, Washington, DC; Sara Gashti, Norm Smith, Kevin T McVary, William J. Catalona, Chicago, IL
Progression-Free Survival Rates for Radical Prostatectomy in the PSA Era
Intro: In the PSA testing era, more than 90 percent of prostate cancers are detected in a clinically localized stage. Also evidence shows a trend to detect prostate cancer earlier.
?: How does the progression-free survival rate in the PSA testing era compare with that of the pre-PSA era?
Study: From 1992 to 2005, 3,459 men underwent a radical prostatectomy by a single surgeon. (Dr. Catalona)
In those men who had tumors with a Gleason score less than 7, 84% had a progression-free survival rate. Those with a Gleason score of 7 (and less than 8) had a 63% progression-free survival rate. And those with Gleason 8 to 10, had a 37% progression-free survival rate.
In the pre-PSA era, the progression-free survival rates using the same Gleason scores were: less than 7, 66%; 7 to less than 8, 49% and 8-10, 32%.
Conclusion: Overall, prostate cancer treated by radical prostatectomy in the PSA era has a low risk of recurrence at 10 years, particularly for patients with negative lymph nodes and a Gleason score of 7 or less.
Outcomes of patients treated with radical prostatectomy have improved in the PSA era.
Vic N Desireddi, Chicago, IL; Kimberly A Roehl, Saint Louis, MO; Stacy Loeb, Washington, DC; Xiaoying Yu, Christopher Griffin, Shalijit Kundu, Misop Han, William J. Catalona, Chicago, IL