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SUMMARIES OF SELECTED PRESENTATIONS MADE AT THE AUA ANNUAL MEETING HELD MAY 2008


Greetings to all my colleagues concerned with prostate issues!

I was recently invited by Robert Robinson, Editor of Health Extra, the AUA quarterly publication, to the American Urological Association (AUA) to attend their annual meeting where more than 11,000 urologists came to give and receive peer reviewed presentations covering research, studies and clinical trials data on all aspects of the field, with a decided portion dedicated to prostate cancer. The AUA is the main society for urologists and has more than 15,000 members 

I encourage you to read the contents of this site first. Then, for more information about the AUA  go to www.auanet.org  and you will find a wide variety of information, including the resources available to their members, such as the Journal of Urology as well as resources for patients in UrologyHealth.org.

Now, back to the AUA annual meeting. The first observation I must make is the zeal to improve diagnosis, detection and treatment was remarkable by any measure. High energy, thoughtful presentations and provocative intellectual debates were the rule. And, on the surface prostate cancer appears receiving good support from the industry, Government and private financial donors.

Also, while there Robert interviewed myself and Dr. Peter Carroll, Dean of Urology, UCSF Hospital, emphasizing how a positive and interdependent doctor patient relationship can contribute strongly to a successful outcome when fighting prostate cancer. Look for the interview in the summer issue of Health Extra, accessible at the AUA website.

I cannot possibly report to you even a modest portion of the information presented but did choose a few topics that have a reasonably broad section of applicability. You will view specific text and editorial comments where appropriate.

Please contact me if you want further elaboration on the subjects discussed and I will get you to the appropriate person.

BASELINE PSA READING A RELIABLE PROSTATE CANCER PREDICTOR UP TO 30 YEARS

“…Premalignant phases of prostate cancer occur over long periods of time and a single PSA reading taken at age 44-50 can help predict prostate cancer diagnosis up to 30 years subsequently, according to updated data from researchers in New York and Malmo, Sweden. The finding expands the previously established baseline age-to-diagnosis interval. Using data from a cohort of men under 50 who submitted blood samples for a cardiovascular study during 1974-1986, researchers examined records and found a greater delay in diagnosis of men who were younger at the time of the blood draw and baseline reading. Men in the original cohort had a mean age of 47 at the time of the blood draw. In this update the mean age was 45. The relationship between PSA and advanced cancer was stronger in this update that the original report. Findings suggest prolonged periods of prostate cancer pre-malignancy and that extra cellular PSA affects cancer development, or, carcinogenesis. The study also reaffirms the relationship between the carcinogenic process and PSA….” Lilja H, Scardino PT, Dahlin A, Bjartel A, Berglund G, et al.

WHICH IS THE MOST IMPORTANT RISK FACTOR FOR PROSTATE CANCER: RACE, FAMILY HISTORY, OR BASELINE PSA LEVEL?

“….African American men with a family history were unlikely to develop prostate cancer if their baseline PSA level was below the age-specific median. The National Comprehensive Network (NCC) currently recommends a baseline PSA at age 40, after which the screening protocol may be individualized based upon the relationship of this level to the age-specific median. Our results demonstrate that the effect of the baseline PSA level on future prostate cancer risk is so robust that the correlation holds true even for men with other significant risk factors. Thus, other organizations may similarly consider recommending a baseline PSA test at a young age for risk assessment….” D.M. Mondo, K.A. Roehl, S. Loeb, S Gashti, C. Griffin, N.Smith, R. Nadler, W. Catalona.

EDITORIAL COMMENT: The conclusion of these two presentations is neither race nor family history drive the age when a man should get his first PSA. Rather, the NCC is recommending all nine of the ‘authoritative’ prostate cancer organizations change the recommended age for first PSA from 50 to 40.

HIGHER COLESTEROL INCREASES THE RISK OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY

“….Poor cholesterol management may not only affect a man’s risk for prostate cancer but also his risk for biomedical recurrence after prostatectomy, according to new data from Duke University. Researchers identified 471 patients from the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent radical prostatectomy between 1998 and 2007 and found that those with a high level of low-density lipoprotein (LDL) cholesterol and those with increased serum cholesterol were up to 2.5 times more likely to experience a biomedical response…” “. …This study, along with other research that has linked obesity to prostate cancer, magnifies the importance of diet and exercise in achieving sound urological health. As many urologic conditions can be linked to cardiovascular problems, high cholesterol is a major concern and should be monitored…..” Banez LL, Hamilton RJ, Aronson WJ,  Terris MK, Presti JC, Kane CJ, etal.

EDITORIAL COMMENT: Amen….! They also said statins, cholesterol reducing drugs, should be considered but more research is necessary.

NEW DATA SHOW BENEFIT OF FINASTERIDE IN PREVENTING PROSTATE CANCER

 “….A comprehensive re-evaluation of the largest prostate cancer prevention study ever completed presented new findings suggesting that men and their doctors should consider a more aggressive approach that included finasteride to prevent the development of prostate cancer…” “….The original study, the Prostate Cancer Prevention Trial (PCPT) had randomized 18,822 men to receive an agent, either a placebo or an agent knows as finasteride, currently approved to control prostate growth, for seven years. Results showed while finasteride reduced prostate cancer risk by 25%, it appeared to increase development of more aggressive tumors ii some men. Because of this finding and concerns that tumors had low PSA values and might be of little risk to patients, since the studies original publication in 2003, few doctors have recommended finasteride. From a new analysis of PCPT data using advanced statistical modeling techniques and a complete assessment of prostate tissue biopsies, they concluded these concerns are now resolved: finasteride actually reduced the risk of developing prostate cancer more than researchers originally thought, did not increase development of more aggressive cancers and the majority of tumors prevented were those that could spread and cause death…” I.M. Thompson, Chair Urology, UT Health Sciences Center

EDITORIAL COMMENT: This report generated a lot of discussion. The debate over the suitability of finasteride has been continuing for so long, the original patent has expired and it is available in generic form. Some in the audience remain unconvinced so your urologist should be seriously involved in your final decision.

OUTCOMES FROM A PHASE 1 TRIAL OF AN ADENOVIRUS/PSA VACCINE FOR PROSTATE CANCER
 
EDITORIAL COMMENT: I do not have a press release so must paraphrase from this presentation. In a few words the gene for PSA is induced to be anti-PSA which can be further modified to become an anti-prostate cancer element. In the Phase 1 Trials 32 patients with advanced prostate cancer were injected. An anti-PSA response was observed in 34%. Also, T cell responses were seen in 68%. The PSA doubling time was slowed in 46% and, 55% survived longer than projected. The time varied from two to 47 months. With these results, Dr. David Lubaroff of the University of Iowa will move to Phase 2 where two groups will be segmented; one with early advanced prostate cancer and the other with late stage prostate cancer. Using a vaccine form the drug will be given a ‘fair shake’ by being used on people who are still treatable.

ADJUVANT RADIOTHERAPY FOR PT3 PROSTATE CANCER

EDITORIAL COMMENT: Beyond a simple press release I was able to get copies of the presentation. The issue addressed here is whether radiation soon after a radical prostatectomy improves the odds of survival, when the patient had some escape of cancer from the capsule. “…Adjuvant radiation reduces the risk of biochemical recurrence in men with advanced (pT3) disease, according to the latest data from Southwest Oncology Group trial 8794, a critically important, long term study. Findings are expected to affect 50,000 men annually and impact standards of care…” Gregory P. Swanson, Ian M. Thompson.

The slides showed the following data from 431 men 64-65 years old and split roughly in half for observation or radiation. Escape occurred in either extra capsular extension and or positive margin or seminal vesicles. The data is reproduced here in text format;

Metastasis-free survival by treatment arm Radiation Observation
Five years    86%    81%
Ten years    70%    60%
Fifteen years    49%    40%
(Improvement varies from 5% to 10% with radiation)

Survival by treatment arm   
Five years    90%    89%
Ten years    74%    66%
Fifteen years    50%    39%
(Improvement varies from 1% to 11% with radiation)

PSA relapse (>0.4ng/ml)
Five years    71%    44%
Ten years    52%     26%
(Improvement is in the range of 26-27% with radiation)