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Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association.

PURPOSE: The American Urological Association convened the Prostate Cancer Clinical Guidelines Panel to analyze the literature regarding available methods for treating locally confined prostate cancer, and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1966 to 1993 on stage T2 (B) prostate cancer and systematically analyzed outcomes data for radical prostatectomy, radiation therapy and surveillance as treatment alternatives. Outcomes considered most important were survival at 5, 10 and 15 years, progression at 5, 10 and 15 years, and treatment complications. RESULTS: The panel found the outcomes data inadequate for valid comparisons of treatments. Differences were too great among treatment series with regard to such significant characteristics as age, tumor grade and pelvic lymph node status. The panel elected to display, in tabular form and graphically, the ranges in outcomes data reported for each treatment alternative. CONCLUSIONS: In making its recommendations, the panel presented treatment alternatives as options, identifying the advantages and disadvantages of each, and recommended as a standard that patients with newly diagnosed, clinically localized prostate cancer should be informed of all commonly accepted treatment options.

Humans↗

Health-related quality of life and cost-effectiveness studies in the European randomised study of screening for prostate cancer and the US Prostate, Lung, Colon and Ovary trial.

Decisions on policies for screening for prostate cancer require that information upon health-related quality of life (HRQL) and cost-effectiveness (CE) be available, as the lead time for some of the cases detected by screening will be very long and detriments in quality of life could have a major impact on the subjects remaining life-span. A framework within which both HRQL and cost-effectiveness of prostate cancer screening can be assessed is presented. Studies of both are ongoing in the European Randomised Study of screening for prostate cancer and the US Prostate, Lung, Colon and Ovary trial. Preliminary information confirms that it is important to study screened subjects and controls, and not to assume that inferences derived from study of prostate cancer outside screening trials can be extrapolated to the trials. However, it will require prolonged study to enable the overall effects on quality of life, and on cost-effectiveness to be determined. Such studies are ongoing for the two trials.

Colonic Neoplasms↗

Overall and disease-specific survival of patients with screen-detected prostate cancer in the European randomized study of screening for prostate cancer, section Rotterdam.

INTRODUCTION: This report describes survival data of participants of the European Randomized Study of Screening for Prostate Cancer (ERSPC), section Rotterdam, diagnosed with prostate cancer (pCA) during the first round of screening, the prevalence screen. PATIENTS AND METHODS: pCA characteristics from cases diagnosed during the first screening round from December 1993 to March 2000 are shown. During follow-up, data were collected by semiannual patient chart review for the first 5 yr and annually thereafter. The causes of death are scored according to the diagnosis of the treating physician and are not based on the review of the independent causes-of-death committee. Overall and disease-specific survival graphs are shown in Kaplan-Maier projections and compared with expected survival outcomes for males in the same age categories from the Dutch provinces of North Holland and Flevoland. Statistical evaluation was based on Cox regression analysis. RESULTS: During the prevalence screening, 1014 patients were diagnosed with pCA. Median follow up was 55 mo, 126 (12.4%) patients died, 20 (2.0%) of pCA. Overall 5-yr observed and expected disease-specific survival was 97.7% and 82%, respectively. In the multivariate analysis, a Gleason sum of 4+4 or higher (p=0.025) was predictive of pCA death. CONCLUSIONS: The observed survival data are in line with the literature and the expected favorable outcome for a screened population. The proportion of men dying from pCA is still small, and a 10-yr follow-up period for the final evaluation of the ERSPC may be too short.

Aged↗

Proprotein convertases regulate activity of prostate epithelial cell differentiation markers and are modulated in human prostate cancer cells.

Prostate derived factor (PDF) is a member of transforming growth factor-beta (TGF-beta) superfamily proteins involved in differentiation of the prostate epithelium. Proprotein convertases (PCs) such as furin are thought to mediate the processing of TGF-beta superfamily. In the present study, we demonstrated for the first time that human prostate cancer cell lines differentially synthesize and secret prostate derived factor (PDF), and that PDF secreted by LNCaP is processed by PCs. Exposure of LNCaP cells to the decanoyl-Arg-Val-Lys-Arg-chloromethylketone (CMK), a synthetic furin-like protease inhibitor, inhibited PDF processing and resulted in the loss of luminal cell phenotype and induction of basal cell phenotype in LNCaP cells as demonstrated by alternations in the expression of cytokeratins 8, 14, 18, and 19, markers of prostate epithelial cell differentiation. These results suggest that proprotein convertases may be involved in the regulation of prostate epithelial cell differentiation, and may be an important target of prostate cancer therapy.

Antigens, Differentiation↗

Radical prostatectomy for prostate cancer patients with prostate-specific antigen >20 ng/ml.

OBJECTIVE: Prostate cancer patients with prostate-specific antigen (PSA) >20 ng/ml are at high risk of progression after radical prostatectomy. Comparison has seldom been made between the outcomes of patients with PSA 20.1-50 ng/ml and those with PSA >50 ng/ml after radical prostatectomy. We retrospectively analyzed the outcomes of these two groups. METHODS: From 1993 to 2002, 60 prostate cancer patients receiving radical prostatectomy were enrolled in this study. Thirty-seven patients with PSA 20.1-50 ng/ml were assigned to Group I. Twenty-three patients with PSA >50 ng/ml were assigned to Group II. Preoperatively, Group II had greater PSA and PSA density than Group I (P < 0.0001). Group II had higher biopsy Gleason score and clinical stage than Group I (P < 0.05). Pathological categories and outcomes of both groups were compared. RESULTS: Group II had higher Gleason score and tumor volume than Group I (P < 0.05). The incidence of organ-confined diseases was 29.7% in Group I and 0% in Group II (P < 0.05). Group II had higher incidence of extracapsular tumor extension, positive surgical margin and lymph node involvement than Group I (P < 0.05). The incidence of postoperative PSA >0.01 ng/ml and PSA failure were higher in Group II than Group I (P < 0.05). Need for adjuvant treatment and death from prostate cancer was similar in both groups. CONCLUSION: Patients with PSA >50 ng/ml had a poorer prognosis than patients with PSA 20.1-50 ng/ml. Those with PSA >50 ng/ml had shorter freedom from PSA failure survivals than those with PSA 20.1-50 ng/ml (P = 0.004). Classification of high-risk prostate patients into two sub-groups with PSA 20.1-50 ng/ml and PSA >50 ng/ml should be considered.

Aged↗

Radioimmunodetection of prostatic cancer: in vivo use of antibody against r-seminoprotein for diagnosis of prostatic cancer.

Forty patients (25 cases of prostatic cancer and 15 cases of benign prostatic hyperplasia) were examined with radioimmunodetection (RAID) using antibody against r-Seminoprotein (r-Sm). The images of malignant tumor sites were revealed from the scan of single photon emission computerized tomography with the tracing of dual radionuclide and computer digital subtraction technique. Of the 25 patients with prostatic cancer tested, twenty-four were demonstrated in RAID with a positive rate of 96%. The ratio of taking in nuclide radioactivity between the tumor tissue and normal tissue (T/N) was 6.9 and the best showing time was the 96th hr from injection of radioactive antibody against r-Sm. The minimum diameter of the tumor detected in RAID was 0.5 cm. All of the 8 cases of metastatic prostatic cancer in pelvic or bone location were detected, with a rate of 100%. Of the 15 cases of benign prostatic hyperplasia, only one showed mild positive result. B-ultrasonography and CT showed a positive detective rate of 72.7% and 65%, respectively. Our results have indicated that RAID using 131I-labeled antibody against r-Sm possesses more advantages in specificity, because RAID not only defines the involved sites, but also shows the sites of the original tumors, and the metastatic location as well as the relationship between them.

Antineoplastic Agents↗

Enantiomerically pure [1, 2-diamino-1-(4-fluorophenyl)butane]platinum(II) complexes: synthesis and antitumor activity against MCF-7 and MDA-MB 231 breast cancer and LnCaP/FGC prostate cancer cell lines.

Enantiomerically pure 1, 2-diamino-1-(4-fluorophenyl)butanes were synthesized by stereoselective procedures. The enantiomeric purity was determined by (1)H NMR spectroscopy after derivatization with (1R)-myrtenal. For the coordination to platinum, the diamines were reacted with K(2)PtI(4). Reaction with Ag(2)SO(4) yielded the respective sulfatoplatinum(II) complexes, which were converted into the dichloroplatinum(II) complexes by treatment with 2 N HCl. The influence of the configuration and the kind of leaving group on the antitumor activity was studied on the MCF-7 and MDA-MB 231 breast cancer cell lines, as well as on the LnCaP/FGC prostate cancer cell line. It was demonstrated that the dichloroplatinum(II) complexes were more active than the respective diiodoplatinum(II) derivatives. Conversion into the sulfatoplatinum(II) complexes further enhanced the antiproliferative effects. The configuration determined the antitumor effects, dependent on the cell line used: MCF-7: (R, R) > (S, S) > (R, S) > (S, R); MDA-MB 231: (S, S) > (R, R) > (R, S) = (S, R); LnCaP/FGC: (S, S) > (R, R) > (R, S) > (S, R).

Antineoplastic Agents↗

Impact of race, age, income, and residence on prostate cancer knowledge, screening behavior, and health maintenance in siblings of patients with prostate cancer.

OBJECTIVE: This study evaluates self-reported changes in knowledge of prostate cancer (CaP), CaP screening behavior and other health-related activities in men whose brothers have been diagnosed with prostate cancer and to characterize those demographic subgroups of siblings at particular risk of failure to change their behavior. METHODS: 112 men were surveyed to self-assess their knowledge of CaP both before and after their brother's diagnosis. In addition, siblings were questioned with regard to other health-related behaviors before and after their brother's diagnosis. Demographic characteristics including age, race, income, and area of residence were also reported. Results were analyzed to determine how a brother's diagnosis with CaP affects changes in prostate cancer knowledge, screening behavior and other health related activities in these high-risk patients. RESULTS: The impact of a brother's diagnosis of CaP affects only 40% of siblings with regard to CaP knowledge. This knowledge appears to translate into increased screening behavior and other-health-related activity in these men. Unfortunately, more than half of men have no change in CaP knowledge and correspondingly no change in screening behavior. Siblings who are older, earn less, and live in rural areas have a lower baseline knowledge of CaP and are less likely to improve their self-assessed knowledge. On regression analysis, correlates of improvement in CaP knowledge included (1) those discussing with their primary physician (OR=6.6), (2) Caucasians (OR=2.7) and (3) non-smokers (OR=3.1). Improvements in prostate cancer knowledge were found to be predictive of subsequent participation in CaP screening and annual physical exams. CONCLUSIONS: Increased attention should be paid to siblings of CaP patients in efforts to improve their knowledge and thereby participation in screening as these patients are at an increased risk of development of this disease. Efforts should be made to educate siblings who are older, of lower income, African American, and rural residents with regard to CaP, as these subgroups appear less likely to change their knowledge and screening behavior despite their sibling's diagnosis.

Age Factors↗

Viewpoint: limiting prostate cancer screening.

Prostate cancer screening is controversial, and major professional associations offer differing screening guidelines. The author addresses 3 key issues about prostate cancer screening: 1) the prostate-specific antigen (PSA) criteria to recommend a prostate biopsy, 2) the appropriate age to start screening, and 3) the appropriate age to stop screening. The author argues, on the basis of evidence published since 2000, that data supporting the efficacy of PSA screening remain unconvincing. The author recommends that screening should not be expanded to include average-risk men younger than age 50 years or older than age 75 years and that a PSA threshold below 4.0 ng/mL should not be used to trigger biopsy referral.

Adult↗

Viewpoint: expanding prostate cancer screening.

Prostate cancer screening is controversial, and major professional associations offer differing screening guidelines. The authors address 3 key issues about prostate cancer screening: 1) the prostate-specific antigen (PSA) criteria to recommend a prostate biopsy, 2) the appropriate age to start screening, and 3) the appropriate age to stop screening. The authors argue, on the basis of evidence published since 2000, that data supporting the efficacy of PSA screening are convincing. They recommend screening for risk assessment for average-risk men beginning at age 40 years, screening selected healthy men older than age 70 years, and lowering the PSA threshold for considering biopsy to 2.5 ng/mL for all men.

Adult↗

Effect of dutasteride on the detection of prostate cancer in men with benign prostatic hyperplasia.

OBJECTIVES: To examine the rate of prostate cancer detection in three large randomized placebo-controlled benign prostatic hyperplasia trials of dutasteride. Dutasteride, which lowers serum dihydrotestosterone more than 93% by inhibiting type 1 and type 2 5-alpha-reductase, is effective in the treatment of benign prostatic hyperplasia. However, its effect on the development of prostate cancer is unknown. METHODS: A total of 4325 men with benign prostatic hyperplasia but without a history, or evidence, of prostate cancer, and a serum prostate-specific antigen level of 1.5 to 10 ng/mL, were randomized to 0.5 mg/day dutasteride or placebo for 24 months. The prostate cancer detection rates for subjects were determined by non-protocol-mandated biopsies, either during the double-blind phase of the study or during the first 3 months of the open-label extension. A follow-up questionnaire was administered to a subset of consenting subjects to ascertain the number, outcomes, and reasons for the prostate biopsies. RESULTS: The cumulative incidence of prostate cancer as an adverse event was significantly lower in the dutasteride versus placebo group at 24 months (1.1% versus 1.9%, P = 0.025) and 27 months (1.2% versus 2.5%, P = 0.002). There were no differences in the diagnosis rates of prostate cancer during the first 15 months, after which time the detection rate of prostate cancer increased in the placebo group and remained low in the dutasteride group. CONCLUSIONS: Prostate cancer detection was significantly lower in subjects randomized to dutasteride compared with the placebo group. These results have prompted the initiation of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study, which was designed and powered to test the hypothesis that treatment with dutasteride decreases the incidence and progression of prostate cancer.

5-alpha Reductase Inhibitors↗

[Genetic analysis of familial prostatic cancer: localization of a gene predisposing to prostatic cancer (PCaP) on chromosome 1q 42.2-43].

OBJECTIVES: To conduct genetic linkage analysis in order to localize predisposition genes for hereditary prostate cancer (CaP), as various epidemiological studies have demonstrated a family aggregation in 15 to 25% of cases, and the development of hereditary forms in 5 to 10% of cases of CaP. MATERIAL AND METHODS: A genetic study on 47 French and German families included 122 patients and 72 subjects considered to be healthy after PSA assay. This study was conducted by linkage analysis of 364 microsatellite markers distributed throughout the genome (on average every 10 cM). RESULTS: Parametric and nonparametric linkage analysis identified a locus on chromosome 1q 42.2-43, which could be with a gene predisposing to CaP (called PCaP). The primary site was confirmed by several markers, using 3 different genetic models. The maximum LOD score (probability of linkage between the locus and the disease) on two-point analysis was 2.7 for the D1S2785 marker. Parametric and nonparametric multipoint analysis provided an HLOD score and an NPL score of 2.2 and 3.1, respectively (with P = 0.001). Heterogeneity analysis with calculations of LOD scores by multipoint analysis estimated that up to 50% of hereditary CaPs were related to this locus, with a heterogeneity probability of 157/1. Analysis of a subgroup of 9/47 families characterized by early onset CaP (before the age of 60 years) confirmed the very high probability of localization of a predisposition gene at locus 1q42.2-43 for these families (multipoint LOD score and NPL score of 3.31 and 3.32, respectively; with P = 0.001). CONCLUSION: The identification of predisposition genes will eventually allow identification within certain families of those subjects who have inherited the genetic abnormality and who therefore present a high risk of CaP. It will then be possible to perform targeted screening of CaP in order to diagnose CaP as early as possible.

Adult↗

Permanent prostate brachytherapy in men with clinically localised prostate cancer.

Permanent prostate brachytherapy techniques are associated with excellent biochemical control for patients with localised prostate cancer. Ten-year data show that permanent prostate brachytherapy is compatible with external beam irradiation or radical prostatectomy. However, treatment protocols and techniques for prostate brachytherapy vary between centres and there is little conformity of treatment protocols. The selection of patients for monotherapy or combined external beam irradiation and brachytherapy is controversial. The role of neoadjuvant androgen deprivation also remains unanswered in patients with localised prostate cancer. In addition, post-implant dosimetry may in fact be more significant for predicting outcome than the addition of adjuvant therapies, and should be a requirement when performing prostate brachytherapy. Data now seem to support specific computed tomography (CT)-based criteria to evaluate implant quality and delivered dose to the prostate. Unfortunately, prostate oedema and poor imaging techniques are limiting factors for evaluating implant dosimetry. Treatment planning techniques that use new treatment planning computers may assist in improving the implant procedure and dosimetry and are now available.

Androgen Antagonists↗

Multiple primary cancers in association with prostate cancer.

Patients with prostate cancer are at a significant risk of either having a preceding tumour or developing a second malignancy. The precise mechanism by which second cancers develop is not clear but may be the result of exposure to a shared mutagen, abnormalities in oncogene activation or the aberrant expression of tumour suppressor genes. In the recent past, case reports and tumour registry studies on the risk of second cancer development have been important and have alerted the clinician that careful surveillance in this group of patients is required. More prospective hospital based studies are required to delineate the true risk of second malignancies in association with prostate cancer.

Age Factors↗

Imaging in the diagnosis and assessment of prognosis in localized prostate cancer. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

As part of a WHO consensus conference on diagnosis and prognostic parameters in localized prostate cancer, a working group of experts discussed the role of various modern imaging techniques. Special attention was focused on transrectal ultrasound (TRUS) in combination with biopsies, magnetic resonance imaging (MRI) using endorectal coil and recent advances in these techniques. Some experimental techniques, especially hormone receptor scintigraphy and positron emission tomography were also discussed and new results were presented. We concluded that MRI seems to be superior to other imaging techniques in the preoperative assessment of local tumor stage. TRUS defends its place in the diagnostic armament; it is easily combined with multiple biopsies, the results of which are important in the assessment of the biological aggressiveness of prostate cancer. The present development in the field of nuclear medicine may result in techniques for in vivo characterization of tumors and will most certainly have important implications for diagnosis of prostate cancer in the future.

Animals↗

Cyclin D1 gene polymorphism and familial prostate cancer: the AA genotype of A870G polymorphism is associated with prostate cancer risk in men aged 70 years or older and metastatic stage.

BACKGROUND: Cyclin D1 is a key protein involved in cell cycle regulation. A common A870G single nucleotide polymorphism in exon 4 of the cyclin D1 gene (CCND1) has an effect on the transcription of two different cyclin D1 mRNAs. Association of the genetic polymorphism of A870G of CCND1 with several cancer risks has been reported. MATERIALS AND METHODS: We performed a case-control study consisting of 99 familial prostate cancer cases and 115 noncancer controls to examine the genotypic frequency of the CCND1 polymorphism. RESULTS: We did not observe a significant association of the genotypic frequency of CCND1 with overall cases and controls. However, the AA genotype of CCND1 showed a tendency to increase prostate cancer risk in subjects aged 70 years or older (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 0.86-5.27, p = 0.096). Stratification of cases according to clinical stages showed that the AA genotype was significantly frequently observed in metastatic cancer in comparison with GG + AG genotypes (OR = 3.03, 95% CI = 1.11-8.23, p = 0.026). CONCLUSION: The present study suggested that the genetic polymorphism might be associated with familial prostate cancer risk in a Japanese population.

Aged↗

IFNalpha induces the expression of the cyclin-dependent kinase inhibitor p21 in human prostate cancer cells.

Prostate cancer, like other types of cancer, is associated with the loss of cell cycle control, resulting in unregulated growth of cells. We report here on the inhibitory effects of interferon alpha (IFN alpha) on the cell cycle of prostate cancer cells, using the human prostate carcinoma cell line DU145 that has mutations in the tumor suppressor genes pRB, p53 and KAI1. IFN alpha inhibited growth and colony formation of DU145 cells and analysis by flow cytometry suggests that IFN alpha inhibited the progression of these cancer cells from the G1 through S phase of the cell cycle. IFN alpha treatment of DU145 cells reduced cyclin dependent kinase 2 (cdk2) activity. In particular, cyclin E dependent cdk2 activity was inhibited by IFN alpha treatment. IFN alpha treatment, however, did not affect the amount of cdk2 bound to cyclin E. Consistent with this data, IFN alpha was able to induce expression of the kinase inhibitor p21 in DU145 cells. Furthermore, IFN treatment increased the amounts of p21 complexed with cdk2 in these cells. These data support a role for p21 in mediating the antiproliferative action of IFN alpha. The induction of p21 and its growth inhibitory effects in DU145 cells appears independent of p53, pRB and KAI1 status.

Antineoplastic Agents↗

Long-term results of Danish Prostatic Cancer Group trial 86. Goserelin acetate plus flutamide versus orchiectomy in advanced prostate cancer.

In a multicenter trial conducted by the Danish Prostatic Cancer Group, 264 patients with advanced prostate cancer were randomized either to undergo bilateral orchiectomy or to receive combination treatment with goserelin acetate and flutamide. This report is an update of that study, covering a median follow-up for survival of 57 months. Of 262 patients who were evaluated, 208 have died. As noted in earlier analyses of this study, no differences in time to progression and cause-specific and overall survival could be identified between the two treatment groups. In conclusion, the combination of goserelin and flutamide was not clinically superior to bilateral orchiectomy in the treatment of advanced prostate cancer.

Antineoplastic Combined Chemotherapy Protocols↗