UroToday.com - At present, no consensus exists on how patients with PSA recurrence after radical prostatectomy (RP) should be treated. Although patients with postoperative PSA recurrence frequently undergo androgen deprivation therapy (ADT) before evidence of metastatic disease, the benefit of this approach is uncertain. As no randomized studies are performed in this clinical setting there is no conclusive evidence that hormone therapy (HT) after RP will prolong survival or reduce morbidity.

Today, three randomized studies have evaluated the effect of adjuvant HT after RP in clinical settings other than PSA recurrence [1-4]. Survival advantage of immediate ADT after RP has only been proven in patients with positive lymph node prostate cancer in a single randomized study [1, 2]. Several retrospective analyses have been performed on the use of immediate and delayed HT in patients with surgically managed lymph node positive prostate cancer. However, to date no recommendations can be made regarding the optimal timing and duration of adjuvant HT after RP. Whether these data of adjuvant HT after RP in other clinical settings are relevant to men with rising postoperative PSA levels is uncertain.

In the meantime we can only rely on the data of 3 retrospective studies including patients with postoperative PSA recurrence who received HT after RP. One study demonstrates that early ADT after PSA recurrence does not affect clinical-metastasis-free survival in the overall cohort of patients but can delay the onset of metastases in high-risk patients with Gleason score > 7 and/or PSADT ? 12 months [5]. A recent study from the Mayo Clinic shows that adjuvant ADT (within 90 days after surgery) after RP results in modest improvements of cancer-specific survival and systemic progression-free survival in a large cohort of high-risk patients. However, the survival advantage is lost when ADT is delivered at the time of PSA recurrence or systemic progression [6]. Another retrospective study demonstrates that even deferred ADT at the time of documented metastases after RP can result in long survival with a median failure time of 168 months from RP to death [7]. We should take into account that these studies are limited by their retrospective design. Moreover, early ADT may unnecessarily expose many patients with prostate cancer to the side effects of therapy.

Evidence from prospective randomized studies is needed before recommending the use of early hormone ADT in patients with PSA recurrence. Other non-traditional hormonal approaches and combinations of HT with radiotherapy and/or chemotherapy are currently under study.

References:

1. Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 1999; 341(24): 1781-1788.
2. Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G et al. Immediate versus deferred androgen deprivation treatment in patients with node positive prostate cancer after radical prostatectomy and pelvic lymhadenectomy. Lancet Oncology 2006; 7: 472-479.
3. Wirth MP, Weissbach L, Marx FJ, Heckl W, Jellinghaus W, Riedmiller H et al. Prospective randomized trial comparing flutamide as adjuvant treatment versus observation after radical prostatectomy for locally advanced, lymph node-negative prostate cancer. Eur Urol 2004; 45(3): 267-270; discussion 270.
4. McLeod DG, Iversen P, See WA, Morris T, Armstrong J, Wirth MP. Bicalutamide 150 mg plus standard care vs. standard care alone for early prostate cancer. BJU Int 2006; 97(2): 247-254.
5. Moul JW, Wu H, Sun L, McLeod DG, Amling C, Donahue T et al. Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol 2004; 171(3): 1141-1147.
6. Siddiqui SA, Boorjian SA, Inman B, Bagniewski S, Bergstralh EJ, Blute ML. Timing of androgen deprivation therapy and its impact on survival after radical prostatectomy: a matched cohort study. J Urol 2008; 179(5): 1830-1837; discussion 1837.
7. Makarov DV, Humphreys EB, Mangold LA, Carducci MA, Partin AW, Eisenberger MA et al. The natural history of men treated with deferred androgen deprivation therapy in whom metastatic prostate cancer developed following radical prostatectomy. J Urol 2008; 179(1): 156-161; discussion 161-152.

Written by H.Van Poppel, MD et al. as part of Beyond the Abstract on UroToday.com

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Journalist, Malini Guha, has won the prestigious new Advances in Renal Cancer Journalists’ Award - Europe for her article “New Advances Deliver Fresh Hope in Kidney Cancer” - which was published in Scrip World Pharmaceutical News on February 13th 2009.

The award was presented by the esteemed Association of German Medical Journalists (VDMJ) at this month’s Fourth European International Kidney Cancer Symposium in Berlin.

In her article, Malini Guha - Science Editor at Scrip - provides a concise and informative review of the current options and prospects of success in the treatment of renal cell carcinoma. “It is a great honour to be the first-ever recipient of this award,” says Malini. “My article focused on the significant progress made in the treatment of kidney cancer in recent years and also examined the outlook for other approaches which may further improve patient outcomes.”

The jury - comprising Professor Peter Mulders, Department of Urology, University Medical Center St Radboud, Nijmwegan in the Netherlands; Dr Bernard Escudier, Institut Gustave Roussy, Villejuif in France; and Torsten Hoffman, President of the VdMJ, Stuttgart in Germany - evaluated submissions from print media and were highly complimentary of Malini’s work.

The panel said: “The article comes across as both scientifically accurate and clearly comprehensible, aiming to give interested readers the necessary information on the latest research into treatment in this indication in a manner that is comprehensive and yet not overtaxing.

“Guha’s writing adheres to the guiding principle of medical journalism: ‘do not stir up anxiety and do not raise unreasonable hopes.’ The article is a testament to the detailed investigative work conducted by Malini Guha herself at research centers, hospitals and amongst specialist oncologists. This, too, is a mark of good journalistic practice. Furthermore, the journalist’s own personal interest in the subject matter also contributes to the success of this commendable publication.”

“We are delighted that Malini’s work has been recognised so publicly in the form of this highly prestigious award,” says Phil Jarvis, Publisher of Scrip World Pharmaceutical News. “It is a testament to her talent, hard work and vast knowledge of the subject matter and we are extremely proud to have published her work in Scrip.”

The Advances in Renal Cancer Journalists’ Award - Europe was sponsored by Bayer Healthcare AG and was presented to Malini Guha on May 8th, 2009.

Source
Scrip World Pharmaceutical News