Prostate news article, April 2009

LATEST NEWS FROM THE AMERICAN ASSOCIATION OF UROLOGY MEETING, APRIL 2009   Reported by:   Professor Roger Kirby, Chairman, Prostate UK

The American Urological Association (AUA) recently met in Chicago and now recommends that physicians start to offer the prostate-specific antigen (PSA) test to men at age 40 to screen for prostate cancer. Dr Peter Carroll, MD, of the University of California-San Francisco and chair of the AUA panel that produced the recommendation, explained the rationale for an earlier baseline test, saying that a PSA value above the median at a relatively young age portends an increased risk of prostate cancer. Following a baseline measurement, subsequent PSA testing should "then" be individualized to a man's risk profile.

A man's PSA value at age 60 reliably predicted the risk of fatal prostate cancer over the next 25 years, according to Memorial Sloan-Kettering Cancer Center researchers who analyzed data from the Malmo Prevention Project. The authors noted that of the 1,167 Swedish participants, 133 men (11.4 percent) developed prostate cancer during follow-up, and 31 men (2.7 percent) died of prostate cancer, with the median PSA value for the entire study group being 1.06 ng/mL. Investigators then found that men who had PSA values at or below the median at age 60 had a 0.3 percent risk of prostate cancer death by age 85, while the risk of dying of prostate cancer by age 85 increased to 1.5 percent in men whose PSA value was 1.5 ng/mL at age 60 (67th percentile). Moreover, prostate cancer mortality increased to 3.7 percent in men who had a PSA level of 2.1 ng/mL at age 60 (80th percentile).

Prostate cancer incidence decreased by 23 percent in high-risk men treated with dutasteride (Avodart), according to Washington University researchers who conducted the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial. REDUCE focused on men with an increased risk of prostate cancer by virtue of elevated PSA levels. In all, 8,200 men ages 50 to 75 from 250 sites in 42 countries were involved. Participants were randomized to dutasteride 0.5 mg/day or to placebo and followed for four years. Over the course of the trial, prostate cancer was diagnosed in 1,516 (22.5 percent) study participants and high-grade PIN [prostatic intraepithelial neoplasia] or ASAP in 621 (9.2 percent). Yet, placebo-treated patients had 857 cases of prostate cancer, compared with 659 in the dutasteride group. Specifically, during the first two years of REDUCE, the placebo group had a prostate cancer incidence of 17.2 versus 13.4 percent in the dutasteride group," and in the "final two years of the trial, prostate cancer incidence was 11.8 percent in the placebo group and 9.1 percent in the dutasteride arm.

A novel, experimental treatment vaccine improved the survival of men with advanced prostate cancer in the largest trial yet of immunotherapy, reported investigators employed by the Seattle-based biotech Dendreon. Now, the vaccine, known as Provenge [sipuleucel-T], is poised to become the first treatment to employ the immune system in the fight against cancer. Trial results were initially presented to the FDA in 2007, but the agency stated that it needed more evidence. So, the firm enrolled 512 men with advanced prostate cancer who had stopped responding to hormone-blocking treatments and who had few other treatment options. According to data presented at the AUA annual meeting, prostate cancer immunotherapy with sipuleucel-T...extended median survival by 4.1 months and improved four-year survival by 38 percent.