Newer Prostate Cancer Treatment Similar to Traditional Surgery
By Amanda Gardner
12 may 2008-- Clinical practice may be trumping science when it comes to treatments for prostate cancer.
According to a new study, many patients are getting a newer, minimally invasive surgery, because they think it is better than conventional surgery, even though there is little data on actual differences in outcomes between the two.
"Patients are choosing and/or being directed towards treatments without fully understanding how much experience there is with the treatment in general, how much experience their particular physician might have doing a particular treatment, and how that compares to other options out there," said Dr. Ronald D. Ennis, director of radiation oncology at St. Luke's Roosevelt Hospital, Continuum Cancer Centers of New York.
The study, appearing in the May 10 issue of the Journal of Clinical Oncology, found that minimally invasive radical prostatectomy (MIRP) tended to involve fewer complications and shorter hospital stays but a higher risk of needing additional treatment and of experiencing incontinence.
The risks, however, tended to decrease the more experience a surgeon had under his or her belt.
"This reaffirms what many other manuscripts have shown, if you go to an individual who has experience, who does this on a consistent basis, your outcomes will be better," said Dr. Ihor S. Sawczuk, chief of urologic oncology for the Cancer Center at Hackensack University Medical Center, in New Jersey. "If you go to someone who does 20 to 50 procedures a year, that's better than somebody who only does two to three a year."
Men diagnosed with prostate cancer, the second leading cancer killer in males, are presented with a maze of treatment options.
Radical prostatectomy, which is surgery to remove the prostate and some surrounding tissue, is currently the most common treatment in the United States. Men can choose between a minimally invasive procedure (introduced in 2000, which includes both robotic surgery and conventional laparoscopic surgery) or traditional surgery, which, these days, still involves only a small incision.
Surprisingly, use of MIRP, still a new procedure, nearly tripled during the time this study was conducted, from 12.2 percent of procedures in 2003 to 31.4 percent in 2005. This happened despite scant evidence on how MIRP compared with more traditional surgery, the investigators stated.
The reason for this quick adoption, said study author Dr. Jim Hu, director of minimally invasive urologic oncology at Brigham and Women's Hospital/Dana-Farber Cancer Institute in Boston, is heavy direct-to-consumer advertising. "A lot of people are jumping the gun before any studies are out," he said. "And the studies that are out are from high-volume, single-center hospitals or academic institutions rather than what's going on nationwide."
This study involved 2,702 men undergoing one or the other procedure between 2003 and 2005, all of them Medicare beneficiaries.
MIRP was associated with fewer perioperative complications than open radical prostatectomy (29.8 percent versus 36.4 percent, respectively) and shorter hospital stays (1.4 versus 4.4 days).
This was noteworthy, the authors stated, because a greater proportion of older men and those with other health problems chose minimally invasive surgery over open radical prostatectomy. These men would automatically be at higher risk for complications.
But, 27.8 percent of men undergoing MIRP needed salvage therapy (hormone therapy or external-beam radiotherapy) within six months of the surgery, compared with only 9.1 percent of those undergoing the more traditional surgery.
And this procedure was associated with a higher risk of scar tissue, which can lead to incontinence and the need for further surgery.
The study did not look at staging and scoring of the tumor, meaning that some of the differences seen might be due to differences in disease rather than in surgical quality, Sawczuk said.
On the other hand, outcomes between the two procedures were more equal when MIRP was performed by surgeons with greater experience. But studies have shown that surgeons may need to perform as many as 150 procedures to duplicate the results of open surgery and as many as 300 to feel comfortable, Hu said.
"This is relatively new, and patients are all excited about it and, as a result of increased demand, the suppliers or surgeons want to rush and give patients what they want, but this is definitely something where a lot of practice is needed," Hu said.
Showing posts with label prostate cancer treatment. Show all posts
Showing posts with label prostate cancer treatment. Show all posts
Monday, May 12, 2008
Saturday, May 03, 2008
Complications Found in Proposed Prostate Cancer Treatment
03 may 2008-- The idea that prostate cancer can be treated successfully just by blocking the activity of a protein called insulin-like growth factor (IGF-1) has been undermined by two new studies.
IGF-1 blockage is a goal being pursed by a number of drug companies and academic researchers, stimulated by studies showing an association between high levels of the protein and prostate cancer risk. Many efforts are aimed at blocking the receptors for IGF-1 in prostate cancer cells.
The new studies showing that blocking IGF-1 receptors isn't as simple a matter as might be wished are published back to back in the May 1 issue of Cancer Research.
One of the studies, by a group led by Norman Greenberg, a member of the clinical research division at the Fred Hutchinson Cancer Research Center in Seattle, found an unexpected interaction with a tumor suppressor gene, p53. The researchers created mice whose prostate cells lacked receptors for IGF-1 and crossed them with mice whose P53 gene function was crippled.
"When the function of p53 is abrogated, the cancers seem to accelerate," Greenberg said. "So when you interfere with the IGF-1 receptor, you might be taking the foot off the brake."
That wouldn't matter in human males whose p53 genes were working properly, Greenberg said. "What we are suggesting is that when p53 is compromised, patients might not respond as indicated," he said.
This might mean that a check of p53 function in someone with prostate cancer might be needed before IGF-1 blockage therapy is started, Greenberg said. That idea has to be checked out, he said.
"So we would get data on a patient's tumor before treatment and after treatment, and see if the status of p53 shows whether it would respond more or less to IGF-1 treatment," Greenberg said.
The other study, this one led by Dr. Pinchas Cohen, chief of pediatric endocrinology at the University of California, Los Angeles, also used mice bred to develop prostate cancer, with some also bred to lack IGF-1 receptors.
"The conventional wisdom was that without the IGF receptors, the tumors would fail to develop or be much smaller," Cohen said. "What happened was that they were not reduced in size. In fact, they were exactly the same size."
Low IGF-1 levels in the mice were accompanied by higher levels of growth hormone and insulin, which stimulated growth of the cancer cells, Cohen said.
"This doesn't argue against IGF-1 blockage as a treatment," he said. "But it shows the need for targeting multiple pathways. As the cancers find ways to overcome IGF-1 blockage, it should be used in conjunction with other therapies."
03 may 2008-- The idea that prostate cancer can be treated successfully just by blocking the activity of a protein called insulin-like growth factor (IGF-1) has been undermined by two new studies.
IGF-1 blockage is a goal being pursed by a number of drug companies and academic researchers, stimulated by studies showing an association between high levels of the protein and prostate cancer risk. Many efforts are aimed at blocking the receptors for IGF-1 in prostate cancer cells.
The new studies showing that blocking IGF-1 receptors isn't as simple a matter as might be wished are published back to back in the May 1 issue of Cancer Research.
One of the studies, by a group led by Norman Greenberg, a member of the clinical research division at the Fred Hutchinson Cancer Research Center in Seattle, found an unexpected interaction with a tumor suppressor gene, p53. The researchers created mice whose prostate cells lacked receptors for IGF-1 and crossed them with mice whose P53 gene function was crippled.
"When the function of p53 is abrogated, the cancers seem to accelerate," Greenberg said. "So when you interfere with the IGF-1 receptor, you might be taking the foot off the brake."
That wouldn't matter in human males whose p53 genes were working properly, Greenberg said. "What we are suggesting is that when p53 is compromised, patients might not respond as indicated," he said.
This might mean that a check of p53 function in someone with prostate cancer might be needed before IGF-1 blockage therapy is started, Greenberg said. That idea has to be checked out, he said.
"So we would get data on a patient's tumor before treatment and after treatment, and see if the status of p53 shows whether it would respond more or less to IGF-1 treatment," Greenberg said.
The other study, this one led by Dr. Pinchas Cohen, chief of pediatric endocrinology at the University of California, Los Angeles, also used mice bred to develop prostate cancer, with some also bred to lack IGF-1 receptors.
"The conventional wisdom was that without the IGF receptors, the tumors would fail to develop or be much smaller," Cohen said. "What happened was that they were not reduced in size. In fact, they were exactly the same size."
Low IGF-1 levels in the mice were accompanied by higher levels of growth hormone and insulin, which stimulated growth of the cancer cells, Cohen said.
"This doesn't argue against IGF-1 blockage as a treatment," he said. "But it shows the need for targeting multiple pathways. As the cancers find ways to overcome IGF-1 blockage, it should be used in conjunction with other therapies."
Tuesday, June 05, 2007
Doctors biased in prostate cancer treatment: study
The type of prostate cancer treatment a man gets has a lot to do with the kind of specialist he sees first, according to a study released on Monday that lends scientific evidence to something many men have likely guessed.
Prostate cancer can be treated effectively using radiation, radioactive seeds or surgical removal of the prostate. Surgery or drugs to stop production of testosterone, known as hormone therapy, may also be used in high-risk patients.
Doctors often also advise close medical observation, also known as watchful waiting.
Each treatment is associated with different benefits and side effects. Prostate surgery can cause urinary incontinence and erectile dysfunction; radiation therapy can cause diarrhea and erectile dysfunction; and hormone therapy can cause hot flashes and breast tenderness.
"You want your physician to convey this information without a bias," Dr. Thomas Jang, a urologist from Memorial Sloan-Kettering Cancer Center in New York, said at the annual meeting of the American Society of Clinical Oncologists.
Although the 5-year survival rate for men with localized prostate cancer is nearly 100 percent, it is the third most common cause of cancer death in men of all ages, and the most common cause of cancer death in men over 75.
No scientific studies have proven which therapy works best, so men typically follow their doctor's recommendation, said Jang.
The study of more than 85,000 men aged 65 and older with prostate cancer that had not yet spread uncovered a strong correlation between physician type and treatment.
If a man's doctor happens to be a urologist, for example, the recommendation for men under 70 most often will be surgery -- 70 percent of the time. For men over 75 who saw only a urologist, the choice was watchful waiting or hormone therapy in 91 percent of the patients.
But if they saw both a urologist and a radiation oncologist, 78 percent of younger men and 85 percent of older men got radiation therapy.
Because patients tend to fare well on all the treatment options, the choice comes down to which side effects and treatment options best fit the patient, Dr. Justin Bekelman, a radiation oncologist at Memorial Sloan-Kettering, who worked on the study, said in an interview.
"It's not enough to say, Google it and check it out," he said.
Most prostate cancer patients tend to see a urologist first because they are the doctors who perform biopsies and make diagnoses.
"I think urologists as gatekeepers have to present balanced information," Jang said.
The American Cancer Society expects 218,890 U.S. men to be diagnosed with prostate cancer in 2007 and 27,000 to die of it.
Prostate cancer can be treated effectively using radiation, radioactive seeds or surgical removal of the prostate. Surgery or drugs to stop production of testosterone, known as hormone therapy, may also be used in high-risk patients.
Doctors often also advise close medical observation, also known as watchful waiting.
Each treatment is associated with different benefits and side effects. Prostate surgery can cause urinary incontinence and erectile dysfunction; radiation therapy can cause diarrhea and erectile dysfunction; and hormone therapy can cause hot flashes and breast tenderness.
"You want your physician to convey this information without a bias," Dr. Thomas Jang, a urologist from Memorial Sloan-Kettering Cancer Center in New York, said at the annual meeting of the American Society of Clinical Oncologists.
Although the 5-year survival rate for men with localized prostate cancer is nearly 100 percent, it is the third most common cause of cancer death in men of all ages, and the most common cause of cancer death in men over 75.
No scientific studies have proven which therapy works best, so men typically follow their doctor's recommendation, said Jang.
The study of more than 85,000 men aged 65 and older with prostate cancer that had not yet spread uncovered a strong correlation between physician type and treatment.
If a man's doctor happens to be a urologist, for example, the recommendation for men under 70 most often will be surgery -- 70 percent of the time. For men over 75 who saw only a urologist, the choice was watchful waiting or hormone therapy in 91 percent of the patients.
But if they saw both a urologist and a radiation oncologist, 78 percent of younger men and 85 percent of older men got radiation therapy.
Because patients tend to fare well on all the treatment options, the choice comes down to which side effects and treatment options best fit the patient, Dr. Justin Bekelman, a radiation oncologist at Memorial Sloan-Kettering, who worked on the study, said in an interview.
"It's not enough to say, Google it and check it out," he said.
Most prostate cancer patients tend to see a urologist first because they are the doctors who perform biopsies and make diagnoses.
"I think urologists as gatekeepers have to present balanced information," Jang said.
The American Cancer Society expects 218,890 U.S. men to be diagnosed with prostate cancer in 2007 and 27,000 to die of it.
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