Interviews and News
Interviews and News
This section is where we gather interviews and news about treatments and prostate cancer information. Click the following links to read more about each entry:
AUA CONFERENCE SUMMARY: Analysis and Comment
The American Urology Association held its annual meeting in San Francisco from May 29 - June 3rd, 2010. With 15,000 attendees from all over the world this event is the focal point for learning results of research, studies, analysis of data and the latest thinking by the luminaries for the diagnosis and treatment of all aspects of urology.
From nearly 2,200 Podium, Moderated Poster and Plenary sessions I chose a small subset of those that I believe will be critical information for men who have prostate concerns, if not outright cancer. The format is to faithfully reproduce the summaries and then, where I believe appropriate, offer Editorial comment. And, I include the URL from the Journal of Urology where the abstracts to each session are posted. You should rely on the information from the experts and use the whole commentary to discuss the subject(s) with your doctor/urologist.
STRATEGIC INTERPRETATION OF RELATED SUBJECTS FROM PAPER TO PAPER:
1. One of the more striking impressions I received was the wide differences in outcomes depending on the volume of treatments at a given facility and the urologists practicing there. That is, within a major Medical Center be sensitive to the level of experience of your physician - the more, the better.
2. There were a large number of presentations that sought to define the benefits/deficiencies of robotic assisted radical prostatectomy (RARP) compared to open retropubic radical prostatectomy (RRP). Generally speaking, there was not a 'smoking gun' that suggested one approach is better than the other regarding quality of life and long term outcomes, when important variables are isolated. The trend is to clearly to employ more robot assisted technology, upwards of 70-80%, and allow an opportunity for younger urologists to be favorably compared to older more experienced ones, since robot assistance has been employed for a much shorter period of time compared to 'open' retropubic radical prostatectomy.
3. This AUA Conference was my first in two years. Comparing my impressions, I was gratified to participate in a very dynamic environment, including spirited debate, intellectual honesty and passion for beating cancer in all aspects of urology. With nearly 2,200 approved Papers presented there appears to be enough research support to make advances. Equally important behind the distinguished urologists such as Drs. Peter Carroll, Peter Scardino and Patrick Walsh, are bright young people anxious to make their mark on this dynamic aspect of medical care.
592 QUALITY OF LIFE AFTER ROBOT ASSISTED COMPARED TO OPEN RADICAL PROSTATECTOMY: INITIAL EXPERIENCE IN THE COMMUNITY SETTING
Urinary and sexual quality of life (QOL) were similar after open radical prostatectomy (ORP) compared to robot-assisted radical prostatectomy (RARP). Our findings refute the inferior RARP QOL outcomes suggested by others who used unreliable coding data to assess outcome. We find, in contrast, that despite a relatively early experience, RARP can achieve similar QOL outcomes as ORP. To determine how outcomes after RARP will evolve as surgeon experience grows will require more patients and longer follow-up.
http://www.jurology.com/article/S0022-5347(10)01120-1/fulltext
EDITORIAL COMMENT: This study by Mathew Cooperburg of UCSF used validated questionnaires and refutes a Medicare study that relied on diagnostic coding.
596 CANCER CONTROL DOES NOT REQUIRE SACRIFICE OF FUNCTIONAL OUTCOMES AFTER RADICAL PROSTATECTOMY: ANALYSIS OF HETEROGENEITY BETWEEN SURGEONS AT A SINGLE CANCER CENTER
Urinary and erectile function outcomes vary widely among surgeons. Correlations between functional outcomes and cancer control indicate that this variation results from differences in technique, rather than from differences in how surgeons deliberately trade-off functional preservation and cancer control. Urologists should address the research, educational, and clinical issues raised by heterogeneity to assure that patients with localized prostate cancer receive care of the highest quality.
http://www.jurology.com/article/S0022-5347(10)01124-9/fulltext
EDITORIAL COMMENT: This presentation, including comprehensive analysis of 6,000 cases was a major contributor to the first strategic observation
above, including urinary and sexual side effects. Read the whole presentation carefully in the URL to see the very wide disparity in outcomes, depending on experience and volume at a given facility as well as the volume of individual urologists. The presenters steered away from suggesting minimum criteria, preferring to share data on individual urologists with only that person - which begs the question, who will set those standards for minimum performance?
930 AGE ADJUSTED VALIDATION OF THE MOST STRINGENT CRITERIA FOR ACTIVE SURVELLIANCE: IMPLICATIONS FOR PATIENT SELECTION
Roughly 15% of patients treated with RP may be selected for AS protocols according to the Van den Bergh et al and the Carter et al. criteria. The performance of such criteria decrease with increasing patient age. Thus, care should be taken when applying these criteria in older patients who are generally considered more suitable for AS.
http://www.jurology.com/article/S0022-5347(10)02002-1/fulltext
EDITORIAL COMMENT: The math is rather complicated and men around 70 and older need to be analyzed very carefully for Active Surveillance versus Radical Prostatectomy.
1058 RADICAL RETROPUBIC PROSTATECTOMY VERSUS ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: AN ASSESSMENT OF BIOCHEMICAL RECURRENCE RATES BY D'AMICO RISK GROUP AND SURGEON VOLUME
Overall robotic-assisted radical prostatectomy (RARP) patients in the D'Amico low risk group had significantly lower rates of biochemical recurrence (BCR), however differences in BCR between retropubic radical prostatectomy (RRP) and RARP were not significant when the analysis was limited to highest surgeon volumes. Among patients in the D'Amico high risk groups, rates of BCR between RARP and RRP were not significant overall or when limited to surgeons with highest volumes. Especially in lower D'Amico risk groups, surgeon volume appears to limit risk of BCR for RRP and RARP.
http://www.jurology.com/article/S0022-5347(10)02438-9/fulltext
EDITORIAL COMMENT: I tried to get the presenter to define 'surgeons with highest volumes' and the best answer I could get is more than 100 annually, or, a mere two/week. Am sure there are lots of very fine surgeons doing a lot more than 100 annually that you may want to consider.In any event, the message above is reenforced - find a high volume surgeon at a major medical center.
1059 COMPARISON BETWEEN COMPLICATION RATES, LENGTH OF STAY AND COSTS OF MINIMALLY INVASIVE VS. OPEN RADICAL PROSTATECTOMY
Complication rates and total hospital charges in minimal invasive radical prostatectomy (MIRP) patients were not statistically significantly different from open radical prostatectomy (ORP) patients. After adjustment for baseline patients' characteristics, differences between both cohorts exist for the length of hospital stay.
http://www.jurology.com/article/S0022-5347(10)02439-0/fulltext
EDITORIAL COMMENT: The cut off in this study was for surgeons doing more than 75 operations/year.
1060 PROSTATE VOLUME AND ITS CORRELATION WITH FINAL HISTOPATHOLOGICAL OUTCOMES
Patients with small prostates and prostate cancer tend to be younger with lower PSA values and higher biopsy Gleason scores than patients with larger prostates. Also, there are increased surgical margin rates and incidence of EPE associated with smaller prostates. Postoperatively, patients with smaller prostates had higher surgical margin rates (11.6%) than the intermediate (8.6%) and large (6.6%) prostate groups.
http://www.jurology.com/article/S0022-5347(10)02440-7/fulltext
EDITORIAL COMMENT: Small prostates were defined as less than 40cc and large are, greater than 70cc. A clear message is here for younger people to be aggressive and proactive if they are experiencing prostate problems.
1062 PATHOLOGIC STAGE AND IMPLICATIONS FOR CURE IN ACTIVE SURVEILLANCE PATIENTS WHO UNDERGO RADICAL PROSTATECTOMY
Men who undergo delayed radical prostatectomy (RP) after initial management with active surveillance (AS) have similar pathological outcomes to those men who are candidates for AS but undergo immediate surgery when matched for Gleason score. These data suggest that active surveillance is associated with a low risk of stage progression. Longer follow-up is needed to determine the association with recurrence or prostate cancer mortality in this generally older cohort.
http://www.jurology.com/article/S0022-5347(10)02442-0/fulltext
EDITORIAL COMMENT: This study will be gratifying for men who are deciding between AS and RP and the whole report should be discussed with your doctor.
1063 TIME TO BIOCHEMICAL RECURRENCE IS A STRONG AND INDEPENDENT PREDICTOR OF CSS AND OS IN HIGH-RISK PROSTATE CANCER
The study included 1584 patients with pre-operative high risk prostate cancer (PSA>20 ng/ml or cT3-4 or biopsy Gleason 8-10) treated with RP and pelvic LND at 7 tertiary referral centers between 1987 and 2009. Outcome of high risk prostate cancer is not invariably poor. However, about 1 in 5 patients experience biochemical recurrence within 2 years from surgery. This group is at significantly elevated risk for cancer related death, and should be considered for trials assessing aggressive systemic treatment strategies.
http://www.jurology.com/article/S0022-5347(10)02443-2/fulltext
EDITORIAL COMMENT: There was a 58% survival rate at ten years for these patients.
1064 PREDICTORS OF LOCAL RECURRENCE OF PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY WITH NEGATIVE SURGICAL MARGINS
The rate of local recurrence of prostate cancer following RP with negative surgical margins is low. Independent predictors of local recurrence despite negative surgical margins include GPSM score, biopsy Gleason score and tumor volume.
EDITORIAL COMMENT: Less than 4% had local recurrence.
1728 EARLY DETECTION OF PROSTATE CANCER (TYROL PROSTATE CANCER DEMONSTRATION PROJECT 1988-2008): 20 YEARS EXPERIENCE
These findings confirm the hypothesis that freely available PSA testing, which has met with wide acceptance in the population, is associated with a reduction in prostate cancer mortality in an area where effective treatment is freely available to all men. It is likely that much of this decline in mortality rates is due to earlier detection and successful treatment of prostate cancer. However, and important corollary implication of our study is that screening is only the first step in the optimal management of prostate cancer. Since 1996 a significant reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003-2008 prostate cancer mortality rates decreased by 48%, 55%, 52%, 49%, 41%, and 64% (2008) respectively.
http://www.jurology.com/article/S0022-5347(10)01832-X/fulltext
EDITORIAL COMMENT: These long term results in decreasing prostate cancer mortality from Austria are impressive and, gleaned from a city population of 100K+ over 22 years.
1730 WHAT IS THE TRUE NUMBER-NEEDED-TO-SCREEN AND TREAT TO SAVE A LIFE WITH PSA SCREENING?
Figure 1 compares the simulated cumulative hazard functions to published data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), cited immediately above. According to our model, the number-needed-to-screen (NNS) and number-needed-to-treat (NNT) at 9 years were 1254 and 43, respectively. This corresponds to a cumulative hazard ratios (CHR) of 0.77 similar to the crude hazard ratio (HR) of 0.80 from the ERSPC report. Subsequently, the NNS decreased from 837 at year 10 to 503 at year 12, and the NNT decreased from 29 to 18. Despite the seemingly simplistic nature of estimating NNT, there is widespread misunderstanding of its pitfalls among the urological community, the media, and the general public. With additional follow-up in the ERSPC, if the mortality difference continues to grow, this will lead to a decrease in the NNT.
http://www.jurology.com/article/S0022-5347(10)01834-3/fulltext
EDITORIAL COMMENT: The importance of these studies cannot be over stated. Dr. William Catalona, Dean of Urology, Northwestern, and one of the most distinguished urologists anywhere stated, as a frame of reference breast cancer screenings of 10-15 women saves one life and prostate cancer needs 503. These numbers and differences are also simple enough for mindless bureaucrats administering Obama Care to question why allow prostate cancer screening when 500+ men are needed, along with associated costs for a smaller number who will be treated, to save one life. I am gratified a urologist as distinguished as Dr. Catalona is working passionately to influence the Federal Government.
June 6, 2010
Conflict on screening recommendations
There is conflict brewing between the American Cancer Society (ACS) and American Urological Association (AUA) on screen recommendations. ACS issues new screening guidelines that are generally less aggressive than the AUA. ".....ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening..."
AUA responds, saying "....the new ACS statement may not fully characterize the potential benefits of an individualized approach to assessing risk in men considering the risk and benefits of early detection strategies and may cause significant confusion for patients. The AUA feels there is no single PSA standard that applies to all men, nor should there be....". And, the AUA content has a more specific set of categories for their recommendations. Be sure to read both articles and, if in doubt, consult your physician!
http://www.auanet.org/content/press/press_releases/article.cfm?articleNo=178
Results Unproven, Robotic Surgery Wins Converts
Enjoy reading how the Davinci Robot is being rapidly adopted by many Urologists. My take is less experienced Urologist need a way to compete with those who have done thousand(s) of prostatectomies. The robot begins to be adopted and the experienced Urologists need to offer it as an alternative. Now, more than 85% of all prostatectomies are robot assisted.
Summaries from AUA annual meeting
Greetings! I recently attended the American Urological Association annual meeting in Orlando, FL. While there I heard many presentations and prepared a summary, including quotes and editorial comments.
New Release
James F. Girand, a prostate cancer survivor announced a new web site, www.prostatecancerpatients.org, is now available, to inform and educate prostate cancer patients so they can take charge of the illness and deal more effectively with their doctor before choosing their treatment. The site does not recommend treatments.