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Selenium is an important trace element that has surfaced in the past decade as a debatable treatment option for prevention of prostate cancer. Selenium is found naturally in such foods as nuts, whole grain wheat (cereals), and some meats and seafood. The Recommended Daily Allowance for selenium is 55 ?g/day, which most Americans receive through their usual diet. Taken orally, selenium accumulates in the prostate gland.

Over 35,000 men from more than 400 sites throughout the United States, Canada, and Puerto Rico were randomly assigned to 1 of 4 groups: selenium 200 ?g/day, vitamin E, selenium and vitamin E, or placebo. All participants were 55 years or older, except for African American men, who were 50 years or older. Inclusion criteria were current prostate-specific antigen serum levels 4 ng/mL or less, no history of prostate cancer, and negative results on digital rectal examination. Patients were evaluated for a median of 5.46 years.


The study did not demonstrate any benefit of selenium compared with placebo for prostate cancer prevention. Prostate cancer was detected in 4.56% and 4.43% of the selenium and placebo groups, respectively. Although the trial was scheduled to run through 2012, the Data and Safety Monitoring Committee cut the trial short because no correlation between taking selenium and prevention of prostate cancer was found.

Antioxidants can also be counterproductive in individuals who are already diagnosed with prostate cancer. Taking into consideration the side effects associated with antioxidants and the risk for drug-drug interactions, other options at this point prove to be more beneficial for prostate cancer prevention.

Anejaculation (absence of ejaculate when having orgasm) is an expected effect from radical prostatectomy. Many men choose radiation therapy for their prostate cancer with the expectation to retain ejaculation after the treatment is completed.

However, researchers reported at the 2010 AUA annual meeting that 90% of men will have anejeculation after radiation for prostate cancer.

To see the full text of this article, copy this link and paste it in your browser's URL: http://www.medscape.com/viewarticle/723321

In a study conducted at Sloan Kettering, salvage prostatectomy (prostatectomy after radiation failure) was associated with a higher probability of medical and surgical complications such as urinary tract infection, bladder neck contracture (scarring), urinary retention (inability to urinate for a prolonged period), urinary fistula (abnormal connection between the bladder/urethra and the skin or rectum), rectal injury, and abscess formation. After 3 years only 30% of patients were continent. Of patients who were potent before the surgery, only 25% retained sexual function.

These are definitely factors that need to be discussed before proceeding with salvage prostatectomy.

Counterfeit drugs for erectile dysfunction pose a significant health risk as presented at the 2010 AUA annual meeting. The counterfeit products contained too much active ingredient (58%), too little active drug or none at all (37%). Many counterfeit tablets contained unapproved and unproven substances as well as heavy metals such as lead or mercury.

SAN FRANCISCO, CA USA (UroToday.com)
May 31, 2010

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Yet another presentation on PCA-3, the genetic marker for prostate cancer in a urine test, showing that the use of dutasteride (Avodart) does not affect the ability PCA-3 to predict prostate cancer. This in contrast to PSA, which changes under the influence of drugs like dutasteride (Avodart) and finasteride (Proscar). PCA-3 also outperformed PSA in predicting the presence of prostate cancer.

SAN FRANCISCO, CA USA (UroToday.com) - The effect of dutasteride on the performance of the PCA3 test was evaluated by Dr. Gerald Andriole and colleagues. They studied the performance of PCA3 in men in the dutasteride arm of the REDUCE trial. The REDUCE trial was a 4-year prostate cancer (CaP) risk reduction study, in which men with a negative baseline prostate biopsy and serum PSA 2.5-10ng/ml were randomized to dutasteride or placebo. At 2 and 4 years, 10-core biopsies were performed. Post-DRE urine specimens were collected prior to years 2 and 4 biopsies and PCA3 measured. PCA3 and PSA were assessed in 1,308 dutasteride and 1,554 placebo participants. Multivariate logistic regression was performed using PCA3, PSA, age, prostate volume and family history of CaP.

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In a presentation at the 2010 annual meeting of the AUA in San Francisco by  E. David Crawford, MD, of the University of Colorado Health Sciences Center in Denver, the urine PCA-3 test for prostate cancer was found to be superior in detecting prostate cancer as compared to the standard PSA blood test. PCA-3 showed a sensitivity of 49% and a specificity of 78% (meaning that it caught "only" 49% of the cancers, but if the test is positive, you have an overall 78% chance that you indeed have cancer) compared to 87% and 21% respectively for PSA. Also noted was that the higher the PCA-3, the higher the likelyhood of cancer, as well as the higher the Gleason score, the higher the PCA-3 score tended to be. To read a summary report on the presentation, copy the link below and paste it in your browser's URL window.

http://www.renalandurologynews.com/urine-pca3-superior-to-psa-in-predicting-prostate-cancer/article/171611/

In a presentation at the annual AUA meeting in San Francisco: HIFU was found to be 90% effective in treating prostate cancer overall, 880 patients, followed over 7 years. HIFU is shown to be at least as effective as EBRT.

   

SAN FRANCISCO -- June 3, 2010 -- New data presented here at the 2010 American Urological Association (AUA) Annual Meeting show that high-intensity focused ultrasound (HIFU) as primary therapy for prostate cancer can produce outcomes equal to external beam radiation therapy.

A series of 880 consecutive patients showed steadily improving results as HIFU technology improves, according to Sebastien Crouzet, MD, Edouard Herriot Hospital, University of Lyon, Lyon, France.

"We have followed some patients as long as 10 years and are reaching results very similar to EBRT, Dr. Crouzet told Doctor's Guide on June 2. "The main issue is that you can repeat HIFU if you see evidence of disease. And if the disease continues to progress, you can add salvage radiation therapy to achieve very good control. Unlike many treatments, HIFU does not represent a therapeutic impasse."

Starting in 1997, all patients with prostate cancer with localised disease who received whole gland ablation and at least 1 year of follow-up were included in the study cohort.

Follow-up included serial prostate specific antigen (PSA) measurements and systematic control biopsies at 6 months. Patients with a rising PSA were given additional biopsies. If there was any evidence of recurring prostate cancer after the initial HIFU treatment, patients were offered additional treatments and a repeat biopsy. Patients with a positive biopsy after follow-up HIFU were offered either external beam radiation therapy or hormonal deprivation.

A total of 880 patients were included in the study. The mean age was 70 years and the mean PSA at first HIFU treatment was 8.4. Of the group, 36% had low-risk disease, 48% had intermediate-risk disease, and 16% had high-risk disease. Gleason scores were 6 in 58% of men, 7 in 34%, and >=8 in 8%. Patients received a mean of 1.4 HIFU treatments. The mean PSA nadir was 0.45 and 69% of patients reached <=0.3. The mean follow-up period was 41 months.

The overall 7-year survival rate was 90% and the 7-year cancer-specific survival rate was 98%. Fully 96% of patients were free of metastases 7 years after HIFU. The 5-year biochemical survival rate was 75%, 59%, and 45% for low-, intermediate-, and high-risk patients. The 7-year biochemical survival rate was 62%, 50%, and 39% for low-, intermediate-, and high-risk patients (P = .0001).

A total of 239 patients had biopsy-proven local relapse after a second HIFU treatment. Of this group, 156 patients had salvage EBRT and 83 patients had androgen deprivation therapy.

"Disease control and survival rates with HIFU are very encouraging," Dr. Crouzet said. "You also have the advantage that HIFU is very minimally invasive. You don't touch the nerve or the sphincter, therefore you avoid the side effects of more invasive treatment."

[Presentation title: Outcomes of HIFU for Prostate Cancer in 880 Consecutive Patients. Abstract 1953]

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It is well established that radical prostatectomy, including robotic prostatectomy causes penile shortening. HIFU and focal (targeted) cryoablation apparently don't. Another reason to give these treatments consideration.

UroToday.com - Penile length and girth are reportedly decreased following radical prostatectomy for prostate cancer (CaP). However, it is not known whether patients experience similar shortcomings after HIFU or targeted cryoablation of the prostate (TCAP). A report in the online version of the Journal of Sexual Medicine by Dr. Li and colleagues form China evaluates this issue.

The study was a non-randomized prospective assessment of differences in erectile function and penile size in men undergoing HIFU or TCAP for clinically localized CaP. Entry criteria also included IIEF-EF scores >26 prior to treatment, normal serum total testosterone and no prior hormonal therapy. For HIFU the Sonoblate 500 device was used and for TCAP treatment an argon-based cryotherapy system was used. Color-duplex ultrasonography was performed following a single intracavernosal injection of PGE1 (20ug) followed by stimulation. Artificial tumescence was graded I-IV (I worst, IV best) by a physician observer. Penile length was measured from the tip of the glans to the pubopenile skin junction and penile circumference was measured at the middle third of the penile shaft. The study included an evaluation of intra-observer variability in a group of 10 men. Following treatment, all men underwent penile rehabilitation using sildenafil sulfate 3 times weekly and they were encouraged to also use an erection vacuum device once daily. Post-treatment assessment was performed using IIEF-EF scores, serum testosterone levels, penile Doppler ultrasound and penile size at 6, 12, 18, 24, and 36 months.

The cohort included 102 Asian men, all with at least 36 months follow-up. In general there was good adherence to the use of the vacuum device (>50%) in the first 24 months, then it decreased. The erectile function recovery rate at 36 months post-treatment was 46.8% for the TCAP group and 65.5% for the HIFU group. Testosterone levels decreased for both treatments significantly across the 24 month follow-up period. There was no significant difference in the proportion of patients in either group with grade III or IV artificial erection during penile Doppler ultrasound. Changes in peak systolic velocity correlated with changes in IIEF-EF scores, but there were no significant differences in end diastolic velocity or resistance index after treatments. There were no significant reductions in penile length or circumference under flaccid or erect conditions following HIFU or TCAP at any post-treatment time point compared with baseline, nor were there differences between treatment groups.

The PCA-3 urine test is more accurate in predicting the presence of prostate cancer than PSA and may also predict the agressiveness of the prostate cancer. To see the article, copy the link and paste it in your browser's URL window.

http://phx.corporate-ir.net/phoenix.zhtml?c=135117&p=irol-newsArticle&ID=1416639&highlight=