Prostate-specific antigen in clinical practice

Signal amplification by magnetic force on polydiacetylene supramolecules for detection of prostate cancer

A method in which a permanent magnet is introduced onto polydiacetylene (PDA) vesicle chips is introduced for enhancement of the fluorescence of PDA vesicles. This strategy can be applied to general antibody-based PDA vesicle chips to detect clinically important biomarkers for disease diagnosis.

Watchful waiting and quality of life among prostate cancer survivors in the Physicians' Health Study

PURPOSE

We examined patient reported outcomes among patients with prostate cancer treated with watchful waiting in a nationwide cohort.

MATERIALS AND METHODS

We collected treatment information and patient reported outcomes from 1,230 patients with prostate cancer diagnosed with T1-T2 prostate cancer in the Physicians' Health Study, of whom 125 were initially treated with watchful waiting. Cox proportional hazards regression was used to identify predictors of treatment initiation among patients on watchful waiting. Logistic regression was used to calculate the OR and 95% CI to assess disease targeted quality of life by initial treatment or watchful waiting.

RESULTS

At a mean 7.3-year followup 41% of patients on watchful waiting remained free of treatment while 34% had received radiotherapy or brachytherapy, 16% had received primary hormonal therapy and 10% had undergone prostatectomy. Younger age, higher clinical stage, higher Gleason score and higher prostate specific antigen at diagnosis predicted progression to treatment. Watchful waiting compared to immediate treatment was associated with less urinary incontinence (3.5% vs 10%) and impotence (68% vs 78%) but more common obstructive urinary symptoms (22% vs 13%) on univariate analysis (each p <0.05). Incontinence and impotence differences remained significant after adjusting for age, comorbidity and time after cancer diagnosis. Quality of life outcomes in men who underwent delayed treatment after initially waiting were not worse than in men who underwent immediate treatment.

CONCLUSIONS

Findings suggest quality of life benefits after watchful waiting in select patients with early stage prostate cancer compared to men treated immediately after diagnosis. Younger age and greater cancer severity at diagnosis predicted progression to treatment.

Between-method differences in prostate-specific antigen assays affect prostate cancer risk prediction by nomograms

BACKGROUND

To date, no published nomogram for prostate cancer (PCa) risk prediction has considered the between-method differences associated with estimating concentrations of prostate-specific antigen (PSA).

METHODS

Total PSA (tPSA) and free PSA were measured in 780 biopsy-referred men with 5 different assays. These data, together with other clinical parameters, were applied to 5 published nomograms that are used for PCa detection. Discrimination and calibration criteria were used to characterize the accuracy of the nomogram models under these conditions.

RESULTS

PCa was found in 455 men (58.3%), and 325 men had no evidence of malignancy. Median tPSA concentrations ranged from 5.5 μg/L to 7.04 μg/L, whereas the median percentage of free PSA ranged from 10.6% to 16.4%. Both the calibration and discrimination of the nomograms varied significantly across different types of PSA assays. Median PCa probabilities, which indicate PCa risk, ranged from 0.59 to 0.76 when different PSA assays were used within the same nomogram. On the other hand, various nomograms produced different PCa probabilities when the same PSA assay was used. Although the ROC curves had comparable areas under the ROC curve, considerable differences were observed among the 5 assays when the sensitivities and specificities at various PCa probability cutoffs were analyzed.

CONCLUSIONS

The accuracy of the PCa probabilities predicted according to different nomograms is limited by the lack of agreement between the different PSA assays. This difference between methods may lead to unacceptable variation in PCa risk prediction. A more cautious application of nomograms is recommended.

Benign prostatic hyperplasia and prostate cancer: an overview for primary care physicians

Benign prostatic hyperplasia (BPH) and prostate cancer (CaP) are major sources of morbidity in older men. Management of these disorders has evolved considerably in recent years. This article provides a focused overview of BPH and CaP management aimed at primary care physicians. Current literature pertaining to BPH and CaP is reviewed and discussed. The management of BPH has been influenced by the adoption of effective medical therapies; nonetheless, surgical intervention remains a valid option for many men. This can be accomplished with well-established standards such as transurethral resection of the prostate or with minimally invasive techniques. Prostate cancer screening remains controversial despite the recent publication of two large clinical trials. Not all prostate cancers necessarily need to be treated. Robot-assisted prostatectomy is a new and increasingly utilised technique for CaP management, although open radical retropubic prostatectomy is the oncological reference standard. The ageing of the population of the developed world means that primary care physicians will see an increasing number of men with BPH and CaP. Close collaboration between primary care physicians and urologists offers the key to successful management of these disorders.

Carbon nanotubes in cancer theragnosis

Carbon nanotubes as a unique and novel class of nanomaterials have shown considerable promise in cancer therapy and diagnosis amidst the myriad of nanocarriers. The presence of a large surface area enables the engineering of the surface of nanotubes, thus making them biocompatible, and large benefits can be harnessed from them. Together with their ability to encapsulate small molecules, stacking interactions and conjugation, nanotubes have improved the profile of anticancer agents. The propensity to absorb the body transparent NIR radiation also envisages photothermal and photoacoustic therapy using nanotubes. This article sheds light on the role of carbon nanotubes in cancer therapy and diagnosis based on recent findings.

Establishment and genomic characterization of mouse xenografts of human primary prostate tumors

Serum prostate-specific antigen screening has led to earlier detection and surgical treatment of prostate cancer, favoring an increasing incidence-to-mortality ratio. However, about one third of tumors that are diagnosed when still confined to the prostate can relapse within 10 years from the first treatment. The challenge is therefore to identify prognostic markers of aggressive versus indolent tumors. Although several preclinical models of advanced prostate tumors are available, a model that recapitulates the genetic and growth behavior of primary tumors is still lacking. Here, we report a complete histopathological and genomic characterization of xenografts derived from primary localized low- and high-grade human prostate tumors that were implanted under the renal capsule of immunodeficient mice. We obtained a tumor take of 56% and show that these xenografts maintained the histological as well as most genomic features of the parental tumors. Serum prostate-specific antigen levels were measurable only in tumor xenograft-bearing mice, but not in those implanted with either normal prostate tissue or in tumors that likely regressed. Finally, we show that a high proliferation rate, but not the pathological stage or the Gleason grade of the original tumor, was a fundamental prerequisite for tumor take in mice. This mouse xenograft model represents a useful preclinical model of primary prostate tumors for their biological characterization, biomarker discovery, and drug testing.

Differential percentage of serum prostate-specific antigen subforms suggests a new way to improve prostate cancer diagnosis

BACKGROUND

Prostate-specific antigen (PSA) is the tumor marker currently used for prostate cancer (PCa) screening and diagnosis. However, its use is controversial as serum PSA levels are also increased in other non-malignant prostatic diseases such as benign prostatic hyperplasia (BPH). PSA sialic acid content is altered in tumor situation and modifies PSA's isoelectric point (pI). Our goal has been to evaluate serum PSA subforms from PCa and BPH patients by two-dimensional electrophoresis (2-DE) and to investigate whether they could be used to improve PCa diagnosis.

METHODS

PSA from 20 PCa and 20 BPH patients' sera was subjected to a four-step method to obtain serum PSA 2-DE subforms from free PSA (fPSA) plus PSA released from the complex with alpha-1-antichymotrypsin. Relative percentages of PSA spots were quantified and subjected to statistical analysis.

RESULTS

Five PSA subforms (F1, F2, F3, F4, and F5) of different pI were obtained. Relative percentages of F3 (%F3) and F4 (%F4) were different between PCa and BPH groups. %F3 decreased in cancers and this decrease correlated with the cancer stage, while F4 behaved oppositely. These observations were also found when only focusing on the patients within the low total PSA (tPSA) range 2-20 ng/ml.

CONCLUSIONS

%F3 showed a tendency of higher sensitivity and specificity than the currently used tPSA and %fPSA tests. Therefore, %F3 measurement should be investigated in a larger cohort of patients to study whether it could be introduced to improve PCa diagnosis.

The expression of androgen-responsive genes is up-regulated in the epithelia of benign prostatic hyperplasia

BACKGROUND

Benign prostatic hyperplasia (BPH) is one of the most common diseases among aging men in the United States. In addition to aging, the presence of androgens is another major risk factor in BPH development. However, whether androgen signaling is altered in BPH remains unclear. To determine androgen signaling in BPH, we characterized the expression of four different androgen-responsive genes, Eaf2/U19, ELL2, FKBP5, and PSA, in BPH and adjacent normal glandular epithelial cells.

METHODS

A set of 17 BPH specimens were resected from patients over 60 years of age with clinical symptoms of BPH. Laser-capture microdissection (LCM) was used to isolate glandular epithelial cells from BPH areas and adjacent normal areas, separately. LCM isolated cells from individual specimens were lysed and RNA isolation, reverse transcription, and real-time PCR were performed using CellsDirect One-Step qRT-PCR Kit (Invitrogen, Carlsbad, CA).

RESULTS

All of the assayed genes displayed increased expression, from approximately 2- to approximately 6-fold, in BPH as compared to the adjacent normal epithelial cells. We also generated a composite androgen response index based on the expression levels of the four genes, which provides a reliable readout for overall androgen action. Our study showed that the composite androgen response index in BPH is approximately 4-fold as compared to that in the adjacent normal tissues.

CONCLUSIONS

Androgen signaling is significantly elevated in BPH relative to the adjacent normal prostate. Understanding the mechanisms causing elevated androgen signaling may lead to novel approaches for prevention and/or treatment of BPH.

Modeling the effects of obesity and weight gain on PSA velocity

BACKGROUND

Hemodilution theory states that higher blood volume in obese men effectively dilutes circulating PSA levels resulting in lower PSA test results. Here we apply hemodilution theory to model the effect of weight gain on PSA velocity.

METHODS

Hemodilution formulas were used to model PSA velocity for a series of plausible scenarios in which initial weight and weight gain were varied. The formulas were also applied to published summary data on weight, weight change and PSA velocity from the Prostate Cancer Prevention Trial (PCPT).

RESULTS

Under hemodilution theory, PSA velocity is understood to be influenced by total circulating PSA mass (ng of PSA) and BMI at the initial test and total circulating PSA mass and BMI at the subsequent test. PSA velocity in a man with a stable BMI of 35 is estimated to be 13% lower than in a man with a stable BMI of 25. A gain of 4 BMI units is predicted to attenuate PSA velocity by as much as 25%. When applied to summary data from the PCPT, the formulas estimate that a 10 pound weight gain causes a -0.028 ng/ml change in PSA, which closely matches PCPT results where a 10 pound weight gain caused a -0.024 ng/ml change in PSA. We provide software to implement the hemodilution formulas to model PSA velocity for different weights and changes in weight through time (http://www.eheintl.com/psa.jsp).

CONCLUSION

Stable obesity and weight gain both independently attenuate PSA velocity, potentially obscuring clinically relevant changes in circulating PSA.

Has blood volume an impact on serum PSA levels?

PURPOSE

Prostate-specific antigen (PSA) is measured in circulating blood volume (BV), which is known to have a wide inter- and intraindividual variability. As data investigating the potential impact of different BV on PSA test validity are scant, we determined the relationship between BV and serum PSA values.

METHODS

Men aged 41-60 years, participating in a health screening project, were evaluated. Serum samples of fasting patients were drawn between 8.00 and 10.00 a.m., all PSA measurements were determined in the same laboratory. Circulating BV was calculated according to the Retzlaff formula based on height, weight and haematocrit.

RESULTS

A total of 400 men with a mean age of 47.9 years entered the analysis. Mean PSA was 1.20 ng/ml (range 0.23-8.59 ng/ml) and mean BV was 3,370 ml (range 2,380-4,220 ml). Mean PSA values stratified from lowest to the highest third of BV were 1.22, 1.17 and 1.19 ng/ml in the total cohort. The respective figures for men aged 41-50 years were 1.08, 0.98 and 1.03 ng/ml, and for those aged 51-60 years: 1.47, 1.48 and 1.53 ng/ml. Neither BV nor three other related biometrical parameters (body mass index, waist-hip ratio, body fat percentage) revealed a correlation with the PSA values.

CONCLUSION

Our data suggest that BV does not have a significant impact on serum PSA values. To exclude a potential minor impact of BV on PSA, larger study cohorts, however, are required.

Beyond PSA: utility of novel tumor markers in the setting of elevated PSA

The introduction of prostate-specific antigen (PSA) for prostate cancer screening and detection has been used for over 20 years and has dramatically changed the face of prostate cancer. Although it is a highly sensitive serum test, its routine use has been the subject of continued controversy owing to its limited specificity. Due to this lack of specificity, many have proposed modifications of PSA in an attempt to bolster the performance of this analyte. The human genome project and high throughput gene expression profiling has recently yielded several promising molecular biomarkers for prostate cancer detection beyond PSA or PSA modifications. This review will first highlight several characteristics of an ideal biomarker, then focus on select emerging biomarkers for the detection of prostate cancer.

Early prostate-specific antigen changes and the diagnosis and prognosis of prostate cancer

PURPOSE OF REVIEW

To delineate how recent findings on prostate-specific antigen (PSA) can improve prediction of risk, detection, and prediction of clinical endpoints of prostate cancer (PCa).

RECENT FINDINGS

The widely used PSA cut-point of 4.0 ng/ml increasingly appears arbitrary, but no cut-point achieves both high sensitivity and high specificity. The accuracy of detecting PCa can be increased by additional predictive factors and a combinations of markers. Evidence implies that a panel of kallikrein markers improves the specificity and reduces costs by eliminating unnecessary biopsies. Large, population-based studies have provided evidence that PSA can be used to predict PCa risk many years in advance, improve treatment selection and patient care, and predict the risk of complications and disease recurrence. However, definitive evidence is currently lacking as to whether PSA screening lowers PCa -specific mortality.

SUMMARY

PSA is still the main tool for early detection, risk stratification, and monitoring of PCa. However, PSA values are affected by many technical and biological factors. Instead of using a fixed PSA cut-point, using statistical prediction models and considering the integration additional markers may be able to improve and individualize PCa diagnostics. A single PSA measurement at early middle age can predict risk of advanced PCa decades in advance and stratify patients for intensity of subsequent screening.

Prostate-specific antigen-based screening for prostate cancer in the third millennium: useful or hype?

Prostate cancer is the most prevalent malignancy in men and the third leading cause of cancer deaths worldwide. Although the wide-spread introduction of total prostate-specific antigen (tPSA) testing has revolutionized the approach to the managed care of this disease, there are some biological, analytical, clinical, and economical issues that argue against the cost-effectiveness of tPSA-based population screening for early identification of cancer. The on-going standardization/harmonization efforts, along with the outcomes of recent epidemiological investigations, demonstrate that the current tPSA thresholds might be revised and possibly recalculated according to several demographical variables, such as age, ethnicity, genotype, family history, and body mass index. A major shortcoming of tPSA screening is the lack of reliable evidences of reduction in prostate cancer-associated mortality, due to the large lead-time because of the indolent growth rate, the impossibility to differentiate high-grade from indolent cancers, and the treatment-associated morbidity. Since no single tPSA cut-off was proven able to efficiently identify men at higher risk of death, the jeopardy of over-diagnosis and over-treatment is also tangible. The large expenditure is an additional source of concern. Finally, a wide-spread population screening also carries several ethical, social, and psychological implications, which might overwhelm the potential benefits.

SN52, a novel nuclear factor-kappaB inhibitor, blocks nuclear import of RelB:p52 dimer and sensitizes prostate cancer cells to ionizing radiation

The activation of nuclear factor-kappaB (NF-kappaB) is thought to protect cancer cells against therapy-induced cytotoxicity. RelB, a member of the NF-kappaB family in the alternative pathway, is uniquely expressed at a high level in prostate cancer with high Gleason scores. Here, we show that ionizing radiation (IR) enhances nuclear import of RelB, leading to up-regulation of its target gene, manganese superoxide dismutase (MnSOD), and renders prostate cancer cells resistant to IR. To selectively block RelB nuclear import, we designed a cell-permeable SN52 peptide, a variant of the SN50 peptide that has been shown to block nuclear import of NF-kappaB family members in the classic pathway. Inhibition of IR-induced NF-kappaB activation by SN50 and SN52 was achieved by selectively interrupting the association of p50 and p52 with nuclear import factors importin-alpha1 and importin-beta1. Importantly, SN52 seems to be more efficient for radiosensitization of prostate cancer cells at clinically relevant radiation doses and has less cytotoxicity to normal prostate epithelial cells compared with the toxicity observed with SN50. These results suggest that targeting the alternative pathway is a promising approach to selectively radiosensitize prostate cancers and that SN52 may serve as a prototype biological agent for sensitizing prostate cancers to clinically relevant doses of IR.

Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time

OBJECTIVES

To compare the accuracy of prostate-specific antigen (PSA) velocity (PSAV) vs PSA doubling time (DT) for predicting the repeat biopsy results in men with localized prostate cancer on active surveillance (AS), as the utility of PSAV vs PSADT in untreated prostate cancer has not been well studied.

PATIENTS AND METHODS

Eligible patients had favourable-risk localized prostate cancer (T1/2a, PSA level <or=15 ng/mL, Gleason score <or=3 + 4, and percentage positive biopsy cores <or=50%), and consented to AS between 2002 and 2005. Repeat biopsies were taken after 18-24 months, with adverse histology defined as any of: primary Gleason grade >or=4, >50% cores positive, or initial Gleason score 3 + 3 upgraded to >or=3 + 4. Using all PSA values for the 2 years preceding repeat biopsy, the PSAV and PSADT were calculated using linear regression and the log-slope method (DT = ln2/slope), respectively.

RESULTS

In all, 199 patients were assessable; the median PSAV and PSADT were 0.71 ng/mL/year and 5.29 years, respectively. Fifty-three patients (27%) had adverse histology on repeat biopsy. On univariate analyses, PSAV (P < 0.001) and PSADT (P = 0.019) were associated with adverse histology. The area under the receiver operating characteristic curve for predicting adverse histology was 0.70 and 0.63 for PSAV and PSADT, respectively. The mean difference was 0.07 (95% confidence interval 0.03-0.12; P < 0.001).

CONCLUSIONS

PSAV is more accurate than PSADT for predicting adverse histology on repeat biopsies. These data suggest that PSAV should be used in preference to PSADT to describe PSA kinetics in untreated, localized prostate cancer.

A personalized approach to cancer treatment: how biomarkers can help

BACKGROUND

The present approach to cancer treatment is often referred to as "trial and error" or "one size fits all." This practice is inefficient and frequently results in inappropriate therapy and treatment-related toxicity. In contrast, personalized treatment has the potential to increase efficacy and decrease toxicity.

CONTENT

We reviewed the literature relevant to prognostic, predictive, and toxicity-related markers in cancer, with particular attention to systematic reviews, prospective randomized trials, and guidelines issued by expert panels. To achieve personalized treatment for cancer, we need markers for determining prognosis, predicting response to therapy, and predicting severe toxicity related to treatment. Among the best-validated prognostic markers currently available are serum concentrations of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) for patients with nonseminoma germ cell tumors and tissue concentrations of both urokinase plasminogen activator and plasminogen activator inhibitor 1 (PAI-1) for breast cancer patients. Clinically useful therapy predictive markers are estrogen and progesterone receptors to select patients with breast cancer for treatment with endocrine therapy and human epidermal growth factor receptor 2 (HER-2) to select breast cancer patients for treatment with trastuzumab (Herceptin). Markers available for identifying drug-induced adverse reactions include thiopurine methyltransferase (TPMT) to predict toxicity from thiopurines in the treatment of acute lymphoblastic leukemia and uridine diphosphate glucuronyltransferase to predict toxicity from irinotecan in the treatment of colorectal cancer.

CONCLUSIONS

Validated prognostic, predictive, and toxicity markers should help cancer treatment move from the current trial-and-error approach to more personalized treatment.

Recurrent gene fusions in prostate cancer

The discovery of recurrent gene fusions in a majority of prostate cancers has important clinical and biological implications in the study of common epithelial tumours. Gene fusion and chromosomal rearrangements were previously thought to be primarily the oncogenic mechanism of haematological malignancies and sarcomas. The prostate cancer gene fusions that have been identified thus far are characterized by 5' genomic regulatory elements, most commonly controlled by androgen, fused to members of the Ets family of transcription factors, leading to the overexpression of oncogenic transcription factors. Ets gene fusions probably define a distinct class of prostate cancer, and this might have a bearing on diagnosis, prognosis and rational therapeutic targeting.

The pathogenesis of prostate cancer: from molecular to metabolic alterations

Prostate cancer (PCa) is a heterogeneous disease with regard to molecular alterations and clinical course. The investigation of genetic alterations associated with PCa pathogenesis is highly challenging. Genome-wide analyses and epidemiological studies have identified only a handful of candidate genes possibly associated with hereditary or sporadic PCa. Cancer cells often rely for survival on common biochemical pathways such as enhanced anaerobic glycolysis and lipogenesis. The lipogenic enzyme fatty acid synthase seems to play a crucial part in PCa by conferring growth and survival advantages to cancer cells. We summarize the current understanding of the molecular events in PCa, and highlight the importance of altered lipid metabolism in the development and progression of prostate malignancy.

Why 3-D? Gel-based microarrays in proteomics

Gel-based microarrays (biochips) consisting of nanoliter and sub-nanoliter gel drops on hydrophobic substrate are a versatile technology platform for immobilization of proteins and other biopolymers. Biochips provide a highly hydrophilic environment, which stabilizes immobilized molecules and facilitates their interactions with analytes. The probes are immobilized simultaneously with gel polymerization, evenly distributed throughout individual elements, and are easily accessible because of large pores. Each element is an isolated nanotube. Applications of biochips in the studies of protein interactions with other proteins, nucleic acids, and glycans are described. In particular, biochips are compatible with MALDI-MS. Biochip-based assay of prostate-specific antigen became the first protein microarray approved for clinical use by a national regulatory agency. In this review, 3-D immobilization is compared with mainstream technologies based on surface immobilization.

The Clinical Impact of who Standardization of PSA Assays

The determination of serum level of the prostate specific antigen (PSA) is widely used for detection and management of prostate cancer. Analytical variability between the various PSA assays on the market has been reported. This discrepancy in the PSA results was shown to be related to non-equimolar detection of total PSA (tPSA) but also to a lack of assay standardization and could have serious clinical repercussions on the diagnostic performance of PSA testing. The recalibration of equimolar assays to common reference preparations (tPSA WHO 96/670 and fPSA 96/668) was thought to promote standardization of PSA assays and limit the clinical implication of assay variability. Comparison studies have demonstrated that PSA assay calibration to the WHO standard certainly improves the harmonisation of PSA testing, but differences between assays remain. Recent evaluations of the clinical impact of analytical variations induced by a calibration to the WHO standard reported that 15% to 30% of prostate cancer could be missed if the historical tPSA cut-off was used. In order to avoid unacceptable erosion of the clinical diagnostic performance of PSA determination for the detection of prostate cancer with WHO calibrated assays, it is critical to define new specific clinical decision points.

Early detection of prostate cancer in 2007. Part 1: PSA and PSA kinetics

OBJECTIVE

This is the first of two review papers attempting to clarify the best way to detect prostate cancer (PCa) in 2007. Screening for PCa has not yet been shown to lower PCa mortality. Still, opportunistic screening is wide spread in Europe and in most other parts of the world.

METHODS

Current literature and data from screening studies are reviewed and discussed. Prostate-specific antigen (PSA) has been and remains one of the corner stones of early detection of PCa. Traditionally used cut-off values cannot be applied in an uncritical fashion after it was shown that a significant amount of overdiagnosis and that large proportions of cancers and poorly differentiated cancers are present in the low PSA ranges. The paper addresses the continued relevance of PSA cut-off values. The diagnostic value of PSA velocity is reviewed in conjunction with PSA cut-off values and as a possible replacement of total PSA. A need for more selective screening in the low PSA ranges is pointed out.

RESULTS AND CONCLUSIONS

The data show that men presenting initially with PSA values below 1 do not have to be rescreened for a period of 8 yr. In the PSA range 1-2.9 ng/ml, new parameters are needed that improve specificity and are selective for screening for aggressive lesions. PSA velocity so far has not been shown to be useful in the early detection of PCa but may be useful in detecting aggressive PCa selectively. For the time being, it seems sensible to continue using PSA cut-off values such as 3.0 or 4.0 ng/ml provided overtreatment is decreased by using available nomograms.

Etude randomisée multicentrique comparant la castration médicale par triptoréline à la castration chirurgicale dans le traitement du cancer de la prostate localement avancé ou métastatique

OBJECTIVE

To report the results of a trial comparing the efficacy of triptorelin and surgical castration in the treatment of locally advanced or metastatic prostate cancer.

MATERIALS AND METHODS

80 patients with previously untreated locally advanced or metastatic prostate cancer prostate cancer were included in a one-year multicentre, randomized, prospective, open-label therapeutic trial. Patients either received a monthly injection of triptorelin (group 1; n = 40), or were treated by pulpectomy (group 2; n = 40). Patients were reviewed every 3 months, then every 6 months.

RESULTS

The mean age of the patients was 71.22 +/- 8.25 years. At 1 month, 38 patients were castrated (plasma testosterone < 0.5 mg/ml) in the pulpectomy group versus 35 in the triptorelin group. The mean follow-up was 38.8 +/- 26 months in the triptorelin group and 36.3 +/- 25 months in the pulpectomy group. On multivariate analysis, age, impaired performance status and PAP level (> 3.2 ng/ml) were predictive factors of a poor outcome. The median survival was 37.5 +/- 9 months in the triptorelin group and 33 +/- 3 months in the pulpectomy group. At 3 years, no significant difference in specific survival was observed between the 2 groups. At 8 years of follow-up, 63 patients had died.

CONCLUSION

This study demonstrates an equivalent specific survival between patients treated by triptorelin or surgical castration. Castration is rapidly obtained with triptorelin (< 2 months) and is maintained over time throughout the duration of treatment.