Cancer Expert Witness

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Prostate Cancer
3 posts in this category

Cancer Answers Docetaxel and/or Zoledronic Acid for Hormone Naïve Prostate Cancer Abstract #5001 ASCO 2015

Category: Prostate Cancer

First results of STAMPEDE trial

Summary:

1. Docetaxel, added to standard hormonal therapy, improved overall survival by median of 10 months with hormone naive, newly diagnosed individuals with advanced prostate cancer. PI of the study Nicholas James MD, PhD of the University of Warwick and Queen Elizabeth Hospital, Birmingham, England

2. "Docetaxel improved survival in patients with newly diagnosed metastatic prostate cancer starting hormones, and it should be routinely used in these patients as part of upfront therapy. In non-metastatic disease, docetaxel should be offered to men about to start hormone therapy for the first time, because it prolongs failure-free survival. There is some uncertainty regarding its effect on overall survival in men with non-metastatic disease, and longer follow-up is needed. It’s clear that zaledronic acid does not benefit patients with advanced prostate cancer and should not be offered as upfront treatment" (ASCO POST, May 25, 2015 page 1)

3. STAMPEDE is the largest randomized trial conducted for treatment of prostate cancer

4. Comment: represents major change in standard of care for newly diagnosed prostate cancer patients presenting with advanced disease

Please don't hesitate to contact Dr. Steven Mamus to discuss this topic. 

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09 June 2015, 02:31
 

Cancer Answers IS TREATMENT REQUIRED FOR ALL PATIENTS WITH PROSTATE CANCER?

Category: Prostate Cancer

In a study reported in the July 19th, 2012 issue of the New England Journal of Medicine, “Radical Prostatectomy versus Observation for Localized Prostate Cancer” 731 patients with localized prostate cancer were randomized to radical prostatectomy versus observation. In this study funded by the Department of Veteran Affairs Cooperative Studies Program the investigators report that radical prostatectomy did not have a significant impact on all-cause or prostate cancer mortality. Wilt et al noted a 21% adverse event rate after surgery. Median follow up for this study was a decade. The investigators report that “our findings are particularly robust among men with PSA value of 10 ng per milliliter or less, including men with a score of 7 or higher on the Gleason histologic scale…”

The accompanying editorial by Thompson and Tangen note however that the study was underpowered. Wilt et al had hoped to randomize 2,000 patients to their study. Nonetheless the findings of Wilt et al are consistent with other studies of surveillance programs for men with with low risk prostate cancer that have been reported. Thompson and Tangen emphasize the tremendous need to better identify patients with high risk prostate cancer and comment on research being conducted by the Early Detection Research Network of theNational Cancer Institute.

With the continued aging of the United States population, the issue of which patients with prostate cancer need treatment and when will become evermore important.

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20 November 2012, 19:01
 

Cancer Answers Review of US Preventative Services Task Force Recommendation Statement for Prostate Cancer Screening

Category: Prostate Cancer

Dr. Virginia Moyer reports the recommendation statement for prostate cancer screening by the U.S. Preventive Services Task Force in the July 17, 2012 issue of the Annals of Internal Medicine.

SUMMARY:

1) Prostate specific antigen (PSA) should not be used as a screening method for the diagnosis of prostate cancer in men with no prior diagnosis of prostate cancer.

2) Regarding harms and benefits of screening, the USPSTF noted that the reduction of prostate cancer mortality 10-14 years after diagnosis by PSA is minimal.

3) The harm of screening is substantial and the benefits of PSA-based screening for prostate cancer are less than the harm caused by overtreatment of early indolent disease.

4) This recommendation is applicable for men not previously diagnosed with prostate cancer.

5) Also commented upon in this article is that 70% of deaths due to prostate cancer occur in patients 75 years of age or older and few men die of the disease before age 60.

COMMENT:

The recommendations for prostate cancer and breast cancer screening with PSA and mammography respectively, remain controversial for different reasons. It is my strong view that the recommendations by the USPSTF are rational. Rational education of patients by their physicians, requires that physicians are better educated about the risks and benefits of the screening tests that they are ordering.

With 25 National awards, Dr. Steven Mamus is Florida's Cancer Specialist. To submit questions or comments, please contact us

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04 October 2012, 15:12