1. Efficacy and potential benefits of intermittent versus continuous androgen deprivation therapy

The ICELAND study, a multicentre phase 3 randomised study was conducted in 20 European countries, investigated the efficacy and safety profile of intermittent androgen deprivation (IAD) compared with continuous androgen deprivation (CAD) therapy in patients with non-metastatic prostate cancer. 700 patients were randomly assigned to either IAD or CAD therapy with leuprorelin acetate. Leuprorelin is also called Prostap or Lutrate and is a type of hormone therapy for prostate cancer.

Results from this study indicate no statistically significant or clinically relevant difference between the IAD or CAD groups for time to PSA progression, PSA progression free survival and mean PSA levels over time or quality of life in patients with non-metastatic locally advanced or relapsing prostate cancer.

The authors concluded the main potential benefit of IAD compared with CAD was reduced drug costs with comparable overall survival rates. 

2. Prostate Cancer Survival in men with metastatic castration-resistance prostate cancer

Several studies have identified the presence of visceral disease as an important adverse prognostic factor of overall survival (OS) in men with metastatic castration-resistant prostate cancer (mCRPC).  In this study, Halabi and colleagues analysed the data of nine phase 3 clinical trials involving over 8,000 men with metastatic prostate cancer, who had been treated with the chemotherapy drug docetaxel.

In the study patients were classified into four groups based on where their prostate cancer had spread to: the lymph nodes only, the lung, the liver (without the lung) or the bone (with or without lymph nodes and no metastases to other organs). 

Men whose cancer had spread to the lymph nodes only had the longest median survival, at 32 months, while those whose cancer had spread to the liver had the shortest median survival, at 14 months.  Men with bone metastasis was associated with a median survival of just over 21 months, while men whose prostate cancer had spread to the lung had a median survival of 19 months.  In conclusion the authors suggested further research and study is needed to understand the development of different metastatic patterns of disease, and a need to biopsy patients with recurrences to identify underlying mechanisms and treatment approaches for men with mCRPC.

3. Impact of radiation therapy dose escalation

American researchers, Zaorsky and colleagues, carried out a meta-analysis looking at how increasing the dose of external radiation therapy (RT) is related with biochemical failure free survival (BFFS) and other overall patient outcomes, including distant metastasis, overall survival (OS) and cancer-specific mortality. Data from almost 7,000 patients with localised and locally advanced prostate cancer from 12 randomised-controlled trials was included in the analysis.

The authors reported although BFFS rates improved with increasing radiotherapy dose, overall patient outcomes (i.e. distant metastasis, cancer-specific mortality, OS) did not improve.  They also reported that increasing dose was not associated with worse treatment toxicity, suggesting that current practices are safe. In conclusion the authors suggested their meta-analysis indicated that reliance on the PSA test as a proxy for patient outcomes may not as useful as previously though, and this results from this study may have broad implications for the design of future clinical trials and the interpretation studies.

4. Is radical prostatectomy linked with favourable outcomes?

Carlsson et al., conducted a prospective analysis of oncological and functional outcomes 12 months after treatment of very-low-risk prostate cancer with radical prostatectomy in men who could have been candidates for active surveillance. Of the 4000 men from 14 participating centres in Sweden, 338 men fulfilled the criteria for very-low-risk prostate cancer and were included in the study analysis.

Results of the study of men with very-low-risk prostate cancer undergoing open or robot-assisted radical prostatectomy showed that there were favourable oncological outcomes in approximately two-thirds. Of the 338 men, 35% experienced upgrading, defined as pT3 or post-operative Gleason sum of at least 7, while positive surgical margins were present in 16%. Only 2.1% of the men in the study were found to have a PSA concentration of greater than 0.1ng/mL 6-12 weeks postoperatively.  Additionally, urinary continence was observed in 84% of the men 12 months postoperatively, and 44% reported good erectile function 1 year after surgery.

From the results of their study, the authors concluded that choosing surgery as the primary treatment for this set of men in Sweden, men with very-low-risk prostate cancer, will result in a favourable oncological outcome for about two-thirds of the cases, but is likely to jeopardise a man's sexual and urinary health to a great extent.

The authors also said their results provided additional support for the use of active surveillance in men with very-low-risk prostate cancer, but the group of men with risk of upgrading and upstaging is not negligible - highlighting improved stratification in the future with more advanced mpMRI and target biopsies is urgently needed.

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