Every month we collate a selection of the latest clinically-relevant research to help you keep up to date with the most important developments in the field of prostate cancer.

Articles have been selected based on impact factor of the journal, relevance to UK clinical practice and general interest. You may be able to access the full text from your Trust's library service or via ATHENS registration. Information from PubMed explains other ways to access full text articles. 

December 2014

Research round up from the clinic - top four articles from December 2014 cover:

1) The impact of recommendations against PSA screening in Canada

Bhindi et al, evaluated whether prostate biopsy rates and cancer detection rates in Toronto, Canada had changed following the U.S. Preventive Services Task Force (USPSTF) recommendation against PSA screening for prostate cancer. The group analysed over 3,000 biopsies from 2008 to 2010. The results of their time series analysis suggested that there was a significant decrease in the overall number of biopsies and first-time biopsies performed following the USPSTF recommendation. Analysis also showed a lower proportion of older men were being subjected to prostate biopsy over time.

2) Psychosocial interventions for men with prostate cancer

A systematic review randomised controlled trials by Parahoo and colleagues evaluated the effectiveness of psychosocial interventions for men with prostate cancer in terms of quality of life, self-efficacy, knowledge, uncertainty, distress and depression. The review included over 3,000 men from 19 studies, showing that psychosocial interventions may have small, short-term beneficial effects on certain domains of wellbeing when compared with usual care. However, the authors also conclude that the evidence from the review was not strong enough to provide meaningful, clinically important conclusions about the effects of psychosocial interventions for men with prostate cancer. 

3) Does Magnetic Resonance Imaging-targeted Biopsy Enhance the Diagnostic Accuracy of Prostate Cancer Detection?

Schoots and colleagues carried out a systematic review and meta-analysis to evaluate the evidence regarding the diagnostic benefits of magnetic resonance imaging targeted biopsy (MRI-TBx) compared to transrectal ultrasound-guided biopsy (TRUS-Bx). Sixteen studies were reviewed, and they reported MRI-TBx had a higher rate of detection of potentially significant prostate cancer and a lower rate of detection of insignificant prostate cancer compared to the standard TRUS-Bx. However the authors concluded MRI-TBx and TRUS-Bx did not significantly differ for overall prostate cancer detection, and recommendations in favour of MRI without randomised systematic biopsies would be misleading, and cannot be drawn from their meta-analysis.

4) Digital rectal examination in primary care is important for early detection of prostate cancer

Researchers from Trinity College, Ireland evaluated the role of digital rectal exam (DRE) in the detection of prostate cancer in men with PSA levels within the normal age-specific range. Walsh et al. reported that the sensitivity and specificity of DRE alone was 81% and 40% respectively, with a positive predictive value of 42% and a negative predictive value (NPV) of 79%. They recommended the use of DRE in conjunction with PSA in those men who are appropriately counselled on the risks associated with over-detection of prostate cancer.

November 2014

Global prostate cancer survival rates

A global study (CONCORD 2), by Allemani et al, analysed data on almost 5 million men with prostate cancer across 61 countries. Five year survival was varied from less 40% to greater than 95%, with striking and persistent increases in prostate cancer survival in many countries between 1995-99 and 2005-09. The article indicated the introduction of new diagnostic techniques in wealthier countries, such as PSA testing for prostate cancer, has led to more patients being diagnosed at an early stage of disease- typically with a good prognosis. This inflates both incidence and survival rates.

Report links obesity to risk of developing aggressive prostate cancer

The World Cancer Research Fund recently analysed and published an updated report on how diet, nutrition, physical activity and weight affect prostate cancer risk and survival. The report looked at data from over nine million men and 191,000 prostate cancer cases from 104 studies from around the world. The report concluded that there is strong evidence that being overweight or obese increases the risk of advanced prostate cancer, and there is strong evidence that consuming beta-carotene (either through food or supplements) is unlikely to have a substantial effect on the risk of prostate cancer. More information on this report and a comment from Prostate Cancer UK can be found here.

New avenues for research into treatments for advanced prostate cancer

Results from Mavrou and colleagues recently found that blocking the activity of a protein called SRPK1 could prevent prostate tumours growing in mice. These blockers work by preventing the growth of blood vessels into the tumour. The researchers showed SRPK1 is found at high levels in human prostate cancers. The study results support the theory that this protein (SRPK1) prevents VEGFA from switching between the form that prevents blood vessel growth to the form that promotes it. Thus in turn preventing the cancer from growing, because there are fewer blood vessels to deliver oxygen. Matthew Hobbs, deputy director of research at Prostate Cancer UK, said: “Each finding like this represents a crucial block in building our understanding of what can slow down and stop the progression of prostate cancer. This will give us the foundations needed to develop new targeted treatments for those men in desperate need.” Further comment on this study from Prostate Cancer UK can be found here.

Diagnostic performance of the 4K score

The results of a multi-institutional, prospective study by Parekh et al in the United States demonstrated that the 4Kscore had good diagnostic performance in identifying patients most likely to benefit from biopsy because of a high risk of having a clinically significant tumour that would require treatment. The accuracy of the 4Kscore was compared to a modified Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) 2.0 and showed superior discrimination in detecting Gleason ≥7 prostate cancer. The authors concluded the 4Kscore, a clinical decision aid that combines measurement of blood-based biomarkers with important clinical information, has potential to reduce the number of prostate biopsies performed while delaying the diagnosis of only a small number of significant cancers.

September-October 2014

Genetic Testing could identify men at six-fold increased risk of prostate cancer

This genome-wide association study, conducted by Al Olama et al., looked at understanding the genetic association with prostate cancer risk. The international study identified 23 new genetic variants associated with increased risk of the disease.

The authors included scientists from The Institute of Cancer Research, London, the University of Cambridge, as well as across the United States. Al Olama et al. conducted a meta-analysis of genetic variants in almost 90,000 men in populations of European, African, Japanese and Latino ancestry. The authors reported 23 new variants explained a third of the familial risk for prostate cancer in European-ancestry populations. Data from this study now brings the total number of common genetic variants linked to prostate cancer to 100, and testing for them can identify the one per cent of men of European ancestry whose risk of prostate cancer is six times higher than the population average, or the ten per cent whose risk is three times higher. A full Press release from Prostate Cancer UK can be found here.

A randomized phase 3 study of abiraterone acetate (AA) in prostate cancer patients without prior chemotherapy

In this phase 3 trial, Ryan et al. investigated the overall survival and safety outcomes of abiraterone acetate in metastatic castration-resistant prostate cancer patients, without prior chemotherapy. The final results presented at the European Society for Medical Oncology 2014 conference appear to confirm that abiraterone significantly improves the survival of men with advanced prostate cancer when given before chemotherapy. Prostate Cancer UK look forward to seeing the findings validated and published in a peer-reviewed journal, which will of course be shared on our Latest Research page.

Does new research show some steroid treatments can drive prostate cancer?

Early stage research conducted at The Institute of Cancer research London, The Royal Marsden NHS Foundation and University of Trento, Italy by Carreira et al., looked at how testing tumour DNA could allow doctors to follow the progression of prostate cancer and get an accurate picture of a man’s cancer development – and therefore match treatment to how an individual man’s cancer is developing. The group used their new technique in 16 men with advanced prostate cancer, who were receiving abiraterone as part of their treatment. In three of the 16 men the test showed that some of the sites of their cancers had developed mutations in the androgen receptors. A full behind the headlines report by Prostate Cancer UK can be found here.

Factors driving inequality in prostate cancer survival

Using data from the National Cancer Registry Ireland, of men diagnosed with prostate cancer from 1998-2009, Burns et al. examined the role of a range of clinical and socio-demographic variables in prostate cancer survival. The researchers concluded patients treated in a private healthcare setting had an average of 40% reduced risk of mortality compared to those who were treated solely in the public setting. In addition, patients who accessed public healthcare provision from the lowest socio-economic group had around 21-25% increased risk of death compared to those from the highest socio-economic group. Due to availability of data the study examined all-cause mortality. The authors’ highlighted care is warranted in the interpretation of their results.