Research round-up from the clinic - top three articles from November 2015:
1. STHLM3 model could reduce unnecessary biopsies without compromising the ability to diagnose prostate cancer
In a study of 58,818 men aged 50-69 published in The Lancet Oncology, researchers found that a test, known as STHLM3, reduced the number of biopsies given to men who received it by 27%, compared to relying solely on PSA measurement. The scientists at the Karolinska Insitute in Sweden combined PSA measurement and a prostate exam, along with analysis of more than 200 genetic markers linked to prostate cancer, and clinical information such as age and family history, to try to develop a more accurate test.
The researchers found that the S3M test was much better than PSA alone at detecting potentially dangerous prostate cancers (those with a Gleason score of 7 or more), and every independent step of the assessment process – from risk assessment, through biomarker panel to prostate exam – added an extra level of prediction to the test. These results give compelling evidence that the S3M risk assessment model can dramatically reduce the number of men undergoing unnecessary biopsies, without compromising the safety of men who do have an aggressive form of prostate cancer.
Prostate Cancer UK believe that men need a better test of their risk as soon as possible. That’s why we’re funding an international team of scientists to develop a risk assessment tool for use within primary care in the UK. These plans are still going full-steam ahead, and we expect to have more to say about this in the New Year. That work will accommodate this new Stockholm model when we’ve shown that it’s effective in the UK.
2. Radiotherapy trial shows fewer, higher doses don't worsen patient side effects and could save the NHS millions per year
Research from the Institute of Cancer Research presented at the National Cancer Research Institute (NCRI) Cancer Conference showed the effectiveness of using IMRT in higher doses over fewer hospital visits than is currently recommended on the NHS. After 5 years of follow-up with 3,216 men, the phase III CHHiP trial has shown that treatment with fewer, higher doses (20 x 3Gy/day) than currently offered by the NHS (27 x 2Gy/day) delays progression of prostate cancer at least as effectively as greater numbers of lower doses. The new regime is just as good for quality of life as the longer, lower-dose regime, and is associated with less than half the rate of side-effects of older conformal radiotherapy.
The new regime for prostate cancer would save each patient 17 fatigue-inducing hospital trips and complex radiotherapy treatments, leading to a reduction nationally of more than 150,000 visits per year.
Note: these results are yet to be published in a peer-reviewed journal.
3. Enzalutamide is effective and well tolerated in elderly patients – an analysis from the PREVAIL trial
In the double-blind, international PREVAIL trial, 1717 chemotherapy-naïve men with mCRPC were randomly assigned to receive enzalutamide 160 mg orally daily or placebo. Of those, 609 patients (35%) were elderly (75+). An further analysis by Graff et al, has shown that overall survival was 32.4 months among the elderly patients taking enzalutamide, compared to 25.1 months in the elderly placebo group (7.3 months survival benefit). In regard to safety, the incidence of adverse events was similar in both treatment arms, but there was an overall higher incidence of falls among elderly patients compared with younger patients and among elderly patients receiving enzalutamide vs those receiving placebo.