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. 

November 2015

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.

October 2015

Research round up from the clinic - top three articles from October 2015:

1. Cardiovascular risks are a better indicator of high-grade prostate cancer than metabolic syndrome

Evaluating Metabolic Syndrome (MS) as a single condition may be an inappropriate approach to investigating prostate cancer risk. This study aimed to evaluate the strength of association between individual cardiovascular risks (CVR) and prostate cancer diagnosis at biopsy by correlating the histological characteristics (Gleason score) with the grading of CVR. This may be a more appropriate method to define the metabolic profile of patients since CVR status includes several possible risk factors such as age, smoking status and personal and family history of renal/cardiovascular disease, which are not included in the definition of MS. According to the study by Nunzio et al, moderate/high CVR was associated with a 2.5 times increased risk of high-grade prostate cancer. Further studies in a large patient population across multiple institutions and countries are needed to confirm the results of the research and to better understand which molecular pathway is responsible for the observed results.

2. ACE inhibitors reduce incidence, severity and duration of radiation proctitis 

Proctitis is one of the complications of prostatic radiotherapy and can have a profound negative effect on a patient’s overall quality of life. It can lead to the clinical manifestations of rectal bleeding, tenesmus, diarrhoea and strictures. Previous studies have shown that ACE inhibitors (ACEIs) may prevent development of radiation-induced injuries in certain tissue types. Research conducted at the University of Dundee with the participation of 817 patients suggests that the use of ACEIs during prostate radical radiotherapy is significantly associated with a low grade proctitis. These findings suggest that ACEIs help to reduce the incidence of proctitis after radical radiotherapy as well as accelerating the resolution of proctitis. The mechanism of action of ACEIs in reducing severity, incidence and resolution time of radiation induced proctitis is still unknown.

3. Family history of prostate cancer increases risk of low grade, but not high grade, prostate cancer

Current urological guidelines consider family history of prostate cancer as a strong risk factor for prostate cancer, particularly in men who have first-degree relatives with prostate cancer. A study using patients from the Swiss arm of the European Randomised Study of Screening for Prostate Cancer (ERSPC), on which patients had systematic PSA level tests done every 4 years, concluded that men with a family history of prostate cancer are at an increased risk of low-grade but not aggressive (high grade) prostate cancer. While family history should still be considered as a risk factor in daily practice, the assessment should become much more sophisticated and detailed, including the exact origins of diagnosis that is whether prostate cancer in relatives has been detected by PSA screening or clinically.

September 2015

Research round up from the clinic - top three articles from September 2015:

1. Intermittent ADT may improve quality of life in men with prostate cancer

Researchers at Laval University in Canada conducted a systematic review and meta-analysis comparing intermittent and continuous androgen deprivation therapy in patients with prostate cancer. Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. However, this treatment causes adverse effects, alters quality of life, and may lead to castration-resistant disease. Intermittent androgen deprivation has been studied as an alternative

The review by Mangan et al. included the results of 15 trials from 22 articles published between 2000 and 2013. The authors observed no significant difference in overall survival between intermittent and continuous therapy. In addition there was no difference between the two treatment regimens in cancer-specific survival and progression-free survival. Only a minimal difference in patient’s self-reported quality of life was observed between the two treatment regimens, with an improvement in physical and sexual functioning with intermittent therapy. Overall the authors concluded that some quality of life criteria appeared to improve with intermittent therapy, and it can be considered as an alternative option in patients with recurrent or metastatic prostate cancer.

2. Clinician and patient evaluation of nurse-led active surveillance

As part of the Prostate testing for cancer and Treatment (ProtecT) trial a nurse-led active monitoring protocol was developed. The aim of this study by Wade et al. was to assess the acceptability of ProtecT nurse-led AM to men, urologists and research nurses within the ProtecT trial, and to compare these with experiences of standard urologist-led AS care in urology centres outside the ProtecT trial. Interviews were conducted with men receiving active monitoring under nurse-led care and questionnaires completed by urologists and research nurses delivering ProtecT trial care and compared with interviews and questionnaires conducted with men, urologists and specialists nurses from non-ProtecT urology centres (non nurse-led active monitoring clinics).

Results of the interviews and questionnaires indicated the ProtecT trial model of nurse-led active monitoring for men with localised PCa was acceptable to men, urologists and nurses within the trial and of interest to those outside it.

Urologists believed that nurse-led active monitoring had enabled high-quality care to be delivered, whilst also reducing the burden on urologist clinics to the benefit of patients. Nurses believed nurse-led AM enabled them to increase their professional development while providing a high-quality, flexible service to patients. Patients within the ProtecT trial were very positive about nurse-led care because it allowed flexibility, accessibility and had greater continuity of service. Patients outside the ProtecT trial perceived nurse-led care to be acceptable and desirable in relation to using NHS resources cost-effectively. However, a small number of men receiving consultant-led care outside ProtecT trial (3/20) expressed a preference for care from the urologist. At first interview (6-12 months post-diagnosis) a similar number receiving nurse-led care within ProtecT trial (2/22) also expressed preferences for care from the urologist, but these preferences were replaced with a preference for nurse-led care by the time of the third interview (5–6 years post-diagnosis). Urologists and Specialist Nurses outside the ProtecT trial advocated a move towards nurse-led active monitoring, as it offered more efficient use of resources, may improve the quality and consistency of care. In conclusion the authors stated the ProtecT trial active monitoring nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology.

3. Prostate cancer death risk linked to stress

Jan and colleagues evaluated the association between perceived stress, social support, disease progression and mortality after diagnosis of prostate cancer in Swedish men. The study surveyed more than 4,000 Swedish men treated for clinically localised prostate cancer regarding stress, grief, sleep habits and social support. The authors reported after a mean follow up of around 4 years, around 3% of men with prostate cancer died from prostate cancer and almost 7% had died from other causes. Results of the study showed that men in the highest third of perceived stress were two thirds more at risk of prostate cancer-specific mortality compared to men in the lowest third of perceived stress. In addition, men with high stress levels were also seen to have high frequencies of sleep loss, and lessened social support, contributing negatively to their quality of life.

The authors also reported that their data did not show a relationship between prostate cancer relapse and perceived stress. The authors acknowledge their study does not recommend or prescribe specific interventions, but confirms previous the recommendation of previous studies to target improvements in quality of life.

If you are feeling stressed or have concerns about prostate cancer, our Specialist Nurses can help support you and answer your questions.