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. 

February 2015

Research round up from the clinic - top four articles from February 2015

1: Increasing cancer rates

Ahmad and his colleagues estimated the lifetime risk of cancer in Britain for men and women born in each year from 1930 to 1960.  The article, published in the British Journal of Cancer, concluded the lifetime risk of cancer increase from 39% to 54% for men born in 1930 and 1960 respectively.  Cancer Research UK, who co-authored the paper, also featured details of the study in its Science blog.

2: Novel prostate cancer drugs which target protein receptors could provide effective treatments for advanced prostate cancer

Early state prostate cancer tumours depend on hormones called androgens. As the disease progresses, it becomes resistant to drugs that block androgen receptors. Researchers from the United States found that GPR158, unlike other members of the GPCR family, is stimulated by androgens, which in turn stimulates androgen receptor expression, leading to tumour growth. Patel and his colleagues conclude their data suggest GPR158 could provide a target for new prostate cancer drugs.
Dr Matthew Hobbs, deputy director of research at Prostate Cancer UK, said: "There's still so much we don't know about advanced prostate cancer. Working out why the disease stops responding to treatment over time is one of the big unanswered questions. The findings revealed in this paper provide us with another clue, but we've still got a long way to go."

3: American cancer society prostate cancer survivorship care guidelines endorsed

The American Society of Clinical Oncology (ASCO) has endorsed the American Cancer Society’s Prostate Cancer Survivorship Care Guidelines. The guidelines provide recommendations to primary care physicians on best practices in follow-up care for men after prostate cancer treatment.
The recommendations include health promotion, prostate cancer surveillance, screening for new cancers, long-term and late functional effects of the disease and its treatment, psychosocial issues, and coordination of care between the survivor’s primary care physician and prostate cancer specialist in the United States.

4: Final survival analysis of a phase 3 study of abiraterone and prednisone

Ryan and colleagues report the final analysis of overall survival from a randomised phase 3 trial of abiraterone and prednisone versus placebo plus prednisone in chemotherapy-naïve patients with advanced and aggressive prostate cancer. The results showed that lived more than four months longer on average if they received abiraterone before chemotherapy than if they did not.
Owen Sharp, chief executive of Prostate Cancer UK, said: "This data further confirms the huge benefits of abiraterone for men with incurable prostate cancer who haven't yet received chemotherapy. We want to see this additional evidence swiftly lead to this use of abiraterone being routinely available for all men who need it in the UK."

January 2015

Research round up from the clinic - top four articles from January 2015

1: Does screening save lives?

Saquib and colleagues from Stanford University conducted a systematic review of randomised controlled trials to evaluate whether screening decreases mortality from diseases. The study evaluated 39 screening tests for 19 diseases, including numerous cancers, heart and vascular diseases and type-2 diabetes. The authors concluded reductions in disease-specific mortality were uncommon and reductions in all-cause mortality were very uncommon, or even non-existent with the screening tests assessed. They also discussed the potential underlying reasons for the overall poor performance of screening in reducing mortality, some of which may coexist: screening tests may not have sufficient sensitivity and specificity to capture the disease early in its process; lack of effective treatment options for the disease; treatments are available but the risk-benefit ratio of the whole screening and treatment process is unfavourable.

2: Can testosterone help fight prostate cancer?

Scientists from the John Hopkins University School of Medicine in the United States conducted a pilot study investigating the effects of bipolar androgen therapy (BAT), a treatment strategy which involves alternating high and low testosterone levels, in 16 patients with asymptomatic castration-resistant prostate cancer (CRPC). The authors reported BAT was well tolerated and resulted in high rates of PSA and radiographic responses. They also suggested the data demonstrated BAT may have the potential to reverse resistance to androgen-ablative therapies, re-sensitising men to drugs to which their cancer had become resistant. Schweizer and his colleagues concluded BAT shows promise as treatment for CRPC and should be further evaluated in larger trials.

3: Does targeted biopsy increase detection of prostate cancer?

Siddiqui and colleagues from the National Cancer Institute in the United States compared targeted and standard biopsy approached alone, and in combination, in diagnosing intermediate- to high-risk prostate cancer. This prospective cohort study assessed the results of 1003 men who had been referred for elevated level of prostate-specific antigen (PSA) or abnormal digital rectal examination results. The authors reported the targeted biopsy technique detected 30% more high-risk cases and 17% fewer low-risk cases than standard technique. They also concluded the utility of standard biopsy in addition to targeted biopsy was limited  - 200 additional men would have to receive both biopsies in order to detect 1 additional case of high-risk cancer.. In addition, for every 1 additional high-risk tumour diagnosed, 17 additional low-risk tumours would also be diagnosed.

4: Variation in cancer risk: Nature, nurture or just bad luck?

Researchers, Tomasetti and Vogelstein, from the United States investigated how stem cell division takes place in different tissue types, to find out whether the sheer number of divisions can lead to more DNA mutations occurring. The results of the study showed that the lifetime risk of cancers is strongly correlated (0.81) with the total number of stem cell divisions. The authors concluded variation in the incidence of cancer across different tissues can be explained largely in terms of the differences in the rates of cell division between tissues: the greater the number of cell divisions, the greater the number of random mutations, hence the greater the incidence of cancer.

See below for more articles of interest published online this month (January 2015).

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.