Prostatic Neoplasms: Eastham JA

Mohler J, Babaian RJ, Bahnson RR, Boston B, D'Amico A, Eastham JA, Hauke RJ, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Logothetis C, MacVicar G, Pollack A, Pow-Sang JM, Roach M, Sandler H, Shrieve D, Srinivas S, Twardowski P, Urban DA, Walsh PC, Anonymous00332. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17692170 No free full text.

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Eastham JA. · No affiliation provided · Eur Urol. · Pubmed #18657350 No free full text.

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Eastham JA. · No affiliation provided · Eur Urol. · Pubmed #17997016 No free full text.

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Eastham JA. · No affiliation provided · Expert Opin Emerg Drugs. · Pubmed #14661990 No free full text.

Abstract: For patients with newly diagnosed prostate cancer, clinical tumour stage, Gleason score of the diagnostic biopsy specimen and serum prostate-specific antigen (PSA) level can be combined to identify a group of men at increased risk of treatment failure after radiotherapy or radical prostatectomy. For these high-risk, but still clinically localised prostate cancers, multimodal treatment strategies may result in improved cancer control outcomes. Indeed, in the setting of clinical stage T3 - T4 tumours, the combination of radiotherapy followed by hormonal therapy has improved patient survival. The benefits of adjuvant or neoadjuvant hormonal and/or chemotherapy followed by radical prostatectomy in this setting are unclear, but are the subject of ongoing or planned Phase III clinical trials. These studies will help define the role of multimodal treatment strategies in this high-risk patient population.

Galvin DJ, Eastham JA. · Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Curr Opin Urol. · Pubmed #19365894 No free full text.

Abstract: PURPOSE OF REVIEW: Radical prostatectomy has evolved enormously over the last 25 years. Improvements include the use of smaller incisions, reduced blood loss, shorter hospital stays, and surgical refinement to improve the recovery of continence and potency. In addition, new technologies and minimally invasive techniques with the potential to further improve patient outcomes have been introduced. This article focuses on outcomes with open radical prostatectomy and is not meant to compare open radical prostatectomy and minimally invasive approaches. RECENT FINDINGS: Despite a lack of randomized controlled trials, strong observational cohort studies demonstrate lower rates of positive surgical margins, high 10-year and 15-year biochemical recurrence-free rates, excellent prostate cancer-specific mortality rates, and improved recovery of urinary incontinence and erectile function after open radical prostatectomy. We review publications from the past 24 months regarding oncologic outcome, continence, and erectile function, as well as some earlier manuscripts that emphasize key aspects of open radical prostatectomy. SUMMARY: Today open radical prostatectomy is a less-invasive procedure with low morbidity providing excellent control of clinically localized prostate cancer. Although open radical prostatectomy now accounts for a minority of radical prostatectomies in the United States, the concepts that have improved oncologic and quality-of-life outcomes are equally applicable to minimally invasive procedures.

Yossepowitch O, Eastham JA. · Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. · Curr Urol Rep. · Pubmed #18765114 No free full text.

Abstract: Controversy remains regarding the preferred therapy for high-risk, clinically localized prostate cancer. High-risk prostate cancer represents a diverse disease entity for which accurate risk assessment is critical to informed counseling and clinical decision making. For men with high-risk features, electing surgery as a local definitive therapy should be based on the best available evidence rather than a surgeon's bias and experience. Patients classified with high-risk prostate cancer by common definitions do not have a uniformly poor prognosis after radical prostatectomy. Many cancers that are clinically categorized as high risk are actually pathologically confined to the prostate, and most of these men do not require additional long-term therapy after surgery. For some high-risk patients, an integrated approach combining local and systemic therapy may be advantageous. Available studies using adjuvant and neoadjuvant strategies have their individual strengths and weaknesses; unfortunately, none has provided persuasive evidence to dictate the standard of care in the high-risk setting. Therefore, results are eagerly anticipated from ongoing randomized trials exploring the merits of perioperative chemohormonal therapy in high-risk patients. This review discusses current limitations and challenges in accurately identifying high-risk patients and focuses on radical prostatectomy alone or as part of multimodal therapy for men with high-risk prostate cancer.

Yossepowitch O, Eastham JA. · Department of Urology, Rabin Medical Center, Petah-Tikva, 49726, Israel. · World J Urol. · Pubmed #18335221 No free full text.

Abstract: OBJECTIVES: Consensus recommendations for the identification and treatment of men whose apparent organ confined prostate cancer has high risk features are lacking. Despite ongoing refinements in surgical technique and improvements in morbidity and functional outcomes, the tradition of steering high-risk patients away from radical prostatectomy (RP) remains steadfast. METHODS: We performed a medical literature search in English using MEDLINE/PubMed that addressed high risk prostate cancer. We analyzed the literature with respect to the historical evolution of this concept, current risk stratification schemes and treatment guidelines and related short and long term outcomes following RP. RESULTS: Contemporary evidence suggest that patients classified with high-risk prostate cancer by commonly used definitions do not have a uniformly poor prognosis after RP. Many cancers categorized clinically as high risk are actually pathologically confined to the prostate, and most men with such cancers who undergo RP are alive and free of additional therapy long after surgery. RP in the high-risk setting appears to be associated with a similar morbidity as in lower-risk patients. CONCLUSION: Men with clinically localized high-risk prostate cancer should not be categorically disqualified from local definitive therapy with RP. With careful attention to surgical technique, cancer control rates should improve further, and adverse effects on quality of life after RP should continue to decrease.

Eastham JA. · Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Nat Clin Pract Urol. · Pubmed #17921971 No free full text.

Abstract: Men with prostate cancer have a variety of treatment choices available, including expectant management with deferred treatment, brachytherapy, external-beam radiation therapy, or both of the latter options--with or without hormonal therapy, cryotherapy, and radical prostatectomy (RP). Physicians have long endeavored to guide patients through these choices on the basis of the health threat posed by the cancer, the potential effectiveness and complications associated with treatment, and the patient's life expectancy. As early detection programs now identify cancers much earlier in their natural history, individual patients have a longer life expectancy than in the past. The patient and physician must, therefore, weigh the potential benefit of the selected treatment with the risk of early or delayed complications that would detract from the patient's quality of life. Optimally, when a surgical approach is used to treat prostate cancer, the operation removes the cancer completely with negative surgical margins, avoids excessive blood loss or serious perioperative complications, and culminates in complete recovery of continence and potency. To achieve this, the surgeon must treat sufficient periprostatic tissue to achieve cure while preserving the cavernosal nerves required for erectile function and the neuromusculature required for normal urinary and bowel function. Evidence suggests that the small details of how a surgery is performed have a major impact on the outcome of RP. Here the role of surgical techniques in determining oncologic and quality of life outcomes after RP, focusing on open RP, are presented.

Huang WC, Lee CL, Eastham JA. · Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Curr Urol Rep. · Pubmed #17459271 No free full text.

Abstract: A significant number of men with prostate cancer will experience biochemical failure following treatment with primary radiation therapy. For patients with biopsy-proven recurrent cancer confined to the prostate, local salvage therapy may be a potentially curative treatment option. Most men, however, do not undergo local salvage therapy owing to difficulties in diagnosis as well as concerns over treatment-related complications in the salvage setting. Recently, improvements in technique and technology have substantially reduced the morbidity associated with locally ablative therapies, resulting in an increased interest in the use of minimally invasive therapies such as brachytherapy, cryotherapy, and high-intensity focused ultrasound in the salvage setting. Although these treatments are well tolerated, concerns remain over incomplete and inadequate treatment with locally ablative therapies. Future studies are required to appropriately select candidates for salvage ablative therapies and to determine the long-term oncologic efficacy of these treatments.

Eastham JA. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. · J Urol. · Pubmed #17161994 No free full text.

Abstract: PURPOSE: Patients with recurrent or metastatic prostate cancer generally receive androgen deprivation therapy, which can result in significant loss of bone mineral density. We explored androgen deprivation therapy related bone loss in prostate cancer, current treatments and emerging therapies. MATERIALS AND METHODS: Literature published on the pathogenesis and management of androgen deprivation therapy related bone loss was compiled and interpreted. Recent drug therapy findings were reviewed, including treatment guidelines. RESULTS: Men with prostate cancer often present with bone loss and the initiation of androgen deprivation therapy can trigger further rapid decreases. This results in an increased fracture risk, and greater morbidity and mortality. Early detection of osteoporosis through androgen deprivation therapy screening and prompt initiation of therapy are critical to prevent continued decreases. Lifestyle changes such as diet, supplementation and exercise can slow the rate of bone loss. Pharmacological therapy with oral and intravenous bisphosphonates has been demonstrated to prevent or decrease the bone loss associated with androgen deprivation therapy. However, important differences exist among various bisphosphonates with respect to efficacy, compliance and toxicity. Only zoledronic acid has been shown to increase bone mineral density above baseline and provide long-term benefit by decreasing the incidence of fracture and other skeletal related events in men with bone metastases. CONCLUSIONS: Androgen deprivation therapy associated bone loss adversely affects bone health, patient quality of life and survival in men with prostate cancer. Increased awareness of this issue, identification of risk factors, lifestyle modification and initiation of bisphosphonate therapy can improve outcomes. Education of patients and physicians regarding the importance of screening, prevention and treatment is essential.

Eastham JA. · Department of Urology at Memorial Sloan-Kettering Cancer Center, New York, NY, USA. · Nat Clin Pract Urol. · Pubmed #16474622 No free full text.

Abstract: Prostate cancer has a varied natural history. Men with similar serum prostate-specific antigen (PSA) levels, clinical stages, and histologic features in their tissue specimens can have markedly different outcomes. While prostate cancer is lethal in some patients, most men die with cancer rather than because of it. Moreover, histologically apparent cancer can be found in the prostate glands of approximately 42% of men over 50 years of age who die from other causes, but the lifetime risk that a man in the US will be diagnosed with prostate cancer is estimated to be 11% and the risk of dying from the disease is only 3.1%. Consequently, appropriate disease management requires risk assessment. How likely is it that a given man's cancer will progress or metastasize over his remaining lifetime? What is the probability of successful treatment? What are the risks of adverse effects and complications of each treatment? Physicians use a variety of clinical and pathologic parameters to assess the risk that a given cancer poses to an individual patient. In addition to the accepted parameters of serum PSA level, clinical staging, and pathologic grading and staging, PSA doubling time has emerged as an important factor in the evaluation of men with newly diagnosed prostate cancer or prostate cancer that recurs after treatment. PSA doubling time can also be used as a surrogate marker for prostate cancer-specific death. This review summarizes current knowledge regarding the role of PSA doubling time as a prognostic marker in men with prostate cancer.

Stephenson AJ, Eastham JA. · Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. · J Clin Oncol. · Pubmed #16278473 No free full text.

Abstract: Patients with isolated local recurrence of prostate cancer after radiation therapy may potentially be cured of their disease by salvage radical prostatectomy (RP). The stage-specific 5-year cancer-control rates of salvage RP resemble those of standard RP. However, the ability to effectively administer salvage treatment to patients with radiorecurrent disease is compromised by the lack of diagnostic tests with sufficient sensitivity and specificity to detect local recurrence at an early stage while it is amenable to local salvage therapy. By the time biochemical recurrence is declared using the current American Society for Therapeutic Radiology and Oncology definition, the majority of patients have advanced local disease, precluding successful local salvage therapy. When salvage RP is performed at prostate-specific antigen levels of 10 ng/mL or less, an estimated 70% of patients are free of disease at 5 years. With better patient selection and technical modifications, the morbidity associated with salvage RP has improved substantially. Rates of urinary incontinence and anastomotic stricture are acceptable, although one third of patients will experience these complications. Salvage cryotherapy is a minimally invasive alternative to salvage RP, but cancer-control rates appear to be inferior and it does not provide a clear advantage over salvage RP in terms of reduced morbidity. Patients with local recurrence after radiation therapy are at increased risk of metastatic progression and cancer-specific mortality. Currently, salvage RP represents the only curative treatment option for these patients. Salvage RP may favorably alter the natural history of biochemical recurrence after radiation therapy, but it must be instituted early in the course of recurrent disease to be effective.

Eastham JA. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Clin Prostate Cancer. · Pubmed #15992461 No free full text.

Abstract: Patients diagnosed with clinically localized prostate cancer face a daunting variety of management choices, including conservative management, brachytherapy, external-beam irradiation therapy with or without neoadjuvant hormonal therapy, as well as surgery. As we have learned to characterize the nature of each cancer, we can now "risk-adjust" treatment decisions. Physicians have long sought to guide patients through these choices based on their best judgment about the threat posed by the cancer, the effectiveness of treatment, the side effects of therapy, and the life expectancy of the patient. Today, many patients wish to participate more actively in decisions about their care, weighing the risks of treatment-related complications and the anxiety of living with an untreated or uncontrolled cancer. Patient utilities measure the value patients place on a health state, such as living with cancer or becoming incontinent, allowing quantitative assessments of risks and benefits of different therapeutic options specific for each patient's own preferences and the nature of his cancer and life expectancy. As early detection programs for prostate cancer expand, men are being diagnosed with prostate cancer earlier in its natural history. Some of these cancers may not require immediate treatment but rather a period of active surveillance with definitive curative therapy being administered only if there are signs of cancer progression. This review summarizes our current understanding of active surveillance with selective delayed definitive therapy.

Stephenson AJ, Scardino PT, Bianco FJ, Eastham JA. · Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. · Curr Treat Options Oncol. · Pubmed #15341674 No free full text.

Abstract: The greatest obstacle in the cure of patients with locally recurrent prostate cancer after radiation therapy is the lack of early detection markers. The majority of patients who are candidates for local salvage therapy have locally advanced disease, precluding successful salvage therapy. A low pretreatment prostate specific antigen (PSA) has shown to be a favorable prognostic variable for disease progression, regardless of the specific local salvage therapy used. Of all the local salvage treatment options for these patients, we believe that salvage radical prostatectomy (RP) offers patients the greatest likelihood of a cure. The salvage RP results approach those achieved with standard RP for patients of similar pathologic stage. When patients are treated early in the course of recurrent disease (preoperative PSA < 10 ng/mL), an estimated two-thirds of patients will be disease-free 5 years after salvage RP alone. With better patient selection and continued technical modifications, the morbidity associated with salvage RP has substantially improved. Perioperative complications approach those observed with standard RP and approximately two-thirds of patients will recover urinary continence. Select patients may also recover functional erections when nerve-sparing techniques are used. Salvage cryotherapy and brachytherapy are minimally invasive alternatives to salvage RP. The cancer control results of these procedures appear to be inferior to results achieved with salvage RP. Each of these procedures is associated with significant morbidity and do not appear to provide a clear advantage over salvage RP in terms of posttreatment complications, urinary continence, and erectile function. A long-term cure is possible for patients with locally recurrent prostate cancer after radiation therapy. Local salvage therapy must be instituted early to be successful in the course of progressive disease.

Eastham JA. · Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Expert Opin Investig Drugs. · Pubmed #14680451 No free full text.

Abstract: By combining the readily available clinical parameters of tumour stage, Gleason score of the diagnostic biopsy specimen and serum prostate-specific antigen level, men with newly diagnosed prostate cancer can be assessed as to their risk of treatment failure after radiotherapy or radical prostatectomy. For men considered to be at high-risk of treatment failure after local therapy alone, multimodal treatment strategies may result in improved cancer-control outcomes. This strategy has proven effective in the setting of clinical stage T3 - T4 tumours in which the combination of radiotherapy followed by hormonal therapy has improved patient survival. The benefit of neoadjuvant or adjuvant hormonal and/or chemotherapy followed by radical prostatectomy in this setting is unclear but is the subject of ongoing or planned Phase III clinical trials. These studies will help examine the role of multimodal treatment strategies in these high-risk patients.

Eastham JA, DiBlasio CJ, Scardino PT. · Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA. · Curr Urol Rep. · Pubmed #12756084 No free full text.

Abstract: The goal of primary radiation therapy in the treatment of prostate cancer is to eradicate all of the local tumor. Although patients with relapsing disease after radiation therapy differ in their risk of death from prostate cancer, many will develop local progression, metastasis, and death. The recognition that local recurrence after radiation therapy portends a poor prognosis has led to the development of improved methods for early detection of recurrence and the development of alternative treatment strategies for radioresistant cancers. This article reviews knowledge regarding radiation failure and the role of salvage radical prostatectomy for men with local recurrence after radiation therapy for prostate cancer.

Carver BS, Venable DD, Eastham JA. · Department of Urology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. · Urology. · Pubmed #11927333 No free full text.

Abstract: Granular cell tumors are soft tissue neoplasms that rarely involve the male external genitalia. Thus far, only 7 cases of granular cell tumor of the penis have been reported. We report a case of granular cell tumor of the penis in a man undergoing radical retropubic prostatectomy for organ-confined adenocarcinoma of the prostate.

Eastham JA, Scardino PT. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · Dis Mon. · Pubmed #11584249 No free full text.

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Eastham JA, Kelly WK, Grossfeld GD, Small EJ, Anonymous00067. · Memorial Sloan-Kettering Cancer Center, New York, New York 94115, USA. · Urology. · Pubmed #14747042 No free full text.

Abstract: The purpose of The Cancer and Leukemia Group B (CALGB) 90203 trial is to determine which of 2 treatment strategies is superior in treating men with high-risk, clinically localized adenocarcinoma of the prostate (stage T1 to T3a NX M0), defined as a predicted probability < or =60% of remaining free from disease recurrence for 5 years after surgery. Patients with a > or =10-year life expectancy will be randomized to either radical prostatectomy (RP) alone versus estramustine and docetaxel before RP. Participants will be excluded if they have received prior therapy for prostate cancer (except transurethral resection of the prostate) or are judged not to be appropriate candidates for RP. Eligible patients will be stratified according to their predicted probability of remaining free from disease recurrence at 5 years after surgery (0% to 20%, 21% to 40%, and 41% to 60%) and randomized. Neoadjuvant chemotherapy will be 6 cycles (1 cycle = 21 days) of estramustine (280 mg tid, days 1 to 5) and docetaxel (70 mg/m2 on day 2). Warfarin (2 mg/day orally) will be given for prophylaxis against deep venous thrombosis. Bilateral pelvic lymph node dissection and RP will be performed within 60 days of registration/randomization for men randomized to the surgery-alone arm. For men randomized to receive preoperative chemotherapy, the surgical procedure will be performed within 60 days of completion of chemotherapy. Patients will be monitored with history review, physical examination, and serum prostate-specific antigen (PSA) levels every 3 months for the first 3 years after surgery, every 6 months for the next 3 years, and annually thereafter. Biochemical disease recurrence will be defined as a serum PSA level >0.4 ng/mL on 2 consecutive occasions > or =3 months apart after RP. The time of biochemical failure is measured from the date of randomization to the time of the first PSA level <0.4 ng/mL that is confirmed on the second serial PSA. The primary study end point is to determine if early systemic treatment with neoadjuvant estramustine and docetaxel before RP in patients with high-risk prostate cancer will decrease 5-year recurrence rates when compared with RP alone. Secondary outcomes will include (1) the safety and tolerability of neoadjuvant estramustine and docetaxel before RP; (2) the impact of this neoadjuvant strategy on pathologic tumor stage, including lymph node and surgical margin status; (3) time to clinically apparent disease recurrence; and (4) overall survival. The impact of RP with and without neoadjuvant estramustine and docetaxel on the patient's quality of life from pretreatment through year 3 will be assessed. Frozen prostate tissue will be obtained from men undergoing prostatectomy who are enrolled in either the treatment or control arms of the trial. These samples will be analyzed for their RNA expression patterns in order to build outcome prediction models. Furthermore, using array-based methods of expression analysis, the sensitivity to chemotherapeutic agents and response to chemotherapy may likewise be predicted. The trial will enroll approximately 700 men during a 48-month period. Patients will be observed for 84 months after study closure. The power to detect a 36% decrease in 5-year recurrence rates is 90%.

Konety BR, Eastham JA, Reuter VE, Scardino PT, Donat SM, Dalbagni G, Russo P, Herr HW, Schwartz L, Kantoff PW, Scher H, Kelly WK. · Department of Urology, Memorial Sloan-Kettering Cancer Center and Cornell University, New York, New York 10021, USA. · J Urol. · Pubmed #14713792 No free full text.

Abstract: PURPOSE:We determined the feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy in locally advanced (stage T3 or greater) and/or high risk tumors (Gleason 8 to 10 and/or serum prostate specific antigen (PSA) greater than 20 ng/ml). MATERIALS AND METHODS: Enrollment criteria included clinical stage T1 to 2 with any Gleason grade and PSA greater than 20 ng/ml, clinical stage T3 to 4 with any serum PSA or Gleason grade, or any clinical stage with biopsy Gleason grade of 8 to 10 and any serum PSA. All patients received neoadjuvant hormonal therapy during chemotherapy (4 cycles of paclitaxel and carboplatin and estramustine) followed by radical prostatectomy. Nerve sparing was decided on an individual basis and a nerve graft was offered to those who underwent unilateral or bilateral nerve resection. Perioperative morbidity, mortality and delayed complications were assessed. RESULTS: A total of 36 patients were enrolled. After chemohormonal therapy clinical stage was less in 39% of patients and greater in 36%. Bilateral nerve sparing was performed in 3 patients and the remaining 33 underwent either unilateral or bilateral neurovascular bundle resection with nerve grafts performed in 17 (52%). Deep vein thrombosis (22%) was the most frequent complication of chemotherapy. Minor postoperative complications occurred in 6 patients. At a median followup of 29 months (range 5 to 51) after radical prostatectomy 32 (89%) were continent and 5 (15%) preoperatively potent men remained potent. The positive surgical margin rate was 22%. Of all subjects 45% remain free from biochemical recurrence. CONCLUSIONS: Neoadjuvant chemohormonal therapy followed by radical prostatectomy can be performed with low morbidity. Positive surgical margin rates are low. This approach yielded good local control of disease, however impact on tumor recurrence and survival is not known.

Eastham JA, Riedel E, Latkany L, Fleisher M, Schatzkin A, Lanza E, Shike M, Anonymous00494. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. · Urology. · Pubmed #14550442 No free full text.

Abstract: OBJECTIVES: To examine whether a diet low in fat and high in fiber, fruits, and vegetables and ethnicity had any influence on serum prostate-specific antigen (PSA) levels, because serum PSA is a marker for the presence of prostate cancer. The incidence of prostate cancer increases with age, varies by ethnicity, and is greater among men with a first-degree relative who has had the disease. Large international variations in the rates of prostate cancer incidence and mortality, as well as the incidence changes in migrants and their offspring, also suggest that exogenous factors, including diet, have a strong influence on the development of this disease. METHODS: We used data and blood samples from the Polyp Prevention Trial, a multicenter randomized trial designed to evaluate the impact of a diet low in fat and high in fiber, fruits, and vegetables on the recurrence of colorectal adenomas. Recruitment was from 1991 through 1994. Participants were followed up from their baseline recruitment date for 4 years. From this group, we identified 1100 white men and 97 black men who were 35 years of age or older, did not have prostate cancer, and had serum samples available for study. RESULTS: At baseline, no difference was present in the fat intake for the black and white men (mean +/- SE, 90 +/- 3.6 g/day and 84 +/- 1.0 g/day, respectively; P = 0.15). The baseline serum PSA levels did not vary by ethnicity. For black men, the mean serum PSA level was 2.2 +/- 0.36 ng/mL compared with 2.0 +/- 0.07 ng/mL for white men (P = 0.64). Although all men assigned to the intervention group markedly reduced their fat intake by approximately 15% and increased their fruit and vegetable intake by approximately 2.25 servings per day, no difference was noted in the kinetics of the serum PSA levels by dietary intervention or race. CONCLUSIONS: Although ethnic differences in the incidence of prostate cancer are well defined, we found no difference in the baseline fat intake among black and white men that might have contributed to this difference. Serum PSA, a marker often used in early detection programs for prostate cancer, was not associated with manipulation of the amount of fat in the diet, regardless of ethnicity.

Thompson RH, Eastham JA, Scardino PT, Sheinfeld J. · Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. · Urol Oncol. · Pubmed #19285234 No free full text.

Abstract: In this article, we present the critical elements of fellowship training for the urologic oncologist. As an example, the Memorial Sloan-Kettering Cancer Center experience is outlined in detail, including the clinical experience, research curriculum, laparoscopic and minimally invasive exposure, and didactic lecture series.

Berglund RK, Stephenson AJ, Cronin AM, Vickers AJ, Eastham JA, Klein EA, Guillonneau BD. · Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. · Urology. · Pubmed #19278718 No free full text.

Abstract: OBJECTIVES: A preoperative nomogram is an effective tool for assessing the risk of disease progression after radical prostatectomy for localized prostate cancer. To better understand the performance of nomograms for patients with a low prostate-specific antigen (PSA) level, we examined whether patients with a PSA level <2.5 ng/mL had outcomes different than predicted by a validated preoperative nomogram. METHODS: A cohort of 6130 patients from 2 referral centers was analyzed. Kaplan-Meier methods were used to estimate the recurrence-free probabilities stratified by PSA group (<2.5 vs >or=2.5 ng/mL). Cox proportional hazards regression analysis was used to evaluate whether the PSA grouping was associated with biochemical recurrence, controlling for preoperative nomogram probability. RESULTS: Of 6130 patients, 399 (6.5%) had a PSA level <2.5 ng/mL. Patients with a PSA level of <or=0.5 ng/mL had a high rate of nonorgan-confined disease (33% vs 15% for PSA levels of 0.6-2.5 ng/mL). The median follow-up for recurrence-free patients was 2.4 years, and 10 patients with a PSA level of <2.5 ng/mL and 597 patients with a PSA level >2.5 ng/mL developed recurrence (total 607/6130). With adjustment for the preoperative nomogram probability, no significant difference was found in recurrence by PSA grouping (hazard ratio 0.78 for PSA <2.5 vs >or=2.5 ng/mL; 95% confidence interval 0.42-1.48; P = .5). CONCLUSIONS: Patients with a low PSA comprise a small proportion of those treated, and most have palpable disease. Patients with especially low PSA values (<or=0.5 ng/mL) have a high rate of nonorgan-confined disease. We saw no evidence that patients with low PSA levels have worse outcomes, after the stage and grade were taken into account.

Helo P, Cronin AM, Danila DC, Wenske S, Gonzalez-Espinoza R, Anand A, Koscuiszka M, Väänänen RM, Pettersson K, Chun FK, Steuber T, Huland H, Guillonneau BD, Eastham JA, Scardino PT, Fleisher M, Scher HI, Lilja H. · Departments of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center,New York, NY 10065, USA. · Clin Chem. · Pubmed #19233911 No free full text.

Abstract: BACKGROUND: Reverse transcription-PCR (RT-PCR) assays have been used for analysis of circulating tumor cells (CTCs), but their clinical value has yet to be established. We assessed men with localized prostate cancer or castration-refractory prostate cancer (CRPC) for CTCs via real-time RT-PCR assays for KLK3 [kallikrein-related peptidase 3; i.e., prostate-specific antigen (PSA)] and KLK2 mRNAs. We also assessed the association of CTCs with disease characteristics and survival. METHODS: KLK3, KLK2, and PSCA (prostate stem cell antigen) mRNAs were measured by standardized, quantitative real-time RT-PCR assays in blood samples from 180 localized-disease patients, 76 metastatic CRPC patients, and 19 healthy volunteers. CRPC samples were also tested for CTCs by an immunomagnetic separation system (CellSearch; Veridex) approved for clinical use. RESULTS: All healthy volunteers were negative for KLK mRNAs. Results of tests for KLK3 or KLK2 mRNAs were positive (> or =80 mRNAs/mL blood) in 37 patients (49%) with CRPC but in only 15 patients (8%) with localized cancer. RT-PCR and CellSearch CTC results were strongly concordant (80%-85%) and correlated (Kendall tau, 0.60-0.68). Among CRPC patients, KLK mRNAs and CellSearch CTCs were closely associated with clinical evidence of bone metastases and with survival but were only modestly correlated with serum PSA concentrations. PSCA mRNA was detected in only 7 CRPC patients (10%) and was associated with a positive KLK mRNA status. CONCLUSIONS: Real-time RT-PCR assays of KLK mRNAs are highly concordant with CellSearch CTC results in patients with CRPC. KLK2/3-expressing CTCs are common in men with CRPC and bone metastases but are rare in patients with metastases diagnosed only in soft tissues and patients with localized cancer.

Eggener SE, Mueller A, Berglund RK, Ayyathurai R, Soloway C, Soloway MS, Abouassaly R, Klein EA, Jones SJ, Zappavigna C, Goldenberg L, Scardino PT, Eastham JA, Guillonneau B. · University of Chicago, Chicago, Illinois, USA. · J Urol. · Pubmed #19233410 No free full text.

Abstract: PURPOSE: For select men with low risk prostate cancer active surveillance is more often being considered a management strategy. In a multicenter retrospective study we evaluated the actuarial rates and predictors of remaining on active surveillance, the incidence of cancer progression and the pathological findings of delayed radical prostatectomy. MATERIALS AND METHODS: A cohort of 262 men from 4 institutions met the inclusion criteria of age 75 years or younger, prostate specific antigen 10 ng/ml or less, clinical stage T1-T2a, biopsy Gleason sum 6 or less, 3 or less positive cores at diagnostic biopsy, repeat biopsy before active surveillance and no treatment for 6 months following the repeat biopsy. Active surveillance started on the date of the second biopsy. Actuarial rates of remaining on active surveillance were calculated and univariate Cox regression was used to assess predictors of discontinuing active surveillance. RESULTS: With a median followup of 29 months 43 patients ultimately received active treatment. The 2 and 5-year probabilities of remaining on active surveillance were 91% and 75%, respectively. Patients with cancer on the second biopsy (HR 2.23, 95% CI 1.23-4.06, p = 0.007) and a higher number of cancerous cores from the 2 biopsies combined (p = 0.002) were more likely to undergo treatment. Age, prostate specific antigen, clinical stage, prostate volume and number of total biopsy cores sampled were not predictive of outcome. Skeletal metastases developed in 1 patient 38 months after starting active surveillance. Of the 43 patients undergoing delayed treatment 41 (95%) are without disease progression at a median of 23 months following treatment. CONCLUSIONS: With a median followup of 29 months active surveillance for select patients appears to be safe and associated with a low risk of systemic progression. Cancer at restaging biopsy and a higher total number of cancerous cores are associated with a lower likelihood of remaining on active surveillance. A restaging biopsy should be strongly considered to finalize eligibility for active surveillance.