American Society of Clinical Oncology, Feb. 26-28, 2009

Genitourinary Cancers Symposium

The Genitourinary Cancers Symposium -- co-sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Urologic Oncology -- took place Feb. 26 to 28 in Orlando and attracted more than 1,300 attendees from around the world. The meeting presented 342 abstracts addressing advances in the prevention, screening and treatment of genitourinary cancers.

Some of the most important studies described innovative approaches to predict the risk of prostate cancer and improve overall survival in men with advanced disease, said Howard Sandler, M.D., of the Cedars-Sinai Medical Center in New York City, chair of the symposium's news planning team. "One of them addresses the clinical utility of a new urine-based test for the presence of an altered gene that is associated with approximately 50 percent of prostate cancers. This association was first observed in the laboratory in 2005, and the test -- which is now being commercially developed -- could get into physicians' offices in the relatively near future."

In a study presented by Jack Goskopf, Ph.D., of Gen-Probe, Inc., researchers assessed the prognostic capability of the test -- which identifies fusions between TMPRSS2 (T2) and the oncogenic transcription factor ERG -- in men scheduled for prostate biopsy, including those who were diagnosed with prostate cancer. Relative to biopsy outcome, they found that the test had a specificity of 86 to 91 percent and a sensitivity of 43 to 50 percent, which was consistent with the approximate 50 percent prevalence of gene fusions in prostate cancer.

"We have some preliminary data showing that the T2/ERG levels correlate with criterion for aggressive cancer," Goskopf said. "The key next steps here are we want to follow-up and confirm the results we've generated to date. But perhaps more importantly is to start looking at the correlation between the urine test and pathologic features in prostatectomy tissues such as tumor volume stage and grade."

One or more of the authors disclosed financial relationships with Gen-Probe, Inc., and DiagnoCure, Inc.

Abstract

"Along similar lines, another study refined the risk of prostate cancer by combining standard measurements such as PSA with factors such as family history, prostate size and biopsy history," Sandler said. "This personalized risk-assessment tool is a very sensible method of integrating other factors besides PSA into the complex problem of prostate cancer screening and detection."

Presented by Monique Roobol, M.D., of the Erasmus Medical Centre in Rotterdam, the Netherlands, the study involved 5,176 men whose risk was plotted against PSA levels and different combinations of predictive factors. For any given PSA level, they found that a positive family history increased the risk while a previous negative biopsy and increasing prostate volume lowered it. For example, their tool showed that the four-year risk of prostate cancer is the same in men with a PSA of 1.3 ng/mL with no previous negative biopsy, a positive family history, and a prostate volume of less than 40 cubic centimeters as it is in men with a PSA of 4.0 ng/mL, a previous negative biopsy, no positive family history, and a prostate volume of more than 40 cubic centimeters.

"It is possible to determine a man's future risk of prostate cancer personalized to their individual predictive factors, and also identify men above certain risk thresholds who may be candidates for heightened surveillance or active risk reduction strategies when these become available," Roobol and colleagues conclude.

Abstract

"An important radiation oncology study looked at a shorter course of radiation therapy for prostate cancer: seven and a half weeks of standard intensity modulated radiotherapy versus five weeks of hypofractionated intensity modulated radiotherapy, which is quite a bit more convenient for patients. It showed that the two regimens are equivalent in terms of outcomes," Sandler said.

"But there's a twist to this study," Sandler added. "Based on a biological model, the researchers thought that the shorter regimen would lead to better outcomes. The study results have led them to rethink the original biological model, which may have implications for other patients who are being treated with very short courses of radiation therapy."

During the study, Alan Pollack, M.D., of the University of Miami, and colleagues assigned 152 patients to receive standard intensity modulated radiotherapy at 76 Gy at 2.0 Gy/fraction and 151 patients to receive hypofractionated intensity modulated radiotherapy at 70.2 Gy at 2.7 Gy/fraction. They found that there were no significant group differences in the five-year biochemical failure rates (21 percent and 17 percent, respectively) or toxicity.

"We were able to achieve similar results using a regimen that was given in two and a half weeks less," Pollack said. The study "also gives us some information on what the alpha-beta ratio might be, which has some implications for how we might design future trials. If the two arms were equivalent, then the alpha-beta ratio might be quite a bit higher than what we initially hypothesized. So even with that, this hypofractionation regimen looks promising."

Abstract

David Dearnaley, M.D., of the Institute of Cancer Research in Sutton, U.K., presented a study suggesting that bisphosphonates may improve overall survival in men with M1, but not M0, metastatic prostate cancer. Based on these results, the researchers have launched a new trial to see if a third-generation bisphosphonate -- zoledronic acid -- is beneficial for men with high-risk M0 or M1 disease.

"It's surprising because these agents are felt to strengthen bone -- and possibly delay the time to bone metastasis -- but not necessarily have an anti-cancer effect," Sandler said. "This study implies that bisphosphonates have a global anti-cancer effect."

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ASCO: Surgeon Volume Affects Radical Cystectomy Outcomes

MONDAY, Mar. 2 (HealthDay News) -- In patients who undergo radical cystectomy, overall survival and bladder cancer-specific survival are higher among those whose surgeons perform a high volume of the operations, according to research presented at the American Society of Clinical Oncology's Genitourinary Cancers Symposium held Feb. 26 to 28 in Orlando.

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ASCO: Statin Use Reduces Prostate Cancer Mortality

MONDAY, Mar. 2 (HealthDay News) -- Statin use in men is independently associated with a 50 percent or greater reduced risk of death from prostate cancer, according to research presented at the American Society of Clinical Oncology's Genitourinary Cancers Symposium held Feb. 26 to 28 in Orlando.

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ASCO: Prostate Cancer Prevention Talk Advised

THURSDAY, Feb. 26 (HealthDay News) -- Healthy men should talk to their doctors about taking a 5-alpha reductase inhibitor (5-ARI) to reduce their risk of prostate cancer, according to a joint guideline published online Feb. 24 in the Journal of Clinical Oncology by the American Society of Clinical Oncology and the American Urological Association, and released to coincide with the American Society of Clinical Oncology's Genitourinary Cancers Symposium held Feb. 26 to 28 in Orlando. The guidelines will also appear in the March issue of the Journal of Urology.

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