Quest Winter 2016 : Page 2

The ProtecT Trial: Comparing Surgery, Radiation and Surveillance… Of the 391 men who had a prostatectomy, 18 had primary treatment failure. Half had a PSA level of 0.2 ng/ml or higher after surgery and received salvage radiation and long-term ADT. The others received adjuvant radiation within a year after surgery due to tumor spread outside the prostate or positive surgical margins. Of the 405 men who started radiation therapy within 9 months of being assigned to the treatment group, 14% had an increase in PSA levels of 2 ng/ml or more above the lowest value after starting treatment. Three of these men had a salvage prostatectomy, 14 had long-term ADT, and 1 had high-intensity focused ultrasound therapy. (continued from page 1.) I Dr. Catalona’s Opinion n patients with early prostate cancer diagnosed because of a screening program, 15-to 20-year follow-up is needed to evaluate the effectiveness of active surveillance versus immediate treatment with surgery or radiation therapy. In the ProtecT trial, it is already clear by 10 years that cancer progression is more common in men managed with active surveillance. It is highly likely that this difference ultimately will translate into a cancer-specific survival advantage for early treatment of patients who have some aggressive tumor features. involved in the study. AS failure rates The purpose of active monitoring was to minimize the risk of overtreatment by avoiding immediate intervention, and to regularly monitor disease progression and treat if necessary. More than half the 545 men (54%) assigned to active monitoring ended up having a radical intervention: 49% had surgery, 33% had radiation therapy, 22% had brachytherapy, 9% had radiation to areas other than the prostate gland, and 1% had high-intensity focused ultrasound therapy. This rate of failure illuminates the need for better clinical tools to identify the patients who are best suited for active surveillance (AS). This is a focus of Dr. Catalona’s SPORE research project, Impact of germline genetic variants on active surveillance for prostate cancer. This project seeks to identify genetic variants that indicate a patient is more likely to “fail” AS, and thus should be monitored more closely. See page 5 for information on getting Looking ahead The study authors estimated that based on their results, treating 27 men with prostatectomy rather than active monitoring would avoid 1 patient having metastatic disease, and treating 33 men with radiation therapy rather than active monitoring would avoid 1 patient having metastatic disease. The results show the effectiveness of immediate treatment over active monitoring, but they have not yet translated into significant differences in mortality rates. Longer follow-up is needed. N Engl J Med. 2016 Oct 13;375(15):1415-1424. Epub 2016 Sep 14. ADT Type, Duration and the Risk of Diabetes A recent study investigated the association between the types and duration of androgen deprivation therapy (ADT, or hormone therapy) and the risk of type 2 diabetes. Researchers used data from the Prostate Cancer database Sweden and compared diabetes risk in 34,031 men with prostate cancer on various types of ADT: anti-androgens (9,143 men), surgical removal of the testicles (3,014 men), or gonadotropin-releasing hormone agonists (21,874 men). When compared to men without prostate cancer, men on gonadotropin-releasing hormone agonists and the surgical testicle removal group had an increased risk of type 2 diabetes during the first 3 years of ADT. The risk decreased thereafter. There was no increased risk seen in men on anti-androgens. The authors concluded that men on ADT, even for a limited period of time such as with radiation therapy, had an increased risk of type 2 diabetes. Int J Cancer. 2016 Dec 15;139(12):2698-2704. doi: 10.1002/ijc.30403. Epub 2016 Sep 19. Q uest The mission of the Urological Research Foundation is to support research and patient education in prostate cancer. Q UEST is a free newsletter, but we need and appreciate your voluntary contributions. Q UEST is published three times a year by the Urological Research Foundation. ©2016 Urological Research Foundation No material reproduced without permission. Circulation: 42,000 Medical Editor: William J. Catalona, M.D. Editor: Betsy Haberl Graphics: Amy L. Davis 2 If you are reading Q UEST for the first time and would like to receive future issues, please send your name and address to: Q UEST , PO Box 855, Manchester, MO 63011 . To receive Q UEST by email, please send your request to URF@drcatalona.com. Find Q UEST online at: www.drcatalona.com Q UEST Winter 2016

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