Prostate Cancer Update

Active surveillance for low-risk prostate cancer may provide better QoL.
The Los Angeles Times (11/30, Kaplan) "Booster Shots" blog reported, "Last year, about 192,000 American men were diagnosed with prostate cancer," and "for 16% to 40% of them, the disease is deemed to be so low-risk that no immediate medical intervention is necessary. Instead, they can undergo 'active surveillance.'" Now, new research reveals that "too many men are passing up a good thing."
The study detailed in the Journal of the American Medical Association "'isn't designed to tell people what is best," Harvard Medical School's Julia Hayes told Bloomberg News (12/1, Ostrow). "It is designed on an individual level to provide a starting point for discussion between the physician and the patient," she added. "Sixty percent of men who are screened and diagnosed are over-treated," yet, "those men would be reasonable candidates for active surveillance if they and their doctor are comfortable with that approach."
Before reaching those conclusions, "Hayes and colleagues developed a model to look at the quality-of-life benefits and risks associated with active surveillance, internal radiation therapy (brachytherapy), intensity-modulated radiation therapy (IMRT), or radical prostatectomy in a hypothetical group of men aged 65 who were diagnosed with localized, low-risk prostate cancer," WebMD (11/30, Mann) reported. "Men aged 65 with low-risk prostate cancer who chose active surveillance (with IMRT if the cancer progressed) scored highest in terms of quality-adjusted life expectancy (QALE)." In fact, "this strategy produces 11.07 quality-adjusted life-years (QALY)."
In comparison, "brachytherapy produced a 10.57 QALYs rating, followed by IMRT at 10.51 QALYs, and surgery to remove the prostate at 10.23 QALYs," HealthDay (11/30, Gardner) reported. "QALYs are a measure often used by scientists to indicate 'the number of good quality years of life left,' explained" an expert not involved in the study, "and therein lie some of the complexities of translating these findings into the real world of real men." In other words, said Duke University Medical Center's Dr. Stephen Freedland, "it depends on your definition of 'good.'"
The authors of an accompanying editorial pointed out, "as did the authors of the paper, that individual patient preferences still play a central role in the decision, particularly for those for whom anxiety caused by active surveillance would result in a relatively low quality of life," MedPage Today (11/30, Phend) reported. The study authors also "noted that they had been conservative in modeling, potentially exaggerating the uncertainty in the results. But, despite the 'substantial uncertainty surrounding this clinical question, active surveillance appears to be a reasonable alternative to initial treatment,' they concluded." The Wall Street Journal (11/30, Hobson, subscription required) "Health Blog" also covered that study.
Men with long index fingers may be less likely to develop prostate cancer. Bloomberg News (12/1, Fourcade) reports, "Men with long index fingers are at lower risk of prostate cancer," according to a paper in the British Journal of Cancer. "Scientists in the UK who compared the hands of 1,500 prostate cancer patients and 3,000 healthy men found that those whose index was longer than their ring finger were 33 percent less likely to develop the potentially fatal disease." Investigators pointed out that "finger length is set before birth, influenced by the level of sex hormones babies are exposed to in the womb." And, a "longer index finger points to less testosterone, which may protect against cancer later in life, they said."
Prostate gland swelling after seed insertion may prompt migration. MedWire (11/30, Guy) reported "that seed migration after prostate cancer treatment with brachytherapy (BRT) is common, and may be caused by the swelling of the prostate gland after seed insertion," according to a paper in the Japanese Journal of Clinical Oncology. "Among the 62 BRT patients in the study, 69.4% had experienced seed migration 30 days after the seeds were implanted," researchers at the National Center for Global Health and Medicine explained. "They add that the percentage of prostate swelling differed significantly between the pre-BRT monitoring scans and initial post-BRT scans."