Time to Biochemical Failure Matters by ProQuest


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      www.renalandurologynews.com                                                                                                                      DECEMBER 2009   Renal & Urology News 9

       High Hb       continued from page 1

      out heart failure, however, had an 86%
                                                     Time to Biochemical Failure Matters
      increased risk.                                After radiotherapy, earlier PSA relapse predicts a higher PCa death risk
        Similarly, patients with diabetes
      mellitus did not have an increased             BY JOHN SCHIESZER
      risk associated with higher Hb tar-            CHICAGO—The interval between
      gets. While patients without diabetes          radiation treatment for prostate can-
      mellitus did have an increased risk            cer and biochemical failure may
      associated with the higher goal, the           predict the likelihood of death from

                                                                                                © HEALTH PROTECTION AGENCY / PHOTO RESEARCHERS, INC.
      interaction between diabetes and               the malignancy, researchers reported
      treatment arm, did not reach conven-           here at the American Society for
      tional levels of statistical significant in    Radiation Oncology annual meeting.
      multivariable analyses.                          In a study, 48% of patients who
        Dr. Szczech and her group also               died from prostate cancer following
      examined the interaction between               radiotherapy experienced biochem-
      diabetes and heart failure and hemo-           ical failure within the first 18 months
      globin goal. Patients without a his-           compared with only 14% of pa-
      tory of either prior heart failure or          tients who did not die from prostate
      diabetes had a twofold increased risk          cancer, said lead investigator Mark
      associated with the higher Hb goal.            Buyyounouski, MD, Director of Clin-       In a study, 19% of radiotherapy patients had a PSA relapse in 18 months or less.
      Patients with diabetes but no history          ical Research at Fox Chase Cancer
      of heart failure had a 75% increased           Center in Philadelphia.                   prostate cancer who had biochemical                                sooner means a patient has a greater
      risk associated with the higher goal,            Clinicians should consider using        failure after treatment. A total of 338                            danger of dying of prostate cancer.”
      and subjects with prior heart failure          the 18-month time point when evalu-       men died from prostate cancer. The                                   In a prior study, Dr. Buyyounouski
      with or without diabetes were not at           ating patients and counseling them        median interval between treatment                                  and his colleagues showed that men
      increased risk.                                about their risk of death and sal-        and biochemical failure was 35.2                                   who experienced early biochemical
                                                     vage therapy after biochemical fail-      months for the entire study group.                                 failure had the highest risk of dying
                                                     ure, Dr. Buyyounuski said.                Biochemical failure occurred in 19%                                from prostate cancer. The new study
      Patients with                                    “If a patient has biochemical failure   of patients in 18 months or less. The                              confirms those results using a multi-
      heart failure and                              at 16 months, rather than wait and        five-year cancer-specific survival was                             national database and shows that the
                                                     learn later that the PSA is rising        69.5% for these men compared with                                  measure is ready for use in the clinic.
      diabetes differ                                sharply and that there is risk for the    89.8% for men whose biochemical                                    “Now, we can use the simple criteria
                                                     development of distant metastasis,        failure occurred after 18 months.                                  from this study, which is widely avail-
      from “all comers.”                             [salvage] therapy can be started            “PSA is the gold standard for fol-                               able for anyone who has PSA testing,
                                                     sooner based on the increased risk of     lowing prostate cancer patients after                              to identify men who have a greater
        “It is unclear whether the mecha-            death,” he said.                          they receive radiation or surgery,”                                than 25% chance of dying from pros-
      nism for this differential treatment             He and his colleagues studied of        Dr. Buyyounouski said. “But we                                     tate cancer in the next five years. That
      effect might be due to the stronger            2,132 men with clinically localized     
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