Dear Friends,

Welcome to the first bi-annual Genitourinary Cancers Symposium, a multidisciplinary forum on kidney, bladder, testicular, and prostate cancers. To help inform people about progress in cancer, the American Society of Clinical Oncology (ASCO) publishes Cancer Advances, a series of consumer information resources. Cancer Advances: News From the Genitourinary Cancers Symposium provides the latest information about improving treatment strategies for prostate and kidney cancers. The information in this issue was presented at the 2008 Genitourinary Cancers Symposium held in San Francisco, California from February 14-16, 2008. For additional information about genitourinary cancers, please visit ASCO’s patient website, People Living With Cancer (www.plwc.org).

Sincerely,

Nancy Davidson, MD
ASCO President

Many older men diagnosed with early-stage prostate cancer will not require treatment or will die of causes other than prostate cancer, according to a new study. This study is the first to examine the development of untreated prostate cancer in a time when prostate-specific antigen (PSA) testing is common, which is important because PSA tests can detect cancer six to 13 months earlier than traditional diagnostic methods.

In this study, researchers analyzed data on 9,018 men from the U.S. Surveillance, Epidemiology and End Results (SEER) database who had been diagnosed with stage I or stage II prostate cancer between 1992 and 2002. The median age of the men was 77, and they had not received surgery, radiation therapy, or hormone therapy within six months of diagnosis.

The results showed that most men died from causes not related to prostate cancer or did not have prostate cancer that advanced to the point where treatment was needed. Of the 2,675 men who did receive treatment, the time between diagnosis and the start of cancer therapy was about 11 years. Men with less aggressive (slower growing) cancer were less likely to need treatment than those with aggressive (faster growing) cancer. After 10 years, 3% to 7% of men with less aggressive or moderately-aggressive cancer had died of prostate cancer, compared with 23% of men with aggressive cancer.

“Because prostate cancer therapies are associated with significant side effects, our data can help patients make better informed decisions about the most appropriate approach for them and potentially avoid treatment without adversely affecting their health,” said lead author Grace Lu-Yao, PhD, Cancer Epidemiologist at The Cancer Institute of New Jersey and Associate Professor at UMDNJ-Robert Wood Johnson Medical School and School of Public Health. Dr. Lu-Yao added that men who choose not to undergo treatment should be carefully monitored for rising PSA levels and other signs of cancer growth, an approach called active surveillance.

What this means for patients

This study suggests that older men with early-stage prostate cancer may not need treatment right away. These men should talk with their doctor to discuss the risks and benefits of active surveillance versus immediate treatment.

An analysis of data from men diagnosed with prostate cancer shows that radiation therapy after a radical prostatectomy (surgery to remove the prostate) can reduce the risk of dying from prostate cancer by more than 60%. This procedure is called salvage radiotherapy (SRT) and is most beneficial for men with rapidly rising levels of prostate-specific antigen (PSA, a protein in prostate tissue).

The researchers compared prostate cancer-specific survival (the probability of not dying from prostate cancer) of 635 men with rising PSA levels who had already been treated for prostate cancer. Of these men, 160 had received SRT alone, 78 had received SRT and hormone therapy, and 397 had received no SRT or hormone therapy.

After 10 years, 86% of men who received treatment with SRT alone and 82% of men who received treatment with SRT and hormone therapy had not died from prostate cancer, compared with 62% of men who did not receive SRT. Prostate cancer-specific survival improved only when SRT was given less than two years after a biochemical recurrence (when PSA levels start to rise after a radical prostatectomy).

The use of SRT was shown to be more effective for men with PSA levels that doubled in less than six months (a measure of more aggressive cancer), reducing the risk of dying from prostate cancer by 86%. For men whose PSA levels doubled in six months or more, SRT did not lower the risk of death, due to the fact that these men had less aggressive prostate cancer and may have fared well even without radiation therapy.

What this means for patients

“These findings are the first to support the effectiveness of salvage radiotherapy for improving survival in men with recurrent prostate cancer. If confirmed, these results suggest that for high-risk prostate cancer, radiotherapy should be given promptly when there is evidence for recurrence after radical prostatectomy, as early salvage radiotherapy may improve overall survival,” said lead author Bruce Trock, MD, Associate Professor of Urology, Epidemiology, Oncology and Environmental Health Sciences at Johns Hopkins University School of Medicine in Baltimore, Maryland.

Sunitinib (Sutent) causes heart failure more often than previously recognized, according to a small study of people with renal cell carcinoma (a type of kidney cancer) and gastrointestinal stromal tumor (GIST). Sunitinib is a drug in the form of a pill taken by mouth that blocks the formation of new blood vessels that are needed for a tumor to grow and spread.

This study examined data on the appearance of heart failure symptoms from 48 patients who had been treated for renal cell carcinoma or GIST with sunitinib between July 2004 and July 2007 at the Stanford University Comprehensive Cancer Center. Of these patients, seven (15%) had symptoms of heart failure during treatment. These symptoms began as early as 22 days and as late as 435 days after beginning treatment and continued after the use of sunitinib was stopped and treatment for heart failure began. Patients with a history of heart failure or coronary artery disease or a low body mass index (BMI, the ratio of a person's weight and height) were more likely to have symptoms of heart failure during sunitinib treatment.

“The results of this study demonstrate the need for regular heart monitoring in patients receiving sunitinib,” said lead author Melinda Telli, MD, a Postdoctoral Fellow in Medical Oncology at Stanford University School of Medicine in California. “Heart-related side effects need to be carefully examined in future clinical trials of sunitinib to determine the factors that place patients at risk for this complication. That information will allow us to administer this medication more safely to patients for whom the benefits of treatment clearly outweigh the risks.”

Previous clinical trials have shown that up to 8% of people taking sunitinib have symptoms of heart failure. However, people with pre-existing heart conditions are often excluded from participating in such clinical trials. This study is the first to examine the heart-related side effects of sunitinib outside of a clinical trial setting.

What this means for patients

A new study shows that women, older people, and people with cerebrovascular disease (disease of the brain involving blood vessels, such as stroke) who have a small kidney tumor are more likely to receive a radical nephrectomy (the removal of the entire kidney) over a partial nephrectomy (the removal of part of the kidney), despite evidence showing that the two approaches are equally effective. Also, a partial nephrectomy has been shown to preserve kidney function better than a radical nephrectomy.

In this study, the researchers used Surveillance, Epidemiology and End Results (SEER) data from 1995 through 2002 to identify pre-operative factors, such as age, gender, race, and other health conditions, that differed between 2,547 patients with small kidney tumors who received a radical nephrectomy and 556 patients who had received a partial nephrectomy.

The results showed that 21% of men received a partial nephrectomy compared with 16% of women, and 22% of patients ages 66 to 69 received a partial nephrectomy compared with 7% of patients 85 or older. In addition, patients who had received a partial nephrectomy were more likely to be treated at a later date in the study period, suggesting that the use of partial nephrectomy may be increasing.

What this means for patients

“Just as lumpectomy can be less invasive but as effective as mastectomy for treating breast cancer, people with kidney cancer should be aware that partial nephrectomy is not only an option, but may be a better option than radical nephrectomy in many circumstances because it may help preserve kidney function in patients with kidney tumors,” said William Huang, MD, Assistant Professor of Urologic Oncology at New York University School of Medicine in New York City and the study’s lead author. Patients undergoing surgery for kidney cancer should discuss these treatment options with their doctor.