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Getting a Better Prognosis for Prostate Cancer

Study suggests doctors should change location of biopsies

THURSDAY, Oct. 23, 2003 (HealthDayNews) -- Doctors may be better able to predict the fates of prostate cancer patients by changing the location of biopsies they take to check for disease.

New research finds biopsy results from the side of the prostate with the most advanced tumors are more closely linked to the chances of the cancer returning after treatment than are biopsy results from all over the gland.

"In the old days, we used to say you had cancer and that was the general information you got," perhaps along with an analysis of how aggressive the cancer is, says the study's co-author, Dr. Stephen Freedland, a clinical instructor at Johns Hopkins University School of Medicine. "What studies like ours are saying is it's no longer acceptable to [just] say that."

Prostate cancer is the most commonly diagnosed cancer among American men and kills about 30,000 each year, according to the National Prostate Cancer Coalition. Doctors can choose from a variety of treatments, but the side effects can include incontinence and impotence, leading many patients to carefully consider their choices.

In the new study, released online this week and appearing in the December issue of the journal Cancer, researchers examined the medical records of 535 men who had prostate removal surgery from 1988-2002. The researchers wanted to see how early biopsies predicted how the men fared later.

According to study co-author Dr. Christopher Kane, an associate professor of urology at the University of California at San Francisco, doctors typically take 10 biopsies from each prostate cancer patient by sticking needles into the prostate and pulling out thin "cores." The process is quick and painless because local anesthetic is given, Kane adds.

If cancer exists, pathologists can measure how advanced it is and how aggressive the cells appear to be.

Prostates have two lobes, and the researchers found the number of "positive" biopsies on the side with the highest degree of cancer is a better predictor of future problems than the number of positive biopsies as a whole.

"The dominant tumor tends to be driving patients' outcomes," Kane says. "It kind of makes sense once you think about it."

While doctors may not be able to immediately use the biopsy information to help them decide which treatment to try, it should give patients a better idea of their prognosis, Kane says. It will also help doctors understand which patients face the highest risk of recurrence and may belong in research trials, he adds.

Dr. Lester Klein, a urologist at Scripps Clinic in San Diego, says more research needs to be done before doctors will accept the results. At this point, the findings are only "suggestive," he says.

But the research is important because doctors need more information when they consider options for prostate cancer patients, he adds.

"What we're trying to figure out is which patients should be operated on and which shouldn't be operated on," he says. "There's no use operating on something if it's going to fail."

Radiation and surgery remain the major treatments for prostate cancer, Klein says, and patients make the final call.

"Most guys want to see their grandchildren grow up," Klein says. "If there's a small chance of success, they'll take it."

More information

Learn about the disease by visiting the National Prostate Cancer Coalition or the National Cancer Institute.

SOURCES: Stephen Freedland, M.D., clinical instructor, Johns Hopkins University School of Medicine, Baltimore; Christopher Kane, M.D., associate professor, urology, University of California at San Francisco, and chief, urology, San Francisco VA Medical Center; December 2003 Cancer
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