Update in Oncology

Update in Oncology

John C. Ruckdeschel, MD

From H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session

Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor

Among the many important topics that currently come under the heading of oncology—from cell markers to molecular biology factors—this Update focuses on the most common diseases: prostate cancer, breast cancer, and lung cancer. Table 1 spells out the statistics on these diseases and makes an important point about survival.

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Table 1. Cancer Incidence

Prostate Cancer

The main questions that are being asked and now answered about prostate cancer are the following: Who is at risk? Can the disease be diagnosed early? Does early diagnosis improve survival? What is the optimal therapy? The articles described here highlight some answers to these questions.

Although prostate cancer is increasingly common (because of increased prostate-specific antigen [PSA] testing], it remains an enigmatic disease with highly variable clinical behavior. The use of the percentage of free PSA in men with total PSA levels of 4 to 10 ng/mL and a normal gland substantially reduces the number of unnecessary biopsies, and a PSA level of 2.0 ng/mL or less allows a reduction in the frequency of testing. When biopsy is done, the Gleason score can reasonably predict which patients might need immediate therapy. Despite all the talk, neither nerve-sparing prostatectomies nor seed implants are the correct answer for all patients. The bottom line is 1) keep on ordering PSA tests and 2) do not just send patients to a urologist—look for an interdisciplinary group.

Survival for Patients with Clinically Localized Prostate Cancer Can Be Predicted on the Basis of Gleason Scores

Albertsen PC, Hanley JA, Gleason DF, et al. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA. 1998; 280:975-80.

To estimate survival for men with clinically localized prostate cancer who were being managed conservatively, Albertsen and colleagues conducted a retrospective cohort study of the Connecticut Tumor Registry. The study …

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