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The  European Multidisciplinary Cancer Congress

Pictures from the 16th ECCO, 36th ESMO, 30th ESTRO Congresses that combined to form the 2011 European Multidisciplinary Cancer Congress (EMCC) in Stockholm, Sweden, September 23-27. Pictures include images from the conference and Stockholm, Sweden. 

Pictures from The 2011 European Multidisciplinary Cancer Congress (EMCC) in Stockholm, Sweden

The 2011 European Multidisciplinary Cancer Congress Slideshow

Stockholm, Sweden—Radiotherapy can be given between or during chemotherapy cycles, rather than sequentially (ie, after or before chemotherapy), for women with early breast cancer, according to a large study from the United Kingdom presented at the 2011 European Multidisciplinary Cancer Congress.

In fact, patients who received “synchronous” radiotherapy and chemotherapy had a reduced risk of local recurrence, though no improvement in survival, reported Indrajit Fernando, MD, of University Hospitals Birmingham NHS Foundation Trust.

“With this approach, patients are also able to avoid the delay of radiotherapy, to potentially shorten the treatment time, which is very important to them,” Fernando said.

The randomized phase III SECRAB trial enrolled 2296 women who underwent breast-conserving surgery or mastectomy. All received chemoradiation after surgery, either sequential (n = 1146) or synchronous (n = 1150). With the synchronous approach, radiotherapy was given in the time interval between chemotherapy cycles, either sandwiched between cycles (when 3 weeks of radiotherapy was prescribed) or given concomitantly (when >3 weeks of radiotherapy was prescribed). The women were followed for a median time of 8.8 years.

The chemotherapy regimens were CMF (cyclophosphamide/methotrexate/fluorouracil) or anthracyclineâ”€CMF. CMF was chosen because it is considered the most acceptable regimen for combining with radiotherapy, Fernando explained.

A number of radiotherapy schedules were considered suitable; more than 60% of patients received 40 Gy in 15 fractions over 3 weeks.

The 5-year local recurrence rate was significantly improved with the synchronous approach: 2.8% versus 5.1% with sequential chemoradiation, which was a 35% reduction in risk (

He noted the importance of this seemingly small but statistically significant difference. “According to the Early Breast Cancer Trialists’ Collaborative Group, one breast cancer death can be avoided for every four local recurrences prevented. Therefore, even a 2.3% reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer.”

There was no difference, however, in locoregional recurrence rates, which were 6.8% with the synchronous approach and 8.2% with the sequential approach, a nonsignificant 17% reduction in risk.

Closer examination of this outcome showed that most of these recurrences were observed in tissue outside the radiation field. The in-field locoregional recurrence rate was 2.9% with the synchronous approach and 5.3% with the sequential approach, for a significant 35% reduction in risk (

There was a “modest” increase in acute skin toxicity in patients in the synchronous arm, 24% versus 15% (

 < .001), he noted, and borderline significant difference in moderate to severe telangiectasia, 2.5% versus 1.3% (

 = .05). There were no differences in other late effects of radiotherapy. There were no differences in global quality of life.

Fernando suggested that with more modern radiotherapy techniques, the incidence of acute toxicity would be much lower.

Lori J. Pierce, MD, of the University of Michigan Comprehensive Cancer Center, Ann Arbor, commented that at the present time the results of the SECRAB trial show no improvement in disease-free survival or overall survival with the synchronous approach, but the absolute benefit in local control might spark conversation between clinicians and their patients.

“Are the results practice-changing? Perhaps,” Pierce commented. “With longer follow-up, if survival gains are observed, absolutely. If subgroups are identified who derive a greater absolute local benefit, it’s very likely.”

Radiotherapy can be given between or during chemotherapy cycles, rather than sequentially, for women with early breast cancer.

Synchronous Radiotherapy With Chemotherapy Improves Local Control in Early Breast Cancer Patients

A number of radiotherapy schedules were considered suitable; more than 60% of patients received 40 Gy in 15 fractions over 3 weeks. The 5-year local recurrence rate was significantly improved with the synchronous approach: 2.8% versus 5.1% with sequential chemoradiation, which was a 35% reduction in risk (

There was no difference, however, in locoregional recurrence rates, which were 6.8% with the synchronous approach and 8.2% with the sequential approach, a nonsignificant 17% reduction in risk. Closer examination of this outcome showed that most of these recurrences were observed in tissue outside the radiation field. The in-field locoregional recurrence rate was 2.9% with the synchronous approach and 5.3% with the sequential approach, for a significant 35% reduction in risk (

Radiotherapy can be given between or during chemotherapy cycles, rather than sequentially for women with early breast cancer.

Stockholm, Sweden—In a global phase III trial, the addition of aflibercept to the standard FOLFIRI chemotherapy regimen improved progression-free survival (PFS) and overall survival (OS) in previously treated patients with metastatic colorectal cancer, Josep Tabernero, MD, of Vall D’Hebron University Hospital in Barcelona, Spain, reported at the 2011 European Multidisciplinary Cancer Congress.

“Adding aflibercept to FOLFIRI in metastatic colorectal cancer patients previously treated with oxaliplatin-based regimens resulted in OS and PFS benefits that are both statistically significant and clinically meaningful,” Tabernero said in his presentation at the Presidential Session.

Aflibercept is a new fusion protein of key domains from human vascular endothelial growth factor (VEGF) receptors 1 and 2. It blocks all VEGF-A isoforms, VEGF-B and placental growth factor (PIGF) as well, binding with high affinity.

The VELOUR study randomized 1226 patients with previously treated metastatic disease to  1-hour intravenous aflibercept (4 mg/kg) or placebo, plus FOLFIRI (folinic acid, 5-FU, oxaliplatin, irinotecan), every 2 weeks until progression.

The primary endpoint of OS was reached, with a hazard ratio [HR] of 0.82 (

 = .0032). Median OS in the intention-to-treat population was 12.1 months with FOLFIRI alone, and 12.5 months with FOLFIRI plus aflibercept.

Positive results were also observed for PFS, with a HR of 0.76 (

 = .00007). Median PFS was 4.7 with chemotherapy alone versus 6.9 months with the addition of aflibercept. Response rates were 11.1% versus 19.8%, respectively (

All subgroups benefited, especially patients with liver-only metastases

Prespecified subgroup analyses were planned to confirm the consistency of the effect of aflibercept on OS and PFS. Investigators assessed the impact by stratification factors (performance status, prior bevacizumab treatment), and patient characteristics (age, gender, geographic region, prior hypertension, number of metastatic sites, disease confined to the liver, location of primary tumor).  

“The preplanned subgroup analyses supported the consistency and robustness of the efficacy results across all domains, including prior treatment with bevacizumab,” he reported.

A significant interaction was observed between treatment arm and the presence of liver metastases only, indicating a greater treatment effect in this group of patients, as compared with patients with disease not confined to the liver or no liver disease.

Among patients with liver metastases only, mortality was reduced by 35%, compared with an 11% risk reduction among other groups. PFS followed a similar pattern. For patients with prior bevacizumab treatment who received aflibercept, median PFS was 6.7 months, and OS was 12.5 months, which did not differ from overall study results.   

The incidence of grade 3-4 adverse events were as expected with the anti-VEGF class of agents, and were similar among patients with and without prior bevacizumab exposure. Grade 3-4 hypertension occurred in 16.6% and 20.5% of these groups, respectively.

“Prior treatment with bevacizumab does not appear to significantly impact the safety profile of aflibercept,” he noted.

David Kerr, MD of the University of Oxford, United Kingdom, who is also president of the European Society of Medical Oncology, called VELOUR a, “well designed and well conducted study,” in his comments at the Presidential Session.  He praised the investigators for conducting a preplanned subgroup analysis with 

 biologic rationale rather than “sifting through the data post hoc” to look for associations, but he added that the findings of subgroup analyses should always be considered hypothesis generating rather than practice changing.

However, he said the main findings from VELOUR do, “change the landscape” of the second-line treatment of advanced disease. “We have a new agent to consider for those patients who progress following frontline treatment with FOLFOX with or without bevacizumab,” he said.  

Aflibercept added to FOLFIRI chemotherapy improved PFS and OS in previously treated patients with metastatic colorectal cancer.

Aflibercept Improves Survival in Metastatic Colorectal Cancer Patients

STOCKHOLM, SWEDEN —Treatment with a novel conjugate antibody/chemotherapy drug called T-DM1 extended progression-free survival (PFS) in HER2-positive metastatic breast cancer compared with standard docetaxel/trastuzumab therapy in the first randomized trial of T-DM1, and T-DM1 was far less toxic than standard treatment.

“Our study showed that women with metastatic breast cancer who received T-DM1 had a 41% improvement in the time they lived without their breast cancer worsening compared with those who received standard docetaxel chemotherapy plus trastuzumab. These provocative phase II data illustrate that front-line treatment with T-DM1 provides a longer time to live without cancer progression with fewer side effects than standard chemotherapy plus trastuzumab,” said Sara Hurvitz, MD, Director of the Breast Oncology Program at the University of California Los Angeles (UCLA).  

About 20% of all breast cancers are HER2-positive, which is more aggressive and difficult to treat than other types of breast cancer. Trastuzumab plus docetaxel is considered standard treatment for metastatic HER2-positive breast cancer, but this therapy has some severe side effects, including neutropenia and alopecia.

T-DM1 is designed to deliver targeted therapy with trastuzumab along with chemotherapy but has an improved tolerability profile compared with standard chemotherapy. T-DM1 links trastuzumab to extremely cytotoxic chemotherapy called emtansine (DM1) through a stable linker. To give some idea of the cytotoxicity of emtasine, this chemotherapy is 100 times more potent than vinorelbine.

“The magic in T-DM1 is the linker,” Hurvitz said. “With the antibody/chemotherapy conjugate, trastuzumab attaches to HER2-positive cells; this triggers release of the lethal chemotherapy component.”

“I tell my patients that trastuzumab is the bullet, but DM1 is the gun,” Hurvitz explained at an official press conference during the 2011 European Multidisciplinary Cancer Congress (ESMO/ECCO/ESTRO).

The randomized, open-label phase II study enrolled 137 patients with no prior chemotherapy or HER2-targeted therapy for locally advanced or metastatic HER2-positive breast cancer. Patients were randomly assigned to treatment with either T-DM1 or standard therapy with trastuzumab plus docetaxel.

Median progression-free survival (PFS) was 5 months longer with T-DM1: 14.2 months in the T-DM1 arm versus 9.2 months in the standard treatment arm (

=.0353). “This represents a 40% relative reduction in the risk of disease progression,” Hurvitz told listeners.

Interestingly, no significant differences in objective response rate (58% for controls versus 64% for T-DM1) or in clinical benefit (complete response plus partial response plus stable disease, 81% for controls versus 75% for T-DM1) were observed between the two arms. However, a major difference was seen favoring T-DM1 for the duration of maintaining response: median of 9.5 months for controls and median duration of response not yet reached in the T-DM1 arm.

Patients were treated with T-DM1 for a median of 10 months versus 5.5 months with standard chemotherapy. Hurvitz said one of the reasons for this difference in the ability to stay on therapy could be attributed to more severe toxicity in the standard chemotherapy arm.

Grade 3 or higher adverse events were reported in 89% of those treated with standard chemotherapy versus 32% in the T-DM1 arm.  Grade 3 or 4 neutropenia was observed in 61% of the standard chemotherapy arm versus 5.8% with T-DM1. Alopecia, a troubling side effect for women, occurred in 67% of the standard chemotherapy arm versus 4.3 in the T-DM1 arm.

Three different phase III studies of T-DM1 in HER2-positive metastatic breast cancer are now under way, Hurvitz said. The EMILIA study will compare T-DM1 versus lapatinib plus capecitabine in 980 patients; the MARIANNE study will compare docetaxel/trastuzumab versus T-DM1 versus T-DM1 plus pertuzumab; and the TH3RESA study is comparing T-DM1 versus best supportive care in the salvage setting.

At the press conference, Jean-Charles Soria, MD, Scientific Cochair for ESMO, Professor at the Institut Gustave-Roissy, Villejuif, France, said that Genentech has at least 12 antibody/conjugate molecules in development. “This is an exciting concept,” he noted.

ESMO member Angelo DiLeo, MD, Istituto Toscano Tumori, Italy, said: “These promising data do not yet allow us to consider T-DM1 as a new standard of care for first-line treatment of HER2-positive metastatic breast cancer. We eagerly await results of ongoing phase III trials.”

Martine Piccart, MD, Jules Bordet Institut, Brussels, Belgium, who was formal discussant of this trial, commented as follows: “I believe this is a magic drug, a clever drug, and the drug we’ve been waiting for…  But we still need validation of these findings in a large randomized trial, and we need to identify markers for response. If the phase III trials are positive, T-DM1 will be available to patients in the not-too-distant future.

T-DM1 extended progression-free survival by 40% in HER2+ metastatic breast cancer and was less toxic, compared with standard  therapy.

T-DM1 Achieves Longer Progression-Free Survival vs. Standard Therapy in HER2+  Metastatic Breast Cancer

Stockholm, Sweden—The addition of panitumumab to chemotherapy improved overall survival (OS) and progression-free survival (PFS) in patients with recurrent or metastatic squamous cell carcinoma of the head and neck that were negative for the human papillomavirus (HPV), but no benefit was shown for HPV-positive tumors.

These results were presented in a subanalysis of the European SPECTRUM trial presented as a late-breaking abstract at 2011 European Multidisciplinary Cancer Congress (ECCO, ESMO, ESTRO).

The main results of SPECTRUM were reported at ESMO 2010, showing that patients who received panitumumab plus chemotherapy, versus chemotherapy alone, had a significant improvement in PFS but not OS.

The current sub-analysis is the first report of treatment outcomes related to HPV status with any drug in the first-line treatment of advanced squamous cell head and neck cancer, according to lead investigator Jan Vermorken, MD of Antwerp University Hospital in Belgium.

SPECTRUM evaluated panitumumab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), plus platinum-based chemotherapy (cisplatin + 5-FU) in 657 patients with recurrent or metastatic disease. Three hundred seventy-seven (57%) had samples evaluable for HPV status, of which 22% were HPV-positive (ie, had staining in at least 10% of cells), and 78% were HPV-negative.

PFS and OS Improved in HPV-Negative Subset Only

Median OS, in the HPV-negative subset, was 11.8 months in the panitumumab/chemotherapy arm versus 8.6 months in the chemotherapy arm, for a 27% statistically significant reduction in the risk of death (

 = 0.02). In contrast, in the HPV-positive subset, the addition of panitumumab was not associated with a survival benefit: median OS was 10.9 months with panitumumab/chemotherapy versus 12.1 months with chemotherapy alone (

“The survival was strikingly and significantly different in the HPV-negative patients who received panitumumab, and this was not the case in the HPV-positive patients,” he noted. The test for interaction, however, was not significant (

 = 0.332), possibly due to small numbers of patients in the HPV-negative group, he added.

Progression-free survival was also significantly, though not as strikingly, improved with panitumumab in the HPV-negative subset, where median PFS was 6.5 months with panitumumab/chemotherapy versus 5.1 months with chemotherapy alone (

 = .002). In the HPV-positive subset, median PFS was 5.5 and 5.3 months, respectively. Again, the test for interaction was not significant (

The effect of panitumumab in HPV-negative patients was consistent across all subsets, including patients with poor performance status and those with prior platinum chemotherapy. Adverse events in the panitumumab arm were as expected, with serious adverse events leading to study or drug discontinuation seen in 14% of the panitumumab arm and 12% of the chemotherapy-alone arm.

In the overall population, he added, there was a trend for a more favorable outcome in patients with HPV-positive disease; however, “this should be confirmed in an independent dataset,” he said.

“Although our data suggest that it may be worthwhile to use HPV status for stratification in future phase III trials with anti-EGFR treatment in recurrent/metastatic squamous cell carcinoma of the head and neck, it remains speculative and confirmation is first needed,” Dr. Vermorken said.

Jean Bourhis, MD, PhD, of the Institute Gustave Roussy, Villejuif, France, discussed the presentation, noting that HPV has become a major prognostic factor in locally advanced head and neck cancer (especially of the oropharynx); however, its prognostic value in recurrent and metastatic disease is unknown.

“The role of HPV in recurrent and metastatic disease for predicting response to EGFR monoclonal antibodies is also unknown,” he noted.

But the value of targeting EGFR with EGFR inhibitors, especially cetuximab, has been established, he said. “The amount of benefit in PFS is significant, and there is also a survival benefit for the first time in 30 years,” he said.

The SPECTRUM trial had a relatively similar design to the pivotal cetuximab trial, and it also demonstrated a significant PFS benefit but not an OS benefit, which was the primary endpoint, he noted. He also noted that in a phase II trial (unpublished) lapatinib, another EGFR inhibitor, has shown benefit in locally advanced disease.

“There are some clear limitations of the study,” according to Bourhis. It is a subgroup and retrospective analysis, only two thirds of the patients had HPV status evaluable, the analysis of HPV status was primarily performed on the primary tumor, and the test for interaction was nonsignificant. 

Nevertheless, this is the first description of EGFR inhibition activity specifically in HPV-negative disease, and the data are consistent with previous findings.

“There is a potentially important clinical impact of these findings,” he commented. “But because of some limitations in the study there is a need for confirmation and for generating additional evidence-based medicine (level 1) in recurrent/metastatic disease.”

Panitumumab + chemo improves OS and PFS in patients with metastatic carcinoma of the head and neck that were negative for HPV.

Panitumumab Extends Progression-Free Survival in HPV-Negative Subset of Advanced Head and Neck Cancer

STOCKHOLM, SWEDEN — An investigational drug that emits alpha radiation achieved a significant improvement in overall survival (OS), as well as delayed time to first skeletal-related event (SRE) in a Phase III trial of men with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases. 

“Radium-223 chloride [Alpharadin™] improved survival and time to SREs and was very well tolerated. If approved, this drug is likely to become standard of care,” stated Chris Parker, MD, Royal Marsden Institute in Surrey, UK. “This is the first drug targeted to bone metastases in prostate cancer that has been shown to improve survival. Other drugs targeted to the bone treat symptoms,” he added. Parker presented this talk at a Presidential Session on the best abstracts at the 2011 European Multidisciplinary Cancer Congress (ECCO/ESMO/ESTRO).

“Injectable radium-223 targets goe to new areas of bone formation, such as cancer metastasis, and emits alpha particles, which are highly damaging and short range. The tumor cells are killed, but the more distant cells in the bone marrow are spared,” he continued. “Only a few hits are required with radium-223, whereas with beta radiation [used in radiopharmaceuticals], thousands of hits are needed and there is damage to the surrounding tissue.”  Treatment with radium-223 takes 5 minutes and is done on an outpatient basis.

The ALSYMPCA international Phase III study enrolled 922 men at more than 100 centers in 19 countries with hormone-refractory prostate cancer and multiple, symptomatic bone metastases. Patients were randomized 2:1 to either radium-223 plus current standard of care, or placebo plus current standard of care. Radium-223 was delivered via injection 1 out of every 4 weeks for 6 cycles. Sham injections were used in the placebo group.

At the first interim analysis, a survival benefit was seen favoring radium-223 and the trial was stopped early in 2010. Median overall survival (OS) was 14 months in the radium-223 arm versus 11.2 months in placebo patients (

=.000185). Median time to first skeletal related event (SRE) was 13.6 months versus 8.4 months, respectively (

=.00046), representing a 64% improvement with the alpha-emitting agent. Other findings were normalization of alkaline phosphatase in 33% of men treated with radium-223 versus 1% of placebo patients, and a 49% improvement in time to PSA progression (

Radium-223 was extremely well tolerated, Parker noted. Grades 3 and 4 hematologic toxicities were: anemia, 11% with radium-223 versus 12% with placebo; neutropenia, 2% versus 1%, respectively; and thrombocytopenia, 4% versus 2%, respectively. The most common nonhematologic adverse events in both groups were bone pain, nausea, diarrhea, constipation, and vomiting.

Although quality of life data were collected in ALSYMPCA, they have not yet been analyzed, Parker said, but a Phase II trial suggested that radium-223 improved bone pain.

The FDA has granted radium-223 Fast Track status. Bayer Health Care plans to file a New Drug Application for the drug in mid-2012. Parker had no information on what the cost of radium-223 will be, if approved. “It will be competitive with all new cancer drugs, I would think. They are all expensive,” he said. 

Investigational drug that emits alpha radiation shows significant improvement in overall survival.

Survival Benefit Shown With Investigational Alpha-Emitting Radiopharmaceutical in Men With Hormone Resistant Metastatic Prostate Cancer 

Stockholm, Sweden—Patients with liver metastases from uveal melanoma had improved survival after treatment with percutaneous hepatic perfusion (PHP), in which chemotherapy is directly infused into the liver, University of Pittsburgh investigators reported at the 2011 European Multidisciplinary Cancer Congress (EMCC). 

“This is the first treatment to show a clinical benefit in patients with liver metastases from ocular melanoma,” said James Pingpank, MD, who presented the results at a press briefing.

The phase III trial randomized 93 patients to receive PHP or best alternative care (BAC), which could involve interleukin 2, ipilimumab, transcatheter arterial chemoembolization, systemic chemotherapy, or inclusion in a clinical trial.

Percutaneous hepatic perfusion saturates the liver with high doses of melphalan 3.0 mg/kg delivered via a 30-minute hepatic artery infusion, using specially designed catheters, with jugular venous return of filtered blood. Treatment was administered every 4 to 5 weeks, for up to 4 cycles.

The rationale for using melphalan is based on its history in limb perfusion, and its ability to produce high response rates with little toxicity in the liver, Pingpank explained.

“Melphalan is an effective agent for melanoma and other histologies because it gives good control, and you can dose-escalate to the level you need,” he said. “In the absence of severe liver disease it is very well tolerated.”

The adverse effects included more grade 3 and 4 neutropenia (61%), thrombocytopenia (74%), and anemia (47%), but these were transient. One patient died of hepatic failure, he said. Risk of progression reduced by 64%

The receipt of PHP significantly extended median progression-free survival (PFS), which was only 1.6 months with BAC, but reached 6.1 months with PHP, a 64%, highly significant, reduction in risk (

 < .001).  For patients with disease confined to the liver, median hepatic-only PFS was 1.6, versus 8.0 months (

“These were highly significant results in the experimental arm,” Pingpank noted.

But despite the fact that 58% of patients crossed over to the PHP arm, no survival differences were observed. Overall survival at one year was 26% with BAC and 29% with PHP, and median survival was 9.9 versus 11.4 months, respectively.  

Interestingly, patients who crossed over and received “late” PHP still experienced an improvement in PFS. Median PFS in this crossover group was 6.5 months overall and 9.2 months for patients with disease confined to the liver, he reported.

Alexander Eggermont, MD, director general of the Institut de Cancerologie Gustave Roussy in Paris, commented, “One of the interesting points is that those patients who crossed over from the BAC arm of the study had PFS after ‘late’ treatment with PHP that is about the same as when PHP was given upfront. Also, in the absence of identified targets for targeted drugs in uveal melanoma, one might consider testing the role of ipilimumab following PHP.”

PHP can potentially be used for liver metastases from other cancers as well, and the investigators are obtaining encouraging results in neuroendocrine tumors, Pingpank added.  The device that delivers and filters the melphalan is approved in Europe and is pending approval in the United States. 

Patients with liver metastases from uveal melanoma had improved survival after treatment with percutaneous hepatic perfusion (PHP).

Novel Infusion Approach Significantly Delays Progression in Uveal Melanoma Patients With Liver Metastases

STOCKHOLM, Sweden — Two studies presented at the 2011 European Multidisciplinary Cancer Congress held jointly by ESMO/ECCO have enhanced understanding of risk factors for prostate cancer.

The first study found that men with benign prostatic hypertrophy (BPH) are at increased risk of prostate cancer and of prostate cancer-related mortality. The second trial found that monitoring prostate-specific antigen (PSA) levels in healthy men at age 40 or 45 can predict long-term risk of prostate cancer and prostate cancer-related mortality.  Both studies were led by David Orsted, Copenhagen University Hospital, Herlev, Denmark.

Commenting on the first study, co-author Stig Bojesen, MD, said, “BPH and prostate cancer are the most common conditions of the prostate, with a large number of incident and prevalent cases each year. A possible association [between the two conditions] has been debated for several years, but previous studies have had ambiguous results. Our study is the largest to date [to look at this association], and has consistent results.”

Growth of the prostate depends on hormone levels in both prostate cancer and BPH, and both conditions are treated with anti-androgen agents. “It has been controversial whether BPH leads to prostate cancer, but this study provides strong epidemiologic evidence of an association. However, one cannot extrapolate causation from this study,” Orsted commented.

The study analyzed the association between BPH and eventual development of prostate cancer from the years 1980 to 2006 in a total of 3 million-plus Danish men enrolled in five national registries. The researchers looked at men who were hospitalized and those who were surgically treated for BPH. Among this population, 53,315 men were diagnosed with prostate cancer and 25,459 deaths were attributed to prostate cancer. The reference group included about 2.7 million men without BPH.

Over 26 years, the presence of BPH was associated with a 2- to 4-fold increased risk of developing prostate cancer and a 2- to 8-fold increased risk of men with BPH dying from prostate cancer.

The implication of the study, according to Bojesen, is that physicians who treat men with BPH who require hospitalization and surgery should follow these men carefully to ensure early diagnosis of prostate cancer and timely treatment. “However, the optimal surveillance program for these men should be addressed in future studies,” he said.

In the second study, the authors studied 4,383 men between the ages of 20 and 94 years who participated in the Copenhagen City Heart Study. Baseline levels of PSA were obtained and samples were stored for 30 years; in 2010, 170 men developed prostate cancer, and 94 of them died of the disease. A stepwise increase in baseline PSA levels predicted a 3 to 44-fold increase in risk of prostate cancer and a 2 to 12-fold increase in risk of prostate cancer-related mortality.

The absolute 10-year risk of developing prostate cancer was 11%-22% in men with PSA levels of 4.01-10 ng/mL and 37%-79% in men with levels above 10 ng/mL. Men with PSA levels of 2 ng/mL or lower, who comprised 90% of the sample, were at very low risk of future prostate cancer.

Prostate cancer is over-diagnosed, and the general benefit of PSA screening is limited. This study suggests that screening efforts should be focused on men with higher baseline PSA levels, while men with lower baseline PSA levels could avoid frequent and unnecessary prostate biopsies and digital rectal exams.

“Measuring PSA levels at age 40 or 45 could identify men who are at high risk and should be screened at regular intervals. I think we can select men better and do more focused screening of high-risk individuals We can use these epidemiologic data to develop guidelines. But we can also reassure men with very low PSA levels that they are at an absolute low risk of prostate cancer. This study suggests that general practitioners may not have to screen as many men. PSA screening should be done at age 40 to 45 years, and then the first measurement of PSA may be used to determine whether or not future screening is needed. This is not the way screening is done now,” Orsted said. 

Two studies enhance understanding of risk factors for prostate cancer.

Two Predictors of Prostate Cancer Explored in Healthy Men

The Municipal Council building for the City of Stockholm in Sweden on Kungsholmen island. Stockholm was the home of the 2011 European Multidisciplinary Cancer Congress.

The 16th ECCO, 36th ESMO, 30th ESTRO Congresses from the 2011 European Multidisciplinary Cancer Congress in Stockholm, Sweden, September 23-27.

The European Multidisciplinary Cancer Congress | Conference

The 2011 European Multidisciplinary Cancer Congress Slideshow

Synchronous Radiotherapy With Chemotherapy Improves Local Control in Early Breast Cancer Patients

Synchronous Radiotherapy With Chemotherapy Improves Local Control in Early Breast Cancer Patients

Aflibercept Improves Survival in Metastatic Colorectal Cancer Patients

T-DM1 Achieves Longer Progression-Free Survival vs. Standard Therapy in HER2+ Metastatic Breast Cancer

Panitumumab Extends Progression-Free Survival in HPV-Negative Subset of Advanced Head and Neck Cancer

Survival Benefit Shown With Investigational Alpha-Emitting Radiopharmaceutical in Men With Hormone Resistant Metastatic Prostate Cancer

Novel Infusion Approach Significantly Delays Progression in Uveal Melanoma Patients With Liver Metastases

Two Predictors of Prostate Cancer Explored in Healthy Men

Image of Stockholm City Hall