The Medical Management of Prostate Cancer II

103 Pages·1991·9.306 MB·English

by  Louis Denis (auth.), Professor Dr. Louis Denis (eds.)

Monographs
Series Editor: U.Veronesi
L. Denis (Ed.)
The Medical Management
of Prostate Cancer II
With 16 Figures and 23 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Professor Dr. LouIs DENIS
Department of Urology
Algemeen Ziekenhuis Middelheim
Lindendreef 1
2020 Antwerp, Belgium
The European School of Oncology gratefully acknowledges sponsorship for the Task Force
received from Pharmacia AB, Helsingborg, Sweden, whose engagement in the research on
prostate cancer has resulted in the origination and development of estramustine phosphate
(Estracyt®) and polyestradiol phosphate (Estradurin®)
ISBN-13: 978-3-642-76280-2 e-ISBN-13: 978-3-642-76278-9
001: 10.1007/978-3-642-76278-9
Library of Congress Cataloging-in-Publication Data
The Medical management of prostate cancer III L. Denis (ed.). p. cm.-(Monographs I European School of Oncology)
ISBN 3-540-53443-1 (alk. paper).-ISBN 0-387-53443-1 (alk. paper) 1. Prostate-Cancer. I. Denis, L. II. Title: Medical
management of prostate cancer 2. III. Series: Monographs (European School of Oncology) [DNLM: 1. Prostatic Neoplasms
therapy.] RC280.P7M441991 616.99'463-dc20 DNLM/DLC
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Foreword
The European School of Oncology came into existence to respond to a need for informa
tion, education and training in the field of the diagnosis and treatment of cancer. There are
two main reasons why such an initiative was considered necessary. Firstly, the teaching of
oncology requires a rigorously multidisciplinary approach which is difficult for the Univer
sities to put into practice since their system is mainly disciplinary orientated. Secondly, the
rate of technological development that impinges on the diagnosis and treatment of cancer
has been so rapid that it is not an easy task for medical faculties to adapt their curricula
flexibly.
With its residential courses for organ pathologies and the seminars on new techniques
(laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic
controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy,
radiotherapy alone or integrated), it is the ambition of the European School of Oncology
to fill a cultural and scientific gap and, thereby, create a bridge between the University and
Industry and between these two and daily medical practice.
One of the more recent initiatives of ESO has been the institution of permanent study
groups, also called task forces, where a limited number of leading experts are invited to
meet once a year with the aim of defining the state of the art and possibly reaching a
consensus on future developments in specific fields of oncology.
The ESO Monograph series was designed with the specific purpose of disseminating the
results of these study group meetings, and providing concise and updated reviews of the
topic discussed.
It was decided to keep the layout relatively Simple, in order to restrict the costs and make
the monographs available in the shortest possible time, thus overcoming a common
problem in medical literature: that of the material being outdated even before publication.
UMBERTO VERONESI
Chairman Scientific Committee
European School of Oncology
Contents
Introduction
L. DENIS •• . . . . . . . . . . . . . . . . . . . . . . .. 1
The Epidemiology of Prostate Cancer
P. BOYLE •••••••••.•••.•• . ..................... 3
The Molecular Biology of ~rostate Cancer
J. TRAPMAN •••••••..•••••••• . ...... 19
The Endocrinological Basis for Hormonal Therapy of Prostate Tumours
M. MOTTA ••.•.•.•..•.•.••..••••..••.•••.•.••..•• 27
Oestrogens and Estracyt in Prostate Cancer
P. EKMAN .••.•.•.••••••.••.. . ................ 45
Antiandrogens in the Treatment of Prostate Cancer
F. H. SCHRODER • . • • • • • . . • • • • . . • . . • • . . • • • • • . . . • • . • • • . 53
Surgical versus Medical Castration in the Management of Advanced Prostate Cancer
M. R. G. ROBINSON • . . • • • . • . • • • . • . . . • . • • • • . . • • . . • • • • • • 61
Second-Line Endocrine Treatment in Advanced Prostate Cancer
C. MAHLER •••.••.••••••.••..• . ......... 65
Chemotherapy for Advance<;l Prostate Cancer
M.A. EISENBERGER •••••••.••.••••••••••••••••••.•.•.• 75
Current Trends of Treatment
L. DENIS ••••••••.•••••••••••••••••••••••••.•••.• 89
Introduction
Louis Denis
Department of Urology, Algemeen Ziekenhuis Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
This monograph is composed of a review and edited contributions of a workshop on the
Medical Management of Prostate Cancer. The workshop was organised in the
framework of the Task Force Programme of the European School of Oncology and
supported by an educational grant of Pharmacia Leo Therapeutics AB.
The timing of this second workshop coincided with major advances in our overall insight
into the treated natural history of this disease, in new clinical technology for the
diagnosis and staging of the disease· and in innovative endocrine treatment. In this
turmoil of events, one should be aware of the fact that we learned to integrate separate
sources of increased knowledge into a clinical approach that will be able to treat the
many different forms of prostate cancer according to their prognosis, and, more
importantly, to adapt this treatment to each individual patient. Clinical over- and
undertreatment is still common and the Task Force feels that each patient is entitled to a
tailored treatment where quality of life is weighed against overall treatment. This
monograph still deals with advanced prostate cancer, but medical treatment might have
to playa role in earlier stages of the disease. The advantage in survival and quality of life
of our patients may be real according to the expectations of the expert panel of the
European Programme Against Cancer, but major breakthroughs will emerge from actual
laboratory research and existing randomised clinical trials. We are not aiming for the
magic bullet against cancer, but we are determined to limit the ravages of this disease in
our greying male population by closing in on our target of cure or stabilisation of this
cancer step by step. It will be a march into the 21st century, but each march has to start
with a first step.
It is my privilege, as chairman 01 the Task Forcce, to thank the faculty for its major and
patient effort. It is clear that this work really represents the end result of a broad
consensus development in prostate cancer, where many organisations, such as the
National Prostate Cancer Project of the U.S.A. - now absorbed into several organisations
-.and the European Organisation on Research and Treatment of Cancer collaborate with
a group of national, active organisations from Japan to Finland. It is appropriate to thank
the dozens of experts who contributed in one way or another to our discussions. They
are represented by the appropriate references to the manuscripts. In addition, we would
like to acknowledge direct scientific support to the preparation of this monograph by Prof.
C. La Vecchia of Milan, Prof. O. Maissonneuve of Lyon, Dr. T. Zheng of Lyon, Prof. D.G.
Zaridze of Moscow, Dr. S. Zoppi of Milano and Dr. J. Bruynseels of Beerse. The
secretarial support of Mrs. R. Denie and, last but not least, the support of the European
School of Oncology team, Ms S. McGrath, Ms M. de Jager and Dr. A. Costa, was vital to
the completion of the monograph. Ms B. Montenbruck managed to speed the project
through the Springer edition with patience and enthusiasm.
The Epidemiology of Prostate Cancer
Peter Boyle
SEARCH Programme, Unit of Analytical Epidemiology, International Agency for Research on Cancer, 150 Cours Albert
Thomas, 69372 Lyon Cedex 08, France
Despite it being one of the commonest forms The highest incidence rates continue to be
of cancer, relatively little is known about the observed among blacks in the United States
aetiology of cancer of the prostate. In 1980 it (Table 1): rates in blacks are around 80%
was estimated that prostatic cancer was the higher than rates in whites in the same areas
fifth most frequent cancer in men, with an es of the United States. Rates in United States
timated 235,800 cases occurring annually whites are the second highest group of rates
worldwide [1]. The incidence continues to in followed by Scandinavian countries. Within
crease [2] and incidence and mortality rates Scandinavia there is considerable variation,
of cancer of the prostate demonstrate wide in with the rates in Sweden more than 50%
ternational variation with, for example, a 120- higher than in Finland [5]. Incidence rates are
fold difference present between areas of intermediate in most areas of Europe, being
highest and lowest incidence, according to higher in western than in southern and east
the most recently available statistics [3]. ern Europe (Fig. 1). The incidence of prostatic
Increases continue to take place in the inci cancer is high in Polynesians (native
dence of prostate cancer in Scotland and Hawaiians and New Zealand Maori).
Connecticut [4] as well as the Scandinavian Prostatic cancer incidence is moderately high
countries [5]. in Central and South America and the lowest
Table 1. Cancer incidence rates in blacks and whites in some populations of the United States. Annual, age-adjusted
incidence rates per 100,000
Black White Relative risk· Black White Relative risk·
Alameda 100.2 44.5 2.3 Alameda 87.8 49.6 1.8
Bay Area 92.2 47.4 1.9 Bay Area 82.5 50.0 1.7
Los Angeles 79.1 44.3 1.8 Los Angeles 82.6 49.6 1.7
Atlanta 95.7 51.9 1.8 Connecticut 72.3 46.8 1.5
New Orleans 72.1 39.2 1.8 Atlanta 91.2 53.4 1.7
Detroit 73.2 41.4 1.8 New Orleans 71.8 42.0 1.7
Detroit 91.1 51.2 1.8
(source: Waterhouse et aI., 1982 [7]) (source: Muir et aI., 1988 [3])
* blacks relative to whites
4 P. Boyle
o 10 20 30 40 50
SWITZERLAND. BASEL 50.1
9MD9I 45.9
SWllZERlAND. ZURICH 45.8
tc:JRNAY 42.0
SWITZERLAND. GENEVA 39.6
ICELAND 36.2
SWITZERLAND. VAUD 35.2
FINlAND 34.2
SWITZERlAND. NEUCHATEL 32.7
FRG. SAARLAND 28.7
NETH.. EINDHOVEN 28.3
DENMARK 27.7
FRANCE. BAS·RHIN 27.4
FRANCE. CALVAOOS 26.8
UK, SE SCOTLAND 26.5
FRG, HAMBURG 26.5
UK, NE SCOTLAND 26.0
UK. EAST SCOTLAND 25.2
FRANCE. OOUBS 24.9
UK, SOUTH weSTERN 24.8
UK,OXFORO 23.7
FRANce. ISERE 23.6
UK, TRENT 22.9
UK, WEST SCOTLAND 21.5
UK, SOUTH THAMES 21.4
SPAIN. TARRAGONA 21.2
UK, NORTH weSTERN 20.8
SPAIN. NAVARRA 20.5
ITALY. VARESE 20.3
IRELAND. SOUTHERN 20.3
GERMAN OEM REP. 19.9
UK, NORTH SCOTLAND 19.3
UK,MERSEY 19.2
UK. BIRMINGHAM 18.9
ITALY. RAGUSA 18.8
YUGOSLAVIA, SLOVENIA 18.7
ITALY. PARMA 17.6
SPAIN. ZARAGOZA 17.0
HUNGARY. VAS 16.9 Fig. 1. Incidence of
CZECH .• SLOVAKIA 15.8
prostate cancer in Europe
POLAND. CRACOW CITY 13.8
HUNGARY.SZABOLCS 12.6 (average age-standardised
POLAND. WARSAW CITY 11.5 incidence rates per
POLAND. NOWY SACZ 10.3
ROMANIA, COUNTY CLW 9.8 100,000, 1978-82)
o
10 20
NafNAY 19.9
SWITZERLAND 19.8
S'M:tel 19.5
BELGIUM 17.5
LUXEM30f..R3 16.7
FINLAND 16.3
NETHERl»IDS '16.0
FFG 15.9
UEN/IMRK 15.9
HUNGARY 15.8
FFWICE 15.3
AUSTRIA 15.3
IRELAND 14.0
POR1lJGAL. 13.8
NORTHEAN~ 12.9
SPAIN 12.8
ENGLAND .. WALES 12.5
SCOTLAND 12.1
czeCHOSLOVAKIA 11.8
ITALY 10.8
YUGOSLAVIA 10.4 Fig. 2. Mortality from
OCR 9.8 prostate cancer in Europe
POlAND 8.4 (average age-standardised
CRBE 7.3
mortality rates per 100,000,
BULGARIA 8.3
ROMANIA 8.2 1978-82)
The Epidemiology of Prostate Cancer 5
25
C
0
,0, ;
.0.. ... 20
.,
~
.,
..U.1, 15
'"
""
.,
-0
:.N;.
10
'"
-0
.'C.". ,
'"
~ 5 Japan
o -
:c
Fig. 3. Age-standardised
o
mortality rates from prostate
I I I
cancer in Sweden, Japan and 1955 1960 1965 1970 1975 1980 1985 1990
Canada 1955-1988 Year
rates are observed in countries of South-East which produces symptoms and, as the name
Asia [3]. It should be noted that prostatic implies, can be diagnosed clinically; occult
cancer rates are also high in blacks in Africa, cancer, which produces clinically overt met-
being of the same order as the rates in
•
TWhees tehrnig hEeusrot pem [o3r,t6a,7lit].y rates for prostatic 1000 ,.•I.II •*• •*• •"• 77eO50---B7794.
cancer are to be found in Carribean countries • • • • 65-69
• • 60-64
- St. Vincent and Grenadines and Martinique, SS-59
unfortunately countries from which no inci t>---i>--C--\> 50-54
~ 45-49
dence statistics are available [4]. Mortality 100 ~ 40-4'"
rates are also high in Sweden and Norway ~ ~~ 3350--3394
while in North America and Europe rates are •~ • • • 25-29
lower (Fig. 2). Once more, the lowest levels of ,.I.II •* •* • 2105--2149
fmroomrt aolriiteyn tfaolr cporuonstrtiaetsic [ 4c].a ncer are reporteo z'eU,"u:1 10 ~.......... . •• •• •• "•• 501--094- 1'
Figure 3 presents the time trends in mortality .e.U.u,1
'"
rates from prostate cancer in Canada, Japan ""
u
and Sweden: these 3 countries chosen cov, ;;: ~
U
ering the range of prostate cancer variation. <II
'Q.", ,
The mortality rate is increasing in all 3 coun I ~
tries since 1955. In 1988, however, prostate .'.":
cancer comprised 2.49% of all cancer deaths
~
among men in Japan, with the corresponding
figure for Canada being 10.64% and for 0.1
~
Sweden 17.73% .. This emphasises the impor
tance of prostate cancer as a public health
problem. When the age-specific mortality
rates for these same countries are examined
0.01
by birth cohort, it is suggestive that rates are I I I I I I I I I I I I I I I I I I I I I
beginning to fall in the younger cohorts in 1970 1890 1910 1930 1950 1970
Japan (Fig. 4) and Canada (Fig. 5) but this Median Year of Birth
drop is not yet apparent in Sweden (Fig. 6).
Prostatic cancer can be subdivided into 3 dis Fig. 4. Mortality from prostate cancer in Japan by birth
tinct categories: clinical prostatic cancer, cohort 1955-1988
6 P. Boyle
•
1000 ,•. ~ 80-84 1000
•* •* '" 75-79
• • • "• 70-74 ?~
...... t • ~ .. • • • • 65-69
.... *.-A • • • 60-64 ........
55-59
,... . ~.'f ~ 50-54
100 ~ 45-49 100
••..•.•..•.•. . c9-----o-Q----oQ---o-<;J 3450--349" ..............
0---0-0--0 30-34
•~ • • a5-a9
.':.;'ee.';";",,l:l;ll 10 ~ •,••. *••• ••*• •"'•" 05a11o-05-9---' a11 449 :''<EI"" II 10 ..... 4 4 4~
'"
..e..l.l
'"
;u:: ~ ''u"" ~
;::
~U
VcQeeI lloIll. ~ V~UQeI lI l . ~
"" celol
""
\f\
~
0.1 0.1
\\(
0.01 0.01
I I I I I I I I I I I I I I I I I I I J I I I I I I I I 1< I I I I I I I I I I I I I
1870 1890 1910 1930 1950 1970 1870 1890 1910 1930 1950 1970
Median Year of Birth Median Year of Birth
Fig. 5. Mortality from prostate cancer in Canada by Fig. 6. Mortality from prostate cancer in Sweden by
birth cohort 1955-1988 birth cohort 1955-1988
astasis while the primary lesion remains in statistics from different areas [2].
significant in size or hidden; latent cancer, Zaridze and Boyle [4] noted the importance of
which is clinically unrecognizable and' is the observation that the prevalence of small
usually an incidental finding at prostatectomy latent carcinomas is about 20% in men aged
or autopsy. 45 years and remains unchanged with in
The frequency of latent carcinoma, unlike the creaSing age [9], while the incidence of clini
frequency of clinical cancer, does 'not appear cal prostatic cancer increases rapidly with in
to vary internationally or among different eth creasing age and that this increase is more
nic groups. Several autopsy studies have re rapid than for any other form of cancer [13].
ported a similar prevalence of small, non-in Migrant studies have demonstrated that mi
vasive latent carcinoma in populations with grants from low- to high-incidence areas ac
contrasting incidence rates of clinically overt quire a higher risk for prostatic cancer [14-16],
prostatic cal1cer [8-12]. The available statis with an increase in risk already apparent in
tics on prostatic cancer incidence and mortal the first generation of migrants from Japan
ity are based on the sum of clinically diag and China. Haenszel [14] has shown that
nosed carcinomas and those latent tumours migrants from Ireland, Norway, Canada and
found unexpectedly at prostatectomy or au Sweden have higher prostatic cancer rates
topsy. The proportion of cases of latent carci than other United States whites, while mi
noma among all prostatic cancer cases obvi grants from Austria, Poland, USSR and Italy
ously depends on its detection rate and show lower rates.
varies from country to country, casting uncer The cancer experience of special population
tainty on the comparability of prostatic cancer groups, whose lifestyle habits distinguish