CHICAGO—For men with prostate cancer who have had their prostate removed and later show signs of cancer recurrence, several factors can help predict response to subsequent radiation therapy, according to a study in the March 17 issue of the Journal of the American Medical Association (JAMA).

Approximately 30,000 men annually in the United States will have recurrence of prostate cancer after radical prostatectomy (removal of the prostate), according to background information in the article. Salvage radiotherapy (radiation therapy following prostatectomy) may potentially cure patients whose disease recurs after radical prostatectomy, but previously gathered evidence suggests that it is ineffective in the patients at highest risk of spread of disease.

Andrew J. Stephenson, M.D., of the Memorial Sloan-Kettering Cancer Center, New York, and colleagues conducted a multicenter analysis of the outcome of salvage radiotherapy in a group of patients with recurrence of prostate cancer after radical prostatectomy to identify variables that are associated with an effective response.

The study included 501 patients at 5 U.S. academic centers who received salvage radiotherapy between June 1987 and November 2002 for detectable and increasing prostate-specific antigen (PSA) levels after radical prostatectomy. PSA is a protein that is found in the blood and that is used to detect and monitor prostate cancer.

The researchers found that over an average follow-up of 45 months, 250 patients (50 percent) experienced disease progression after treatment, 49 (10 percent) developed distant metastases, 20 (4 percent) died from prostate cancer, and 21 (4 percent) died from other or unknown causes. The 4-year progression-free probability (PFP) was 45 percent. "In this cohort, a Gleason score [tumor grade] of 8 to 10, preradiotherapy PSA level greater than 2.0 ng/mL, negative surgical margins [no evidence of cancer cells in the edges of the removed tissue], PSA doubling time (PSADT) of 10 months or less, and seminal vesicle invasion [cancer spreading to structures near the urinary bladder of males] were significant predictors of disease progression despite salvage radiotherapy. Yet we demonstrated that subsets of patients with high-grade disease and/or a rapid PSADT who were thought to be incurable could still achieve a durable response to salvage radiotherapy when the treatment was administered early in the course of recurrent disease. These results suggest that salvage radiotherapy may prevent metastatic disease progression for those patients at the highest risk," the authors write.

CHICAGO—Use of a transdermal patch to deliver pain medication was found to be equivalent to medication delivered by an intravenous pump for controlling pain following surgery, according to a study in the March 17 issue of the Journal of the American Medical Association (JAMA).

Patient-controlled analgesia (PCA) allows the patient to self-administer small doses of opioids, such as fentanyl and morphine, as needed to control pain, according to background information in the article. PCA with an intravenous (IV) pump with morphine is a common method of providing postoperative pain control after major surgery. The fentanyl hydrochloride patient-controlled transdermal system (PCTS) eliminates the need for the use of needles, intravenous tubing, a large pump, and does not hinder mobility. The transdermal system is a self-adhesive unit, about the size of a credit card, and is worn on the patient's upper arm or chest. It delivers small doses of fentanyl into the skin, where it then diffuses into the local circulation and is transported to the central nervous system.

Eugene R. Viscusi, M.D., of Thomas Jefferson University, Philadelphia, and colleagues conducted a study to determine whether the transdermal PCA delivery system is equivalent to a standard morphine IV PCA regimen in postoperative pain management. The trial included 636 adult patients who had just undergone major surgery between September 2000 and March 2001 at 33 North American hospitals. In surgical recovery rooms, patients were randomly assigned to intravenous morphine by a patient-controlled analgesia pump (n = 320) or fentanyl hydrochloride by a patient-controlled transdermal system (n = 316).

The researchers found that fentanyl hydrochloride PCTS and IV PCA morphine were equivalent according to the primary end point of ratings of pain control during the first 24-hour treatment period. Ratings of good or excellent pain control were reported by 73.7 percent of patients who received fentanyl PCTS and 76.9 percent of patients who received IV PCA morphine.

CHICAGO—Home blood pressure monitoring may have better prognostic accuracy than office blood pressure measurements for patients treated for high blood pressure, according to a study in the March 17 issue of the American Medical Association (JAMA).

Guillaume Bobrie, M.D., from the Hopital Europeen Georges Pompidou, Paris, and colleagues from the SHEAF (Self-Measurement of Blood Pressure at Home in the Elderly: Assessment and Follow-up) study assessed the prognostic value of home versus office blood pressure measurement by general practitioners in a European population of elderly patients treated for hypertension (high blood pressure). Office and home blood pressure and cardiac risk factors were measured at baseline (the start of the study) in a group of 4,939 patients being treated for hypertension. The average age of the study participants was 70 years and 48.9 percent of the participants were men. The patients were followed up for an average of 3.2 years.

The researchers report that at the end of the study follow-up at least one cardiovascular event (for example: cardiovascular cause of death, or non-fatal heart attack, stroke, angioplasty, coronary artery bypass graft surgery) had occurred in 324 patients. "For BP (blood pressure) self-measurement at home, each 10-mm Hg (millimeters of mercury) increase in systolic [first, larger BP number] BP increased the risk of a cardiovascular event by 17.2 percent and each 5-mm Hg increase in diastolic [second, smaller BP number] BP increased that risk by 11.7 percent," the authors write. "Conversely, for the same increase in BP observed using office measurement, there was no significant increase in the risk of a cardiovascular event."

PAIN PATCH AN EQUAL MATCH