Fran Lowry

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, identification of early-stage prostate cancers has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%. However, this trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage,” he said. But now, the rise in rates of cure because of the likelihood of having an organ-confined disease has ended.

“We're not going to see gains in cure rates beyond what we've already achieved simply based on PSA screening. Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, identification of early-stage prostate cancers has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%. However, this trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage,” he said. But now, the rise in rates of cure because of the likelihood of having an organ-confined disease has ended.

“We're not going to see gains in cure rates beyond what we've already achieved simply based on PSA screening. Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, identification of early-stage prostate cancers has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%. However, this trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage,” he said. But now, the rise in rates of cure because of the likelihood of having an organ-confined disease has ended.

“We're not going to see gains in cure rates beyond what we've already achieved simply based on PSA screening. Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

ORLANDO — A new tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with a shortened time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” Dr. Donovan said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

When applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, between 1985 and 2003, the tool was 84% accurate in predicting the time to clinical progression and spread of prostate cancer within 5 years.

It also showed that the risk of cancer progressing increased as the level of androgen receptors in a single prostate cancer cell increased.

The predictive tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with a special software application to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2 to 2 times the likelihood of having clinical failure within a 5-year period,” he said.

The model can also analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to be able to apply it in an active surveillance cohort of patients. He and his coinvestigators are in the final stages of building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in two groups in the United States and Europe.

“Conceptually, this is very exciting. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought, and does the patient in fact need additional, adjuvant therapy?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired the press conference where Dr. Donovan presented his new model.

Dr. Donovan disclosed that he also is employed by Aureon Biosciences and that he owns stock in that company and Aureon Laboratories.

ORLANDO — A new tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with a shortened time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” Dr. Donovan said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

When applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, between 1985 and 2003, the tool was 84% accurate in predicting the time to clinical progression and spread of prostate cancer within 5 years.

It also showed that the risk of cancer progressing increased as the level of androgen receptors in a single prostate cancer cell increased.

The predictive tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with a special software application to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2 to 2 times the likelihood of having clinical failure within a 5-year period,” he said.

The model can also analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to be able to apply it in an active surveillance cohort of patients. He and his coinvestigators are in the final stages of building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in two groups in the United States and Europe.

“Conceptually, this is very exciting. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought, and does the patient in fact need additional, adjuvant therapy?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired the press conference where Dr. Donovan presented his new model.

Dr. Donovan disclosed that he also is employed by Aureon Biosciences and that he owns stock in that company and Aureon Laboratories.

ORLANDO — A new tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with a shortened time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” Dr. Donovan said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

When applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, between 1985 and 2003, the tool was 84% accurate in predicting the time to clinical progression and spread of prostate cancer within 5 years.

It also showed that the risk of cancer progressing increased as the level of androgen receptors in a single prostate cancer cell increased.

The predictive tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with a special software application to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2 to 2 times the likelihood of having clinical failure within a 5-year period,” he said.

The model can also analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to be able to apply it in an active surveillance cohort of patients. He and his coinvestigators are in the final stages of building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in two groups in the United States and Europe.

“Conceptually, this is very exciting. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought, and does the patient in fact need additional, adjuvant therapy?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired the press conference where Dr. Donovan presented his new model.

Dr. Donovan disclosed that he also is employed by Aureon Biosciences and that he owns stock in that company and Aureon Laboratories.

ORLANDO — Toremifene citrate, a selective estrogen receptor modulator, increased bone mineral density and improved lipid levels in men receiving androgen deprivation therapy for advanced prostate cancer, investigators reported at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In a planned interim analysis, toremifene (80 mg/day) given orally for 12 months significantly increased BMD in the lumbar spine, hip, and femoral neck in men randomized to the drug. Conversely, men who received placebo experienced decreases in BMD at these sites, said lead investigator Dr. Matthew R. Smith, of the department of medicine at Massachusetts General Hospital and Harvard Medical School, Boston.

In a second interim analysis of lipid results, toremifene significantly decreased total cholesterol by an average of 7.1%, and also decreased LDL cholesterol by 9.0% and triglyceride levels by 20.1%. The total cholesterol: HDL cholesterol ratio dropped an average of 11.7%, whereas HDL cholesterol levels increased by 5.4%, Dr. Smith said at the symposium, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, either with bilateral orchiectomy or treatment with GnRH agonists, is the mainstay of treatment for metastatic prostate cancer. This therapy has also become routine for many men with nonmetastatic disease. But the treatment is not without considerable side effects, including an increased risk of fracture and cardiovascular disease.

Currently, about a third of the estimated 2 million prostate cancer survivors in the United States receive treatment with GnRH agonists, and this expanded use in a greater proportion of men—especially in those who have long life expectancies—has heightened concerns about these deleterious effects, Dr. Smith said.

In the study, 1,392 men aged 50 years and older who were on androgen deprivation therapy for metastatic disease were randomly assigned to toremifene or placebo for 2 years. These analyses were done at the midpoint of the randomized, controlled trial; BMD and changes in lipid profiles were secondary end points. The primary end point, vertebral fractures in the two arms, will be analyzed at the end of 2 years.

ELSEVIER GLOBAL MEDICAL NEWS

ORLANDO — Toremifene citrate, a selective estrogen receptor modulator, increased bone mineral density and improved lipid levels in men receiving androgen deprivation therapy for advanced prostate cancer, investigators reported at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In a planned interim analysis, toremifene (80 mg/day) given orally for 12 months significantly increased BMD in the lumbar spine, hip, and femoral neck in men randomized to the drug. Conversely, men who received placebo experienced decreases in BMD at these sites, said lead investigator Dr. Matthew R. Smith, of the department of medicine at Massachusetts General Hospital and Harvard Medical School, Boston.

In a second interim analysis of lipid results, toremifene significantly decreased total cholesterol by an average of 7.1%, and also decreased LDL cholesterol by 9.0% and triglyceride levels by 20.1%. The total cholesterol: HDL cholesterol ratio dropped an average of 11.7%, whereas HDL cholesterol levels increased by 5.4%, Dr. Smith said at the symposium, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, either with bilateral orchiectomy or treatment with GnRH agonists, is the mainstay of treatment for metastatic prostate cancer. This therapy has also become routine for many men with nonmetastatic disease. But the treatment is not without considerable side effects, including an increased risk of fracture and cardiovascular disease.

Currently, about a third of the estimated 2 million prostate cancer survivors in the United States receive treatment with GnRH agonists, and this expanded use in a greater proportion of men—especially in those who have long life expectancies—has heightened concerns about these deleterious effects, Dr. Smith said.

In the study, 1,392 men aged 50 years and older who were on androgen deprivation therapy for metastatic disease were randomly assigned to toremifene or placebo for 2 years. These analyses were done at the midpoint of the randomized, controlled trial; BMD and changes in lipid profiles were secondary end points. The primary end point, vertebral fractures in the two arms, will be analyzed at the end of 2 years.

ELSEVIER GLOBAL MEDICAL NEWS

ORLANDO — Toremifene citrate, a selective estrogen receptor modulator, increased bone mineral density and improved lipid levels in men receiving androgen deprivation therapy for advanced prostate cancer, investigators reported at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In a planned interim analysis, toremifene (80 mg/day) given orally for 12 months significantly increased BMD in the lumbar spine, hip, and femoral neck in men randomized to the drug. Conversely, men who received placebo experienced decreases in BMD at these sites, said lead investigator Dr. Matthew R. Smith, of the department of medicine at Massachusetts General Hospital and Harvard Medical School, Boston.

In a second interim analysis of lipid results, toremifene significantly decreased total cholesterol by an average of 7.1%, and also decreased LDL cholesterol by 9.0% and triglyceride levels by 20.1%. The total cholesterol: HDL cholesterol ratio dropped an average of 11.7%, whereas HDL cholesterol levels increased by 5.4%, Dr. Smith said at the symposium, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, either with bilateral orchiectomy or treatment with GnRH agonists, is the mainstay of treatment for metastatic prostate cancer. This therapy has also become routine for many men with nonmetastatic disease. But the treatment is not without considerable side effects, including an increased risk of fracture and cardiovascular disease.

Currently, about a third of the estimated 2 million prostate cancer survivors in the United States receive treatment with GnRH agonists, and this expanded use in a greater proportion of men—especially in those who have long life expectancies—has heightened concerns about these deleterious effects, Dr. Smith said.

In the study, 1,392 men aged 50 years and older who were on androgen deprivation therapy for metastatic disease were randomly assigned to toremifene or placebo for 2 years. These analyses were done at the midpoint of the randomized, controlled trial; BMD and changes in lipid profiles were secondary end points. The primary end point, vertebral fractures in the two arms, will be analyzed at the end of 2 years.

ELSEVIER GLOBAL MEDICAL NEWS

ORLANDO — Men aged 65 years or older who received androgen deprivation therapy for localized prostate cancer had an increased risk of cardiovascular death, according to a registry review presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Older men who received androgen deprivation therapy had a 3% risk of dying from cardiac causes at 5 years, significantly higher than the 0.9% risk in similarly aged men who did not receive hormone therapy, reported Dr. Henry K. Tsai, of Harvard Medical School, Boston. Androgen deprivation therapy was not associated with a significant increase in the risk of death from cardiac causes in men younger than 65 (1.5% for men on androgen treatment, and 0.3% for men not receiving androgen therapy, he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, which is commonly used to treat men with prostate cancer, causes weight gain, thus predisposing men to diabetes and the metabolic syndrome. Dr. Tsai and his colleagues at Harvard reviewed data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database to determine whether the use and duration of this treatment might be linked to a fatal cardiac event. They identified 3,636 men with localized prostate cancer who were treated with surgery, external beam radiotherapy, brachytherapy, or cryotherapy. Of these, 735 received androgen deprivation therapy and 2,901 did not.

The investigators analyzed the cardiac mortality and all-cause mortality, controlling for age and other cardiac risk factors including hypertension, diabetes, body mass index, and smoking.

The median age of the subjects was 64 years at baseline, median duration of hormone therapy in the men who received it was 4.1 months, and median duration of follow-up was 4 years.

Overall, men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years, compared with 0.6% in men who did not get hormones. That difference was statistically significant, but when the data were analyzed separately for men younger than age 65 and men aged 65 or older, a significant difference in risk was seen only in the older men, Dr. Tsai said.

Limitations of this study included an inability to control for hypercholesterolemia and other coronary artery disease risk factors, as well as the retrospective nature of the analysis.

Nevertheless, the findings point to the importance of a cardiovascular evaluation in men with prostate cancer who are being considered for androgen deprivation therapy. They also underscore the importance of monitoring cardiovascular risk factors in such patients. Further prospective evaluations are needed to corroborate these findings, he added.

Men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years. DR. TSAI

ORLANDO — Men aged 65 years or older who received androgen deprivation therapy for localized prostate cancer had an increased risk of cardiovascular death, according to a registry review presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Older men who received androgen deprivation therapy had a 3% risk of dying from cardiac causes at 5 years, significantly higher than the 0.9% risk in similarly aged men who did not receive hormone therapy, reported Dr. Henry K. Tsai, of Harvard Medical School, Boston. Androgen deprivation therapy was not associated with a significant increase in the risk of death from cardiac causes in men younger than 65 (1.5% for men on androgen treatment, and 0.3% for men not receiving androgen therapy, he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, which is commonly used to treat men with prostate cancer, causes weight gain, thus predisposing men to diabetes and the metabolic syndrome. Dr. Tsai and his colleagues at Harvard reviewed data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database to determine whether the use and duration of this treatment might be linked to a fatal cardiac event. They identified 3,636 men with localized prostate cancer who were treated with surgery, external beam radiotherapy, brachytherapy, or cryotherapy. Of these, 735 received androgen deprivation therapy and 2,901 did not.

The investigators analyzed the cardiac mortality and all-cause mortality, controlling for age and other cardiac risk factors including hypertension, diabetes, body mass index, and smoking.

The median age of the subjects was 64 years at baseline, median duration of hormone therapy in the men who received it was 4.1 months, and median duration of follow-up was 4 years.

Overall, men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years, compared with 0.6% in men who did not get hormones. That difference was statistically significant, but when the data were analyzed separately for men younger than age 65 and men aged 65 or older, a significant difference in risk was seen only in the older men, Dr. Tsai said.

Limitations of this study included an inability to control for hypercholesterolemia and other coronary artery disease risk factors, as well as the retrospective nature of the analysis.

Nevertheless, the findings point to the importance of a cardiovascular evaluation in men with prostate cancer who are being considered for androgen deprivation therapy. They also underscore the importance of monitoring cardiovascular risk factors in such patients. Further prospective evaluations are needed to corroborate these findings, he added.

Men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years. DR. TSAI

ORLANDO — Men aged 65 years or older who received androgen deprivation therapy for localized prostate cancer had an increased risk of cardiovascular death, according to a registry review presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Older men who received androgen deprivation therapy had a 3% risk of dying from cardiac causes at 5 years, significantly higher than the 0.9% risk in similarly aged men who did not receive hormone therapy, reported Dr. Henry K. Tsai, of Harvard Medical School, Boston. Androgen deprivation therapy was not associated with a significant increase in the risk of death from cardiac causes in men younger than 65 (1.5% for men on androgen treatment, and 0.3% for men not receiving androgen therapy, he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Androgen deprivation therapy, which is commonly used to treat men with prostate cancer, causes weight gain, thus predisposing men to diabetes and the metabolic syndrome. Dr. Tsai and his colleagues at Harvard reviewed data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database to determine whether the use and duration of this treatment might be linked to a fatal cardiac event. They identified 3,636 men with localized prostate cancer who were treated with surgery, external beam radiotherapy, brachytherapy, or cryotherapy. Of these, 735 received androgen deprivation therapy and 2,901 did not.

The investigators analyzed the cardiac mortality and all-cause mortality, controlling for age and other cardiac risk factors including hypertension, diabetes, body mass index, and smoking.

The median age of the subjects was 64 years at baseline, median duration of hormone therapy in the men who received it was 4.1 months, and median duration of follow-up was 4 years.

Overall, men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years, compared with 0.6% in men who did not get hormones. That difference was statistically significant, but when the data were analyzed separately for men younger than age 65 and men aged 65 or older, a significant difference in risk was seen only in the older men, Dr. Tsai said.

Limitations of this study included an inability to control for hypercholesterolemia and other coronary artery disease risk factors, as well as the retrospective nature of the analysis.

Nevertheless, the findings point to the importance of a cardiovascular evaluation in men with prostate cancer who are being considered for androgen deprivation therapy. They also underscore the importance of monitoring cardiovascular risk factors in such patients. Further prospective evaluations are needed to corroborate these findings, he added.

Men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years. DR. TSAI

ORLANDO — A therapeutic, investigational vaccine given in combination with chemoradiotherapy after surgery was associated with improved survival in patients with resected pancreatic adenocarcinoma, according to a phase II trial presented at a symposium on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

The median overall survival for patients who received the vaccine was 26.8 months, compared with 20 months for historic controls, said Dr. Daniel A. Laheru of the department of oncology at Johns Hopkins University, Baltimore.

Of the 60 patients who received the vaccine, 88% survived for 1 year and 76% survived for 2 years. These results compare very favorably with those of previous studies, in which patients treated with surgery alone had an average 1-year survival rate of 63% and a 2-year survival rate of 42%, Dr. Laheru said at the symposium, which was also sponsored by the AGA Institute, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.

Most of the participants (52 of 60) were considered to be at high risk because their cancer had spread to the regional lymph nodes.

The vaccine, known as GVAX immunotherapy, boosts the patient's own immune system to help it recognize cancer cells throughout the body and destroy them. GVAX is made up of lethally irradiated lines of pancreatic cancer cells that were engineered to secrete granulocyte macrophage colony stimulating factor (GM-CSF).

“The GM-CSF molecule attracts immune cells to the vaccine site, where the immune cells encounter pancreas cancer antigens. They then patrol the rest of the patient's body in a kind of seek and destroy mission, to destroy pancreas tumor cells possessing the same antigen profile,” Dr. Laheru explained. The vaccine does not prevent cancer, he added.

Patients who were deemed to be free of cancer 30 days after their surgery were eligible to receive the vaccine. The first infusion was given 8–10 weeks after pancreatic resection.

This was followed by treatment with a standard regimen of 5-fluorouracil-based chemotherapy plus radiation.

Patients who were disease free 1 month after chemoradiotherapy received three additional vaccine doses, 1 month apart, followed by a fifth booster 6 months later.

The vaccine immunotherapy was well tolerated. Side effects included transient vaccine injection site reactions, such as itching, redness, and swelling. These typically resolved within 10 days.

“Pancreatic cancer is the fourth leading cause of cancer-related death [in the United States]. Surgery is the only known cure for early pancreatic cancer, but most patients [have a recurrence] even after optimal resection. We are optimistic about the results from this study, which suggest that the vaccine could provide additional benefit over chemoradiotherapy, but prospective randomized trials are needed to confirm this observation,” Dr. Laheru said.

He and the Johns Hopkins investigators also plan to study whether the vaccine is most effective in combination with chemotherapy alone or with chemotherapy plus radiation.

Dr. Laheru disclosed that he received research funding from Cell Genesys Inc., which developed the vaccine.

ORLANDO — A therapeutic, investigational vaccine given in combination with chemoradiotherapy after surgery was associated with improved survival in patients with resected pancreatic adenocarcinoma, according to a phase II trial presented at a symposium on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

The median overall survival for patients who received the vaccine was 26.8 months, compared with 20 months for historic controls, said Dr. Daniel A. Laheru of the department of oncology at Johns Hopkins University, Baltimore.

Of the 60 patients who received the vaccine, 88% survived for 1 year and 76% survived for 2 years. These results compare very favorably with those of previous studies, in which patients treated with surgery alone had an average 1-year survival rate of 63% and a 2-year survival rate of 42%, Dr. Laheru said at the symposium, which was also sponsored by the AGA Institute, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.

Most of the participants (52 of 60) were considered to be at high risk because their cancer had spread to the regional lymph nodes.

The vaccine, known as GVAX immunotherapy, boosts the patient's own immune system to help it recognize cancer cells throughout the body and destroy them. GVAX is made up of lethally irradiated lines of pancreatic cancer cells that were engineered to secrete granulocyte macrophage colony stimulating factor (GM-CSF).

“The GM-CSF molecule attracts immune cells to the vaccine site, where the immune cells encounter pancreas cancer antigens. They then patrol the rest of the patient's body in a kind of seek and destroy mission, to destroy pancreas tumor cells possessing the same antigen profile,” Dr. Laheru explained. The vaccine does not prevent cancer, he added.

Patients who were deemed to be free of cancer 30 days after their surgery were eligible to receive the vaccine. The first infusion was given 8–10 weeks after pancreatic resection.

This was followed by treatment with a standard regimen of 5-fluorouracil-based chemotherapy plus radiation.

Patients who were disease free 1 month after chemoradiotherapy received three additional vaccine doses, 1 month apart, followed by a fifth booster 6 months later.

The vaccine immunotherapy was well tolerated. Side effects included transient vaccine injection site reactions, such as itching, redness, and swelling. These typically resolved within 10 days.

“Pancreatic cancer is the fourth leading cause of cancer-related death [in the United States]. Surgery is the only known cure for early pancreatic cancer, but most patients [have a recurrence] even after optimal resection. We are optimistic about the results from this study, which suggest that the vaccine could provide additional benefit over chemoradiotherapy, but prospective randomized trials are needed to confirm this observation,” Dr. Laheru said.

He and the Johns Hopkins investigators also plan to study whether the vaccine is most effective in combination with chemotherapy alone or with chemotherapy plus radiation.

Dr. Laheru disclosed that he received research funding from Cell Genesys Inc., which developed the vaccine.

ORLANDO — A therapeutic, investigational vaccine given in combination with chemoradiotherapy after surgery was associated with improved survival in patients with resected pancreatic adenocarcinoma, according to a phase II trial presented at a symposium on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

The median overall survival for patients who received the vaccine was 26.8 months, compared with 20 months for historic controls, said Dr. Daniel A. Laheru of the department of oncology at Johns Hopkins University, Baltimore.

Of the 60 patients who received the vaccine, 88% survived for 1 year and 76% survived for 2 years. These results compare very favorably with those of previous studies, in which patients treated with surgery alone had an average 1-year survival rate of 63% and a 2-year survival rate of 42%, Dr. Laheru said at the symposium, which was also sponsored by the AGA Institute, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.

Most of the participants (52 of 60) were considered to be at high risk because their cancer had spread to the regional lymph nodes.

The vaccine, known as GVAX immunotherapy, boosts the patient's own immune system to help it recognize cancer cells throughout the body and destroy them. GVAX is made up of lethally irradiated lines of pancreatic cancer cells that were engineered to secrete granulocyte macrophage colony stimulating factor (GM-CSF).

“The GM-CSF molecule attracts immune cells to the vaccine site, where the immune cells encounter pancreas cancer antigens. They then patrol the rest of the patient's body in a kind of seek and destroy mission, to destroy pancreas tumor cells possessing the same antigen profile,” Dr. Laheru explained. The vaccine does not prevent cancer, he added.

Patients who were deemed to be free of cancer 30 days after their surgery were eligible to receive the vaccine. The first infusion was given 8–10 weeks after pancreatic resection.

This was followed by treatment with a standard regimen of 5-fluorouracil-based chemotherapy plus radiation.

Patients who were disease free 1 month after chemoradiotherapy received three additional vaccine doses, 1 month apart, followed by a fifth booster 6 months later.

The vaccine immunotherapy was well tolerated. Side effects included transient vaccine injection site reactions, such as itching, redness, and swelling. These typically resolved within 10 days.

“Pancreatic cancer is the fourth leading cause of cancer-related death [in the United States]. Surgery is the only known cure for early pancreatic cancer, but most patients [have a recurrence] even after optimal resection. We are optimistic about the results from this study, which suggest that the vaccine could provide additional benefit over chemoradiotherapy, but prospective randomized trials are needed to confirm this observation,” Dr. Laheru said.

He and the Johns Hopkins investigators also plan to study whether the vaccine is most effective in combination with chemotherapy alone or with chemotherapy plus radiation.

Dr. Laheru disclosed that he received research funding from Cell Genesys Inc., which developed the vaccine.

ORLANDO — The investigational 5-α-reductase inhibitor dutasteride induces genetic changes in noncancerous prostate tissue and may play a role in reducing the risk of prostate cancer, Dr. Elahe Mostaghel said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Dutasteride, which is currently used to treat benign prostatic hyperplasia, reduced the activity of 98 genes—including trefoil factor 3 (TFF3), whose overexpression has been associated with the development of prostate and other cancers—by more than twofold, said Dr. Mostaghel of the Fred Hutchinson Cancer Research Center, Seattle.

The 5-α-reductase inhibitors curb the conversion of testosterone to dihydrotestosterone (DHT) inside the prostate, decreasing DHT levels and thereby inhibiting cancer development. In the Prostate Cancer Prevention Trial, inhibition with the 5-α-reductase inhibitor finasteride resulted in a 25% reduction in the overall incidence of prostate cancer, but this finding was accompanied by an unexpected increase in the number of high-grade prostate cancers in the men who did get cancer.

“The results from the [Prostate Cancer Prevention] trial are what have really prevented this chemoprevention idea from becoming more widespread, because we really don't understand yet why there was an increase in the number of higher-grade tumors. It appears to be an artifact in the way the study was performed, the way the biopsies were done, and the way that the prostate-specific antigen thresholds were adjusted,” Dr. Mostaghel said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

In the present study, the researchers wanted to determine what was actually going on at the molecular level to decrease the development of prostatic tumors. Accordingly, Dr. Mostaghel and her coinvestigators examined gene expression changes in benign prostate epithelium from 75 men diagnosed with localized prostate cancer.

The men were randomized to prostatectomy alone (n = 25) or neoadjuvant dutasteride at 0.5 mg (n = 26) or 3.5 mg (n = 24) orally per day for 4 months prior to prostatectomy.

Dihydrotestosterone levels fell by 93% in the men treated with 0.5 mg dutasteride, and by 98% in the 3.5-mg-per-day group. Treatment with dutasteride induced upregulation of 32 genes and downregulated 98 genes, including several genes potentially involved in prostate cancer development. Among them were:

▸ Insulinlike growth factor-binding protein 3 (IGFBP3). This gene was upregulated in response to dutasteride. It promotes apoptosis and inhibits cell proliferation and is decreased in patients with prostate cancer.

▸ Transmembrane protease, serine 2 (TMPRSS2). This gene was downregulated in response to dutasteride. It is an androgen-regulated gene that is thought to promote the development of prostate tumors when it fuses with other oncogenes, such as ETS. TMPRSS2-ETS fusions have been found in up to 70% of prostate cancers.

▸ TFF3. This gene inhibits apoptosis and promotes tumor aggression. It is also overexpressed in gastrointestinal and breast cancers, in addition to prostate cancer.

Dutasteride is being evaluated in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, which will be completed in 2009, Dr. Mostaghel said.

“We need to wait for the results of the REDUCE trial,” he said. “In our exploratory study, we demonstrated a mechanism by which dutasteride may reduce the risk of prostate cancer. REDUCE will tell us whether the gene expression changes we are seeing with dutasteride will correlate with developing or not developing prostate cancer, so our findings need validation in larger studies of longer duration.”

ORLANDO — The investigational 5-α-reductase inhibitor dutasteride induces genetic changes in noncancerous prostate tissue and may play a role in reducing the risk of prostate cancer, Dr. Elahe Mostaghel said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Dutasteride, which is currently used to treat benign prostatic hyperplasia, reduced the activity of 98 genes—including trefoil factor 3 (TFF3), whose overexpression has been associated with the development of prostate and other cancers—by more than twofold, said Dr. Mostaghel of the Fred Hutchinson Cancer Research Center, Seattle.

The 5-α-reductase inhibitors curb the conversion of testosterone to dihydrotestosterone (DHT) inside the prostate, decreasing DHT levels and thereby inhibiting cancer development. In the Prostate Cancer Prevention Trial, inhibition with the 5-α-reductase inhibitor finasteride resulted in a 25% reduction in the overall incidence of prostate cancer, but this finding was accompanied by an unexpected increase in the number of high-grade prostate cancers in the men who did get cancer.

“The results from the [Prostate Cancer Prevention] trial are what have really prevented this chemoprevention idea from becoming more widespread, because we really don't understand yet why there was an increase in the number of higher-grade tumors. It appears to be an artifact in the way the study was performed, the way the biopsies were done, and the way that the prostate-specific antigen thresholds were adjusted,” Dr. Mostaghel said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

In the present study, the researchers wanted to determine what was actually going on at the molecular level to decrease the development of prostatic tumors. Accordingly, Dr. Mostaghel and her coinvestigators examined gene expression changes in benign prostate epithelium from 75 men diagnosed with localized prostate cancer.

The men were randomized to prostatectomy alone (n = 25) or neoadjuvant dutasteride at 0.5 mg (n = 26) or 3.5 mg (n = 24) orally per day for 4 months prior to prostatectomy.

Dihydrotestosterone levels fell by 93% in the men treated with 0.5 mg dutasteride, and by 98% in the 3.5-mg-per-day group. Treatment with dutasteride induced upregulation of 32 genes and downregulated 98 genes, including several genes potentially involved in prostate cancer development. Among them were:

▸ Insulinlike growth factor-binding protein 3 (IGFBP3). This gene was upregulated in response to dutasteride. It promotes apoptosis and inhibits cell proliferation and is decreased in patients with prostate cancer.

▸ Transmembrane protease, serine 2 (TMPRSS2). This gene was downregulated in response to dutasteride. It is an androgen-regulated gene that is thought to promote the development of prostate tumors when it fuses with other oncogenes, such as ETS. TMPRSS2-ETS fusions have been found in up to 70% of prostate cancers.

▸ TFF3. This gene inhibits apoptosis and promotes tumor aggression. It is also overexpressed in gastrointestinal and breast cancers, in addition to prostate cancer.

Dutasteride is being evaluated in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, which will be completed in 2009, Dr. Mostaghel said.

“We need to wait for the results of the REDUCE trial,” he said. “In our exploratory study, we demonstrated a mechanism by which dutasteride may reduce the risk of prostate cancer. REDUCE will tell us whether the gene expression changes we are seeing with dutasteride will correlate with developing or not developing prostate cancer, so our findings need validation in larger studies of longer duration.”

ORLANDO — The investigational 5-α-reductase inhibitor dutasteride induces genetic changes in noncancerous prostate tissue and may play a role in reducing the risk of prostate cancer, Dr. Elahe Mostaghel said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Dutasteride, which is currently used to treat benign prostatic hyperplasia, reduced the activity of 98 genes—including trefoil factor 3 (TFF3), whose overexpression has been associated with the development of prostate and other cancers—by more than twofold, said Dr. Mostaghel of the Fred Hutchinson Cancer Research Center, Seattle.

The 5-α-reductase inhibitors curb the conversion of testosterone to dihydrotestosterone (DHT) inside the prostate, decreasing DHT levels and thereby inhibiting cancer development. In the Prostate Cancer Prevention Trial, inhibition with the 5-α-reductase inhibitor finasteride resulted in a 25% reduction in the overall incidence of prostate cancer, but this finding was accompanied by an unexpected increase in the number of high-grade prostate cancers in the men who did get cancer.

“The results from the [Prostate Cancer Prevention] trial are what have really prevented this chemoprevention idea from becoming more widespread, because we really don't understand yet why there was an increase in the number of higher-grade tumors. It appears to be an artifact in the way the study was performed, the way the biopsies were done, and the way that the prostate-specific antigen thresholds were adjusted,” Dr. Mostaghel said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

In the present study, the researchers wanted to determine what was actually going on at the molecular level to decrease the development of prostatic tumors. Accordingly, Dr. Mostaghel and her coinvestigators examined gene expression changes in benign prostate epithelium from 75 men diagnosed with localized prostate cancer.

The men were randomized to prostatectomy alone (n = 25) or neoadjuvant dutasteride at 0.5 mg (n = 26) or 3.5 mg (n = 24) orally per day for 4 months prior to prostatectomy.

Dihydrotestosterone levels fell by 93% in the men treated with 0.5 mg dutasteride, and by 98% in the 3.5-mg-per-day group. Treatment with dutasteride induced upregulation of 32 genes and downregulated 98 genes, including several genes potentially involved in prostate cancer development. Among them were:

▸ Insulinlike growth factor-binding protein 3 (IGFBP3). This gene was upregulated in response to dutasteride. It promotes apoptosis and inhibits cell proliferation and is decreased in patients with prostate cancer.

▸ Transmembrane protease, serine 2 (TMPRSS2). This gene was downregulated in response to dutasteride. It is an androgen-regulated gene that is thought to promote the development of prostate tumors when it fuses with other oncogenes, such as ETS. TMPRSS2-ETS fusions have been found in up to 70% of prostate cancers.

▸ TFF3. This gene inhibits apoptosis and promotes tumor aggression. It is also overexpressed in gastrointestinal and breast cancers, in addition to prostate cancer.

Dutasteride is being evaluated in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, which will be completed in 2009, Dr. Mostaghel said.

“We need to wait for the results of the REDUCE trial,” he said. “In our exploratory study, we demonstrated a mechanism by which dutasteride may reduce the risk of prostate cancer. REDUCE will tell us whether the gene expression changes we are seeing with dutasteride will correlate with developing or not developing prostate cancer, so our findings need validation in larger studies of longer duration.”

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, the number of early-stage prostate cancers being identified has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%.

However, this encouraging trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing was introduced, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer that was outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage, and fewer being diagnosed at advanced stages. This trend, which we call stage migration, appears to have gone as far as it can go,” he said.

“Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

Nevertheless, he added, it is still important for men to undergo PSA screening.

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, the number of early-stage prostate cancers being identified has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%.

However, this encouraging trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing was introduced, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer that was outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage, and fewer being diagnosed at advanced stages. This trend, which we call stage migration, appears to have gone as far as it can go,” he said.

“Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

Nevertheless, he added, it is still important for men to undergo PSA screening.

ORLANDO — For the first time since the advent of widespread prostate-specific antigen screening, the number of early-stage prostate cancers being identified has begun to level off, Dr. Eric A. Klein said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

An analysis of prostate cancer detection trends among 3,364 men treated with prostatectomy at the Cleveland Clinic between 1987 and 2005 showed that the percentage of tumors that had spread beyond the prostate at the time of surgery decreased from 79% to 25%.

However, this encouraging trend has now plateaued, said Dr. Klein, professor of surgery and head of urologic oncology at the Cleveland Clinic's Glickman Urological Institute. Since 1998, the percentage of tumors found to have spread beyond the prostate ranged from 25% to 36%.

Before prostate-specific antigen (PSA) testing was introduced, half of men initially diagnosed with prostate cancer had stage C or D disease—incurable cancer that was outside the prostate. Just 5 years after PSA screening was introduced, 95% of newly diagnosed prostate cancer was being picked up at a curable stage, Dr. Klein said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

“The increase in prostate cancer survival rates that we have seen over the past 20 years is no doubt due to widespread PSA testing that has allowed us to detect cancers in their early, more curable stage, and fewer being diagnosed at advanced stages. This trend, which we call stage migration, appears to have gone as far as it can go,” he said.

“Additional increments in cure to 100% will require [truly] new therapeutic advances both in surgery and radiation therapy, and, I believe, in molecular agents,” Dr. Klein said.

Nevertheless, he added, it is still important for men to undergo PSA screening.

ORLANDO — An innovative tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with less time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, in 1985–2003, the tool was 84% accurate in predicting time to clinical progression and spread of prostate cancer within 5 years. The risk of progression rose as the level of androgen receptors in a single prostate cancer cell increased. The tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with special software to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2–2 times the likelihood of having clinical failure within a 5-year period.

“Androgen receptor measurement is an important feature in this predictive tool, and our preliminary analyses suggest that such measurement may play a role in predicting the response to hormonal therapy,” Dr. Donovan said.

The model has also been used to analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to apply it in an active surveillance cohort of patients. He and his associates are building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in a U.S. group and a European group.

“We lack biologic tools to help patients and their physicians decide whether or not aggressive disease is present. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired a press briefing where Dr. Donovan presented his new model. “These are the kind of tools that need to be developed.”

Dr. Donovan disclosed that he owns stock in Aureon Laboratories.

ORLANDO — An innovative tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with less time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, in 1985–2003, the tool was 84% accurate in predicting time to clinical progression and spread of prostate cancer within 5 years. The risk of progression rose as the level of androgen receptors in a single prostate cancer cell increased. The tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with special software to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2–2 times the likelihood of having clinical failure within a 5-year period.

“Androgen receptor measurement is an important feature in this predictive tool, and our preliminary analyses suggest that such measurement may play a role in predicting the response to hormonal therapy,” Dr. Donovan said.

The model has also been used to analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to apply it in an active surveillance cohort of patients. He and his associates are building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in a U.S. group and a European group.

“We lack biologic tools to help patients and their physicians decide whether or not aggressive disease is present. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired a press briefing where Dr. Donovan presented his new model. “These are the kind of tools that need to be developed.”

Dr. Donovan disclosed that he owns stock in Aureon Laboratories.

ORLANDO — An innovative tool can predict the risk of tumor progression or death within 5 years for men with prostate cancer, the physician who developed the technique said at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

In the model, high levels of androgen receptor, as measured by quantitative immunofluorescence staining in prostate tissue from men who had radical prostatectomy, correlated with less time to clinical failure, said Dr. Michael J. Donovan of Aureon Laboratories Inc., Yonkers, N.Y.

“This tool is the first to measure the amount of androgen receptor protein present in a single cancer cell. Androgen receptors are proteins present in normal as well as cancerous prostate cells, and play a role in prostate cancer progression by acting as binding sites for the androgens that fuel cancer growth,” he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

Applied to tissue samples from 881 men who had surgery at Memorial Sloan-Kettering Cancer Center, New York, in 1985–2003, the tool was 84% accurate in predicting time to clinical progression and spread of prostate cancer within 5 years. The risk of progression rose as the level of androgen receptors in a single prostate cancer cell increased. The tool incorporates the patient's clinical features, including biopsy and prostatectomy Gleason grade, lymph node status, and seminal vesicle invasion.

A sample of the patient's prostate tissue is stained with a multiplex immunofluorescent assay to highlight androgen receptor antibodies and other antibodies, which are then analyzed with special software to predict the likelihood of clinical failure within 5 years. A relative risk number is also generated, Dr. Donovan said.

“A patient could have a 30% or 40% risk of having a clinical failure within 5 years, and depending upon the features that generated the model, he could have a relative risk of 1.2–2 times the likelihood of having clinical failure within a 5-year period.

“Androgen receptor measurement is an important feature in this predictive tool, and our preliminary analyses suggest that such measurement may play a role in predicting the response to hormonal therapy,” Dr. Donovan said.

The model has also been used to analyze tissue obtained from needle biopsies, and Dr. Donovan hopes to apply it in an active surveillance cohort of patients. He and his associates are building a predictive model that will use biopsy tissue from patients after prostatectomy to predict outcome in a U.S. group and a European group.

“We lack biologic tools to help patients and their physicians decide whether or not aggressive disease is present. Will the pathology tell us what the likelihood of cure is, or is there something that the pathologist can't see that suggests that the cure rate might be lower than we thought?” asked Dr. Eric A. Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, who chaired a press briefing where Dr. Donovan presented his new model. “These are the kind of tools that need to be developed.”

Dr. Donovan disclosed that he owns stock in Aureon Laboratories.

ORLANDO — Men with very-low-risk prostate cancer are reluctant to choose active surveillance, or “watchful waiting,” as a strategy to manage their disease, according to a review of a large prostate cancer database presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Just 9% of men who were eligible for active surveillance chose to be so managed. The vast majority instead opted for a more active treatment approach, said Dr. Daniel A. Barocas of New York-Presbyterian Hospital-Weill Cornell Medical College, New York.

Active surveillance of men with very-low-risk prostate cancer involves follow-up every 6 months with a digital rectal exam and a prostate-specific antigen (PSA) test, as well as biopsies at certain intervals. Treatment interventions are warranted if and when there are signs that the disease is progressing. Because of the long interval between prostate cancer diagnosis and the symptoms of localized cancer or metastases, the benefit of treatment vs. active surveillance is a matter of debate.

Dr. Barocas and his colleagues sought to determine the proportion of men presenting with very-low-risk disease who would be potential candidates for surveillance, and then calculated the percentage of these men who actually would select surveillance as their form of management. They analyzed the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a large, longitudinal observational prostate cancer disease registry that drew information from 41 community and academic practices across the United States from 1999 to 2004.

Criteria for very-low-risk disease that are highly predictive of indolent tumors include a PSA level less than 10 ng/mL; PSA density of less than 0.15; clinical T1- or T2a-stage disease; nonpalpable tumor on the digital rectal exam; Gleason score of 6 or less; and less than one-third of biopsy cores are positive.

Overall, 1,886 patients met all parameters, and 310 (16%) met the criteria for active surveillance. Patients who met the criteria for active surveillance were significantly more likely to be younger, privately insured, had higher education and income levels, and were white.

Only 28 patients (9%) chose active surveillance. Asked to speculate about why such a small number chose this type of management, Dr. Barocas said that factors such as the anxiety produced by a new diagnosis of cancer and the uncertainty of active surveillance as a strategy for management probably were involved.

Men who were older were more likely to choose surveillance. Men aged 63–70 years were 5 times more likely to choose surveillance than were men younger than 63, and men older than 70 years were 26 times more likely to choose surveillance than were men younger than 63.

Dr. Eric A. Klein, a professor of surgery at the Cleveland Clinic, noted that such reluctance to choose surveillance also is related to the inability to cure those men who progress after they have chosen observation.

“It's very clear that we are overtreating some men, but the problem right now [is that] we do not have the right tools to identify just who is going to run into trouble if they are not treated immediately. Until we have those tools at hand, there's going to be hesitation on the part of most patients and also clinicians about recommending a surveillance strategy,” he said.

That being said, active surveillance still is an option to offer to patients. “I have several dozen patients on active surveillance. We are comfortable with the idea, but there's always some uncertainty at the back of my mind about it,” Dr. Klein said.

Dr. Barocas agreed: “You have to explain the situation to the patient and be a partner in that decision-making process with him. The older the patient, the more prudent the watchful waiting approach becomes, Dr. Barocas said at the meeting, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

ORLANDO — Men with very-low-risk prostate cancer are reluctant to choose active surveillance, or “watchful waiting,” as a strategy to manage their disease, according to a review of a large prostate cancer database presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Just 9% of men who were eligible for active surveillance chose to be so managed. The vast majority instead opted for a more active treatment approach, said Dr. Daniel A. Barocas of New York-Presbyterian Hospital-Weill Cornell Medical College, New York.

Active surveillance of men with very-low-risk prostate cancer involves follow-up every 6 months with a digital rectal exam and a prostate-specific antigen (PSA) test, as well as biopsies at certain intervals. Treatment interventions are warranted if and when there are signs that the disease is progressing. Because of the long interval between prostate cancer diagnosis and the symptoms of localized cancer or metastases, the benefit of treatment vs. active surveillance is a matter of debate.

Dr. Barocas and his colleagues sought to determine the proportion of men presenting with very-low-risk disease who would be potential candidates for surveillance, and then calculated the percentage of these men who actually would select surveillance as their form of management. They analyzed the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a large, longitudinal observational prostate cancer disease registry that drew information from 41 community and academic practices across the United States from 1999 to 2004.

Criteria for very-low-risk disease that are highly predictive of indolent tumors include a PSA level less than 10 ng/mL; PSA density of less than 0.15; clinical T1- or T2a-stage disease; nonpalpable tumor on the digital rectal exam; Gleason score of 6 or less; and less than one-third of biopsy cores are positive.

Overall, 1,886 patients met all parameters, and 310 (16%) met the criteria for active surveillance. Patients who met the criteria for active surveillance were significantly more likely to be younger, privately insured, had higher education and income levels, and were white.

Only 28 patients (9%) chose active surveillance. Asked to speculate about why such a small number chose this type of management, Dr. Barocas said that factors such as the anxiety produced by a new diagnosis of cancer and the uncertainty of active surveillance as a strategy for management probably were involved.

Men who were older were more likely to choose surveillance. Men aged 63–70 years were 5 times more likely to choose surveillance than were men younger than 63, and men older than 70 years were 26 times more likely to choose surveillance than were men younger than 63.

Dr. Eric A. Klein, a professor of surgery at the Cleveland Clinic, noted that such reluctance to choose surveillance also is related to the inability to cure those men who progress after they have chosen observation.

“It's very clear that we are overtreating some men, but the problem right now [is that] we do not have the right tools to identify just who is going to run into trouble if they are not treated immediately. Until we have those tools at hand, there's going to be hesitation on the part of most patients and also clinicians about recommending a surveillance strategy,” he said.

That being said, active surveillance still is an option to offer to patients. “I have several dozen patients on active surveillance. We are comfortable with the idea, but there's always some uncertainty at the back of my mind about it,” Dr. Klein said.

Dr. Barocas agreed: “You have to explain the situation to the patient and be a partner in that decision-making process with him. The older the patient, the more prudent the watchful waiting approach becomes, Dr. Barocas said at the meeting, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

ORLANDO — Men with very-low-risk prostate cancer are reluctant to choose active surveillance, or “watchful waiting,” as a strategy to manage their disease, according to a review of a large prostate cancer database presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.

Just 9% of men who were eligible for active surveillance chose to be so managed. The vast majority instead opted for a more active treatment approach, said Dr. Daniel A. Barocas of New York-Presbyterian Hospital-Weill Cornell Medical College, New York.

Active surveillance of men with very-low-risk prostate cancer involves follow-up every 6 months with a digital rectal exam and a prostate-specific antigen (PSA) test, as well as biopsies at certain intervals. Treatment interventions are warranted if and when there are signs that the disease is progressing. Because of the long interval between prostate cancer diagnosis and the symptoms of localized cancer or metastases, the benefit of treatment vs. active surveillance is a matter of debate.

Dr. Barocas and his colleagues sought to determine the proportion of men presenting with very-low-risk disease who would be potential candidates for surveillance, and then calculated the percentage of these men who actually would select surveillance as their form of management. They analyzed the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a large, longitudinal observational prostate cancer disease registry that drew information from 41 community and academic practices across the United States from 1999 to 2004.

Criteria for very-low-risk disease that are highly predictive of indolent tumors include a PSA level less than 10 ng/mL; PSA density of less than 0.15; clinical T1- or T2a-stage disease; nonpalpable tumor on the digital rectal exam; Gleason score of 6 or less; and less than one-third of biopsy cores are positive.

Overall, 1,886 patients met all parameters, and 310 (16%) met the criteria for active surveillance. Patients who met the criteria for active surveillance were significantly more likely to be younger, privately insured, had higher education and income levels, and were white.

Only 28 patients (9%) chose active surveillance. Asked to speculate about why such a small number chose this type of management, Dr. Barocas said that factors such as the anxiety produced by a new diagnosis of cancer and the uncertainty of active surveillance as a strategy for management probably were involved.

Men who were older were more likely to choose surveillance. Men aged 63–70 years were 5 times more likely to choose surveillance than were men younger than 63, and men older than 70 years were 26 times more likely to choose surveillance than were men younger than 63.

Dr. Eric A. Klein, a professor of surgery at the Cleveland Clinic, noted that such reluctance to choose surveillance also is related to the inability to cure those men who progress after they have chosen observation.

“It's very clear that we are overtreating some men, but the problem right now [is that] we do not have the right tools to identify just who is going to run into trouble if they are not treated immediately. Until we have those tools at hand, there's going to be hesitation on the part of most patients and also clinicians about recommending a surveillance strategy,” he said.

That being said, active surveillance still is an option to offer to patients. “I have several dozen patients on active surveillance. We are comfortable with the idea, but there's always some uncertainty at the back of my mind about it,” Dr. Klein said.

Dr. Barocas agreed: “You have to explain the situation to the patient and be a partner in that decision-making process with him. The older the patient, the more prudent the watchful waiting approach becomes, Dr. Barocas said at the meeting, which was cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.

ATLANTA – Early identification and intervention are crucial to a good long-term outcome in children with autism, experts agreed at the annual meeting of the American Academy of Pediatrics.

The disorder can be tricky to diagnose; when in doubt, the child should be referred for further evaluation and intervention sooner rather than later, they said.

Red flags that a child may have autism include no pointing or babbling by 1 year; no single words by 16 months; no two-word phrases by 24 months; no pretend play; intense tantrums; and strong resistance to a change in routine, said Dr. Marshalyn Yeargin-Allsopp of the Centers for Disease Control and Prevention, Atlanta.

“The autistic child has a marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, [as well as] flat affect, failure to develop peer relationships, [and] lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, characterized by a lack of showing, bringing, or pointing at objects of interest. They may only eat one type of food, or use repetitive, restricted language if they talk at all,” she said.

Parents often do not recognize these as problems that may portend a diagnosis of autism, but most do worry that something is not quite right with their child. It is therefore essential to pay close attention to the parents, Dr. Yeargin-Allsopp said.

Autistic children are affectionate but on their own, unique terms. For example, they may form a strong attachment to inanimate objects.

Unfortunately, autism is not rare. Autism spectrum disorders affect an estimated 1 in 166 children, according to the CDC. “You are very likely to see children with an autism spectrum disorder in your practice,” Dr. Yeargin-Allsopp told her audience.

Clinicians should screen for autism in all children at 9, 18, 24, and 30 months. They should refer the child to a specialist as soon as they discover anything that might indicate autism.

“The autistic label is frightening to parents and to professionals, so there is a tendency to wait and see, but waiting is not the best strategy. Early and intense intervention does make a difference,” she said.

School and learning problems develop in the older child with autism. Children with some form of autism, like Asperger's syndrome, also can suffer from comorbid conditions such as depression or anxiety, or both, said Catherine E. Rice, Ph.D., also of the CDC.

Older children with autism may be bullied by their peers, and often develop unusual hobbies. Suicidality and shutting down or withdrawing may increase, especially in children with higher than normal intelligence. Seizure disorder is another important comorbid diagnosis in older autistic children, she said.

Dr. Rice said that telling parents their child may have autism is difficult, but it is better to suggest further testing than to do nothing. “Saying you are 'a bit concerned about the way Johnny is communicating, so let's check it out' is preferable to having to say 'oops, sorry' some 10 years later.”

Clinicians also should be aware of the so-called cures for autism that are on the Internet. These include separation from the parents, a yeast-free diet, and chelation therapy.

“It is our belief that there is currently no cure for autism, but a lot of pressure is put on parents to use some of these treatments,” she said.

“However, a lot of progress can be made by helping a family [to] tailor interventions to their child's needs. Our role as clinicians is to give the family as much support as we can, because a child with autism means a great deal of stress for the family,” she added.

A good acronym to remember is ALARM, added Dr. Yeargin-Allsopp. Published by the AAP, it stands for: Autism is prevalent, Listen to the parents, Act early, Refer, and Monitor. “If [physicians] remember the autism alarm, they'll be in good shape.”

ATLANTA – Early identification and intervention are crucial to a good long-term outcome in children with autism, experts agreed at the annual meeting of the American Academy of Pediatrics.

The disorder can be tricky to diagnose; when in doubt, the child should be referred for further evaluation and intervention sooner rather than later, they said.

Red flags that a child may have autism include no pointing or babbling by 1 year; no single words by 16 months; no two-word phrases by 24 months; no pretend play; intense tantrums; and strong resistance to a change in routine, said Dr. Marshalyn Yeargin-Allsopp of the Centers for Disease Control and Prevention, Atlanta.

“The autistic child has a marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, [as well as] flat affect, failure to develop peer relationships, [and] lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, characterized by a lack of showing, bringing, or pointing at objects of interest. They may only eat one type of food, or use repetitive, restricted language if they talk at all,” she said.

Parents often do not recognize these as problems that may portend a diagnosis of autism, but most do worry that something is not quite right with their child. It is therefore essential to pay close attention to the parents, Dr. Yeargin-Allsopp said.

Autistic children are affectionate but on their own, unique terms. For example, they may form a strong attachment to inanimate objects.

Unfortunately, autism is not rare. Autism spectrum disorders affect an estimated 1 in 166 children, according to the CDC. “You are very likely to see children with an autism spectrum disorder in your practice,” Dr. Yeargin-Allsopp told her audience.

Clinicians should screen for autism in all children at 9, 18, 24, and 30 months. They should refer the child to a specialist as soon as they discover anything that might indicate autism.

“The autistic label is frightening to parents and to professionals, so there is a tendency to wait and see, but waiting is not the best strategy. Early and intense intervention does make a difference,” she said.

School and learning problems develop in the older child with autism. Children with some form of autism, like Asperger's syndrome, also can suffer from comorbid conditions such as depression or anxiety, or both, said Catherine E. Rice, Ph.D., also of the CDC.

Older children with autism may be bullied by their peers, and often develop unusual hobbies. Suicidality and shutting down or withdrawing may increase, especially in children with higher than normal intelligence. Seizure disorder is another important comorbid diagnosis in older autistic children, she said.

Dr. Rice said that telling parents their child may have autism is difficult, but it is better to suggest further testing than to do nothing. “Saying you are 'a bit concerned about the way Johnny is communicating, so let's check it out' is preferable to having to say 'oops, sorry' some 10 years later.”

Clinicians also should be aware of the so-called cures for autism that are on the Internet. These include separation from the parents, a yeast-free diet, and chelation therapy.

“It is our belief that there is currently no cure for autism, but a lot of pressure is put on parents to use some of these treatments,” she said.

“However, a lot of progress can be made by helping a family [to] tailor interventions to their child's needs. Our role as clinicians is to give the family as much support as we can, because a child with autism means a great deal of stress for the family,” she added.

A good acronym to remember is ALARM, added Dr. Yeargin-Allsopp. Published by the AAP, it stands for: Autism is prevalent, Listen to the parents, Act early, Refer, and Monitor. “If [physicians] remember the autism alarm, they'll be in good shape.”

ATLANTA – Early identification and intervention are crucial to a good long-term outcome in children with autism, experts agreed at the annual meeting of the American Academy of Pediatrics.

The disorder can be tricky to diagnose; when in doubt, the child should be referred for further evaluation and intervention sooner rather than later, they said.

Red flags that a child may have autism include no pointing or babbling by 1 year; no single words by 16 months; no two-word phrases by 24 months; no pretend play; intense tantrums; and strong resistance to a change in routine, said Dr. Marshalyn Yeargin-Allsopp of the Centers for Disease Control and Prevention, Atlanta.

“The autistic child has a marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, [as well as] flat affect, failure to develop peer relationships, [and] lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, characterized by a lack of showing, bringing, or pointing at objects of interest. They may only eat one type of food, or use repetitive, restricted language if they talk at all,” she said.

Parents often do not recognize these as problems that may portend a diagnosis of autism, but most do worry that something is not quite right with their child. It is therefore essential to pay close attention to the parents, Dr. Yeargin-Allsopp said.

Autistic children are affectionate but on their own, unique terms. For example, they may form a strong attachment to inanimate objects.

Unfortunately, autism is not rare. Autism spectrum disorders affect an estimated 1 in 166 children, according to the CDC. “You are very likely to see children with an autism spectrum disorder in your practice,” Dr. Yeargin-Allsopp told her audience.

Clinicians should screen for autism in all children at 9, 18, 24, and 30 months. They should refer the child to a specialist as soon as they discover anything that might indicate autism.

“The autistic label is frightening to parents and to professionals, so there is a tendency to wait and see, but waiting is not the best strategy. Early and intense intervention does make a difference,” she said.

School and learning problems develop in the older child with autism. Children with some form of autism, like Asperger's syndrome, also can suffer from comorbid conditions such as depression or anxiety, or both, said Catherine E. Rice, Ph.D., also of the CDC.

Older children with autism may be bullied by their peers, and often develop unusual hobbies. Suicidality and shutting down or withdrawing may increase, especially in children with higher than normal intelligence. Seizure disorder is another important comorbid diagnosis in older autistic children, she said.

Dr. Rice said that telling parents their child may have autism is difficult, but it is better to suggest further testing than to do nothing. “Saying you are 'a bit concerned about the way Johnny is communicating, so let's check it out' is preferable to having to say 'oops, sorry' some 10 years later.”

Clinicians also should be aware of the so-called cures for autism that are on the Internet. These include separation from the parents, a yeast-free diet, and chelation therapy.

“It is our belief that there is currently no cure for autism, but a lot of pressure is put on parents to use some of these treatments,” she said.

“However, a lot of progress can be made by helping a family [to] tailor interventions to their child's needs. Our role as clinicians is to give the family as much support as we can, because a child with autism means a great deal of stress for the family,” she added.

A good acronym to remember is ALARM, added Dr. Yeargin-Allsopp. Published by the AAP, it stands for: Autism is prevalent, Listen to the parents, Act early, Refer, and Monitor. “If [physicians] remember the autism alarm, they'll be in good shape.”