16th International Prostate Cancer Update

Introduction

RIUS0000(Watson)_04-24.qxd 24/4/06 12:31 Page S1 INTRODUCTION 16th International Prostate Cancer Update Michael K. Brawer, MD Northwest Prostate Institute, Northwest Hospital, Seattle, WA [Rev Urol. 2006;8(suppl 2):S1-S2] © 2006 MedReviews, LLC he 16th International Prostate Cancer Update was held in Beaver Creek, Colorado, on January 18–22, 2006. Once again, E. David Crawford, MD, of the University of Colorado Health Sciences Center in Denver, chaired the meeting. The purpose of the meeting, as stated in its promotional materials, was “to provide clinicians involved in the management of patients diagnosed with or at risk for prostate cancer with up-to-date information on the latest diagnostic tools, surgical approaches, and treatment strategies for early- and late-stage disease, both androgen-responsive and androgen-independent.” This broad and ambitious goal was easily met, thanks to the efforts of a world-class advisory board and faculty. Thanks to generous support from Watson Pharma, Inc., it is our great pleasure to present this special supplement to Reviews in Urology, dedicated to reporting on this meeting. The meeting comprised 8 scientific sessions, and each is excellently reviewed by one of that session’s expert presenters. T VOL. 8 SUPPL. 2 2006 REVIEWS IN UROLOGY S1 RIUS0000(Watson)_04-24.qxd 2/5/06 3:14 Page S2 Introduction continued We begin with a report by Gerald Chodak, MD, on prostate cancer epidemiology, biomarkers, and screening. Dr. Chodak, from the Midwest Prostate and Urology Health Center in Chicago, IL, devotes much of his report to the question, “Is screening worthwhile?” He proposes 3 reasons (lead time bias, length time bias, and overdetection) prostate-specific antigen (PSA) screening cannot be proved to save lives, and he offers advice as to how the uncertainties of screening should be presented to patients. Dr. Chodak cites data from the Prostate Cancer Prevention Trial (PCPT) indicating that “no man can be told definitively that he does not have prostate cancer, regardless of his PSA level.” Next, Philip Kantoff, MD, of the Dana-Farber Cancer Institute in Boston, reviews prevention, complementary therapies, and new scientific developments in the field. Dr. Kantoff reviews data from the PCPT regarding the 5
reductase inhibitor finasteride for prostate cancer prevention. In particular, he addresses the question of whether the finding of an increased incidence of high-grade cancer in the finasteride arm of the PCPT is real or artifactual. Antioxidants and statins as chemoprotective agents, immunomic profiling of prostate cancer, and diet are also discussed here. The next 2 articles address treatment of localized disease. Dr. Crawford and his colleague Bulent Akduman, MD, discuss the role of radical prostatectomy (RP) and the relative merits of open versus laparoscopic approaches S2 VOL. 8 SUPPL. 2 2006 to RP. Positive surgical margin after RP is the authors’ next subject: specifically, whether margins can be altered by surgical technique and what might be done to decrease the risk of positive margins. Joycelyn L. Speight, MD, PhD, and Mack Roach, III, MD, of the UCSF Comprehensive Cancer Center, also weigh in on the “open versus laparoscopic RP” debate, focusing more specifically on robotic-assisted laparoscopic techniques; they present the latest data in the areas of cryotherapy (for which advances in imaging technology have signaled “a new era”) and permanent seed brachytherapy. “Monitoring Response, Prediction Methodology, Staging, and Imaging” was the topic of the 5th session of the meeting. Nicholas Vogelzang, MD, from the Nevada Cancer Institute, was one of the presenters in this session. His article (co-authored with David Pomerantz, MD) reviews post-treatment biopsy and Gleason grading, PSA doubling time as an indicator of recurrence, and new developments in imaging techniques. Michael K. Brawer, MD, offers a thorough review of hormonal therapy for prostate cancer, beginning with an overview of the subject and then focusing more closely on combined androgen blockade, intermittent androgen blockade, and targeted systemic therapy. The complications of hormonal therapy are addressed here, and a 10-step approach to advising patients about hormonal therapy (as presented at the meeting by Mark Moyad, MD) is reviewed. REVIEWS IN UROLOGY In his review of the treatment of hormone-refractory disease, Daniel P. Petrylak, MD, of Columbia University Medical Center, states that “the future is bright for the treatment of prostate cancer.” Dr. Petrylak focuses on docetaxel-based therapy and the results of 2 randomized clinical trials of this drug versus mitoxantrone and prednisone. He goes on to review endothelin receptor antagonists, new antimicrotubule agents, antiangiogenic agents, and new treatments to activate the immune system. Finally, Anne R. Simoneau, MD, of the University of California at Irvine, reports on the meeting session addressing treatment- and diseaserelated complications. At this session, Dr. Simoneau spoke on the complications of complementary medicines, including commonly used dietary supplements (eg, vitamin E and zinc) and herbal supplements. Skeletalrelated complications, side effects of cryotherapy, and complications of radiotherapy were other topics of this session, and Dr. Simoneau reviews each of these. We thank Dr. Crawford for heading up another exciting gathering of clinicians at the vanguard of prostate cancer treatment. Clearly, this annual meeting should be a destination for anyone involved in the treatment of this disease. The 17th International Prostate Cancer Update will be held from February 14–18, 2007, in Vail, CO. More information about the meeting can be found at www. clinicaloptions.com.