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Volume 10, Number 1View Issue
Volume 9, Number 4View Issue
Estrogenic Side Effects of Androgen Deprivation Therapy
Treatment Update
Michael S CooksonJames A EasthamTheresa A GuiseMichael G OefeleinMatthew R SmithCelestia Higano
Androgen deprivation therapy (ADT) is part of standard therapy for locally advanced or metastatic prostate cancer and is frequently used in men with a rising prostate-specific antigen following radical prostatectomy or radiation therapy. In some men, ADT may be administered for years or even decades. The intended therapeutic effect of ADT is testosterone deficiency. Because estrogen is a normal metabolite of testosterone, ADT also results in estrogen deficiency. ADT has a variety of adverse effects, many of which are primarily related to estrogen deficiency. Bone mineral density may decrease by 4% to 13% per year in men receiving ADT. The fracture rate for patients on ADT averages 5% to 8% per year of therapy. Hot flashes, gynecomastia, and breast tenderness are common side effects associated with ADT. In the clinic, minimum baseline testing should include weight measurement, blood pressure reading, and fasting lipid panel and serum glucose tests. Currently, there are no large outcome trials in men on ADT testing the available therapies for adverse effects. No therapies are specifically approved for treatment of adverse effects in men on ADT. Although some therapies can be used for a single indication (based upon small studies), there is currently no agent to treat the multiple estrogenic side effects of ADT. [Rev Urol. 2007;9(4):163-180]
Androgen deprivation therapyCardiovascular diseaseGynecomastiaOsteoporosis fractureMale hot flashes
Volume 9, Number 3View Issue
Prostate Biopsy: Current Status and Limitations
Diagnostic Update
The technique of prostate biopsy has evolved over the past 10 years to improve our ability to detect prostate cancer. Extended biopsy schemes can be performed in the office under local anesthesia and are well tolerated. In addition to detection, the role of extended biopsy schemes in refining tumor grading and risk assessment has become better defined. This review discusses the evolution of prostate biopsy techniques from the sextant scheme to the extended scheme and demonstrates the latter's utility in clinical decision making. [Rev Urol. 2007;9(3):93-98]
Volume 9, Number 2View Issue
Understanding the Natural Biology of Kidney Cancer: Implications for Targeted Cancer Therapy
Treatment Update
Arie S BelldegrunAllan J PantuckTobias KlatteMark D Kleid
During the past several decades, there has been a significant increase in the understanding of the biology, clinical behavior, and prognostic factors of renal cell carcinoma (RCC). Such progress has led to greater sophistication in the diagnosis and classification of RCC. Here, we review recent advances in our knowledge of the biologic characteristics of RCC that have resulted in notable achievements in staging, prognosis, patient selection, and treatment. [Rev Urol. 2007;9(2):47-56]
AngiogenesisGeneticsMolecular markersTargeted treatmentTumor-node-metastasis classification
Volume 9, Supplement 2View Issue
Volume 9, Supplement 1View Issue
Volume 9, Number 1View Issue
Recent Progress in the Treatment of Advanced Prostate Cancer With Intermittent Dose-Intense Calcitriol (DN-101)
Treatment Update
Docetaxel is becoming standard therapy for androgen-independent prostate cancer (AIPC), and investigational agents are being added to docetaxel to assess potential additive effects and synergy. Although one of these agents, calcitriol, has repeatedly demonstrated antiproliferative properties against cancer of the prostate, breast, colon, and lung, the antineoplastic activity of calcitriol requires superphysiologic levels. Unfortunately, chronic exposure to superphysiologic levels of calcitriol causes hypercalcemia and resulting toxicity. Therefore, a host of analogues of calcitriol have been investigated for antineoplastic function, including intermittent dose-intense calcitriol, or DN-101. Because of encouraging results from phase II studies of DN-101 combined with docetaxel, the ASCENT (AIPC Study of Calcitriol Enhancement of Taxotere) phase II trial investigated docetaxel plus DN-101 versus docetaxel plus placebo in 250 men with metastatic AIPC and an abnormal baseline prostate-specific antigen (PSA) level. Although the ASCENT trial did not achieve its primary endpoint for increased PSA response, there was a significant trend in PSA response rate in the DN-101 arm. DN-101 in combination with docetaxel seems to improve overall survival and, interestingly, has a favorable safety profile compared with docetaxel alone. The DN-101/docetaxel combination is currently being studied in a much larger international trial, ASCENT-2. [Rev Urol. 2007;9(1):1-8]
Volume 8, Supplement 4View Issue
Volume 8, Number 4View Issue
Prostate Biopsy: Targeting Cancer for Detection and Therapy
Technology Update
Despite improvements in cancer detection, prostate biopsy still lacks the ability to accurately map locations of cancer within the prostate. Improvements in prostate imaging may allow more accurate mapping of overall disease volume. Magnetic resonance (MR) spectroscopy allows improved specificity in detecting even small foci of disease within the peripheral zone. Improvements in MR-guided biopsy techniques may allow this technology to be adapted to therapeutics as well. Computer modeling of individual prostates serves as a means of designing optimized plans for prostate biopsy. The use of novel targeted biopsy schemes may allow an integration of available technologies in detection and localization of prostate cancer. Computer-directed needle biopsies based on anatomic landmarks within the prostate and computerized three-dimensional reconstruction of the gland may allow a highly reproducible means of identifying small foci of cancer, targeting them for therapy, and monitoring for recurrence. The TargetScan® system (Envisioneering Medical Technologies, St. Louis, MO) is the first technology to integrate available targeting methodologies in a systematic fashion. [Rev Urol. 2006;8(4):173-182]
