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Prostate cancer

All articles from this key word are listed below.

Volume 8, Supplement 2 Review Articles

Monitoring Response, Prediction Methodology, Staging, and Imaging in Prostate Cancer

16th International Prostate Cancer Update

Nicholas Vogelzang David Pomerantz

The predictive values of various tests and examinations are assessed as they relate to prostate cancer progression and treatment. The usefulness of post-treatment biopsy specimens is greatest 2 years after radiation therapy completion. Gleason grading is not reliable in the setting of hormonal ablation therapy. For patients with extracapsular extension, the survival curves separate depending on whether positive or negative surgical margins are obtained. Prostate-specific antigen doubling time is increasingly used as an indicator of disease recurrence after local therapy and prostate cancer–specific survival. [Rev Urol. 2006;8(suppl 2):S30-S34]

Prostate cancer Immunotherapy Prostate-specific antigen Predictive modeling Prostate-specific antigen doubling time

Volume 8, Supplement 2 Review Articles

New Techniques and Management Options for Localized Prostate Cancer

16th International Prostate Cancer Update

Joycelyn L Speight Mack Roach III

Prostate cancer is diagnosed in younger men who want treatment that does not compromise their quality of life, take time away from work, or cause worrisome side effects. Laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, and third-generation cryotherapy are modifications of previously used techniques in the treatment of prostate cancer and are presented in this article. Although some or all of the outcomes might be expected to change in the future, the urologic surgeon is left to select an approach, presumably on the basis of the experience, level of training, and care pathways at his or her institution. [Rev Urol. 2006;8(suppl 2):S22-S29]

Prostate cancer Laparoscopic radical prostatectomy Third-generation cryotherapy

Volume 8, Supplement 2 Review Articles

Treatment of Localized Prostate Cancer

16th International Prostate Cancer Update

Bulent Akduman E David Crawford

This article provides an overview of treatment of localized prostate cancer, which was discussed in detail in the second scientific session of the 16th International Prostate Cancer Update. The role of radical prostatectomy in localized disease was presented by Bob Djavan, MD. Benefits and risks of radical prostatectomy were addressed by Gerald Chodak, MD. Robert E. Donohue, MD, presented the role of radical prostatectomy in Gleason grade 8, 9, and 10 tumors. Impact of positive margins on outcomes after radical prostatectomy was presented by James A. Eastham, MD. E. David Crawford, MD, provided an overview of the role of targeted therapy. Indications and results of brachytherapy were presented by Mack Roach, III, MD. Finally, Michael J. Manyak, MD, described the evolution of radioimmunoscintigraphy and clinical outcomes data. [Rev Urol. 2006;8(suppl 2):S15-S21]

Prostate cancer Radical prostatectomy Targeted therapy Cryotherapy Brachytherapy Localized disease

Volume 8, Supplement 2 Review Articles

Prevention, Complementary Therapies, and New Scientific Developments in the Field of Prostate Cancer

16th International Prostate Cancer Update

Prostate cancer prevention and therapies were reviewed in a recent update. Finasteride, a 5 reductase inhibitor, shows promise as a preventative; however, it may increase the incidence of high-grade cancer. There are ongoing studies regarding the positive effects of antioxidant therapy (vitamin E, selenium, and lycopene) on the prevention of prostate cancer; initial results are promising. Lipid-lowering drugs are associated with a statistically significant reduction in prostate cancer incidence, a 46% reduction in risk of high-grade or high-stage prostate cancer, and a 66% reduction in mortality from prostate cancer. Overexpression of transcription factors is caused by translocation of the promoter of the TMPRSS2 gene, which may be a primary event in prostate cancer. Immunomic profiling with use of autoantibodies directed against prostate-specific antigens may be used to identify cases of prostate cancer. [Rev Urol. 2006;8(suppl 2):S9-S14]

Prostate cancer 5a reductase inhibitors Prostate-specific antigens

Volume 8, Supplement 2 Review Articles

Prostate Cancer: Epidemiology, Screening, and Biomarkers

16th International Prostate Cancer Update

Gerald W Chodak

Carcinoma of the prostate continues to be a major health problem in the United States. Beginning in 1988, a marked increase in detection of prostate cancer occurred due to the development of a test for prostate-specific antigen (PSA). Controversy exists, however, about the value of PSA as a tumor marker. Although it has prognostic significance both before and after definitive therapy for prostate cancer, it is unclear whether routine PSA screening will translate into a survival advantage for patients. Because of its limitations, PSA may not ultimately be a good enough marker to be used as a screening tool. However, molecular biology has led to a rapid rise in the number of potential new prostate tumor markers, which may eventually overcome the weaknesses of PSA. Considerable progress has occurred in the diagnosis and management of prostate cancer: more is understood about the risk factors for the disease, possible ways to prevent it, and new ways to diagnose and monitor it. These developments have already translated into better patient care, while also identifying where further improvements are needed. [Rev Urol. 2006;8(suppl 2):S3-S8]

Prostate cancer Prostate-specific antigen Biomarkers Prostate-specific membrane antigen Prostate-specific antigen doubling time

Volume 8, Number 2 Review Articles

Erectile Function Outcomes in the Current Era of Anatomic Nerve-Sparing Radical Prostatectomy

Therapeutic Challenges

Arthur L Burnett

The contemporary use of anatomic nerve-sparing radical prostatectomy, which entails preserving the autonomic nerve supply to the penis required for penile erection, has led to improved erectile function outcomes compared with what has been seen historically. However, delay of postoperative recovery of erection for as long as 2 years is common, such that dysfunctional erection status lingers as a major postoperative problem. Several possible strategies to improve overall recovery rates and to hasten postoperative recovery of erectile function are currently being advanced. These include pharmacologic rehabilitation therapy and neuromodulatory therapy. Rigorous basic scientific investigation and clinical assessment of these new strategic approaches are critically important to establish their actual therapeutic benefits. [Rev Urol. 2006;8(2):47-53]

Prostate cancer Radical prostatectomy Erectile dysfunction Neuromodulation Penile erection

Volume 8, Supplement 1 Review Articles

Fused Radioimmunoscintigraphy for Treatment Planning

Prostate Cancer Imaging

Deborah A Kaminsky Rodney J Ellis

Advances in imaging technologies, including computerized tomography (CT) and single-photon emission tomography (SPECT), are improving the role of imaging in prostate cancer diagnosis and treatment. Hybrid (SPECT/CT) imaging, in particular, shows an increased sensitivity for identification of prostate cancer. Published studies have also recently proposed a new paradigm in the administration of radiation therapy for prostate cancer, favoring doseescalation strategies to improve tumor control for localized disease. Conventional dose-escalation protocols have previously relied primarily on margin extension to the entire prostate gland to achieve dose-escalation; extending increased risk to radiosensitive normal structures. A newer strategy proposes use of advanced imaging to confine dose-escalation to biological target volumes identified on capromab pendetide SPECT/CT-fused image sets or imageguided radiation therapy (IGRT). This strategy defines a shift in radiation dosimetry and planning from uniform glandular prescription dosing with doseescalation applied generically to the peripheral regions and margin extension; to dose-escalation confinement to discrete regions of known disease as defined by focal uptake on radioimmunoscintigraphy fusion with anatomic image sets, with minimal margin extension. The introduction of advanced imaging for IGRT in prostate cancer has also introduced an improved capability for the early-identification of patients at risk for metastatic disease, where more aggressive therapeutic interventions may prove beneficial. [Rev Urol. 2006;8(suppl 1):S11-S19]

Prostate cancer Radiotherapy Brachytherapy ProstaScint SPECT/CT Biological targetvolumes Survival

Volume 8, Supplement 1 Review Articles

Magnetic Resonance Imaging and Spectroscopy of Prostate Cancer

Prostate Cancer Imaging

John Kurhanewicz Fergus V Coakely Peter R Carroll

Magnetic resonance imaging may improve the staging of prostate cancer compared with clinical evaluation alone, computerized tomography, or transrectal ultrasound, and it allows simultaneous and detailed evaluation of prostatic, periprostatic, and pelvic anatomy. Endorectal magnetic resonance imaging and magnetic resonance spectroscopic imaging (endoMRI/MRSI) allow better visualization of the zonal anatomy of the prostate and better delineation of tumor location, volume, and extent (stage). Metabolic criteria used to identify and localize prostate cancer with endoMRI/MRSI have been standardized, thus improving the accuracy of the examination and limiting interobserver variations in interpretation. Evidence is now emerging that endoMRI/MRSI may also be helpful in assessing response to prostate cancer treatment, most commonly with radiation and/or androgen-deprivation therapy. [Rev Urol. 2006;8(suppl 1):S4-S10]

Prostate cancer Magnetic resonance imaging Magnetic resonance spectroscopy Endorectal MRI

Volume 8, Supplement 1 Review Articles

The Emergence of Radioimmunoscintigraphy for Prostate Cancer

Prostate Cancer Imaging

M Scott Wingo Inger L Rosner Thomas E Keane David G McLeod

The ability to label tissue-specific antibodies has long been of interest for improving detection and guidance for therapeutic applications. The most studied target for prostate cancer is the prostate-specific membrane antigen, which is upregulated in prostate cancer, hormone-refractive disease, and prostate cancer metastases. Investigations using radioimmunoscintigraphy with the radiolabeled 7E11 antibody capromab pendetide have significantly improved sensitivity for prostate cancer detection compared with standard cross-sectional imaging, based on tissue confirmation of pathologic results. Over the past 5 years, significantly greater image resolution from improved camera technology and the use of co-registration to fuse functional and anatomic (computerized tomography and magnetic resonance imaging) images have dramatically enhanced prostate cancer localization. Outcomes data from several sources have spurred a resurgence in interest in this imaging modality. [Rev Urol. 2006;8(suppl 1):S20-S28]

Prostate cancer ProstaScint Prostate-specific membrane antigen Radioimmunoscintigraphy Capromab pendetide Image co-registration Lymph node metastasis

Volume 8, Supplement 1 Review Articles

Contrast-Enhanced Ultrasound Imaging of Prostate Cancer

Prostate Cancer Imaging

Ethan J Halpern

Ultrasound imaging of the prostate is commonly used to assess the size of the gland and for needle placement during systematic biopsy. Ultrasound evaluation of prostate cancer is limited by difficulty in distinguishing benign from malignant tissue. Although Doppler techniques may provide some improvement in the detection of prostate cancer, targeted biopsy based on conventional ultrasound with Doppler is not sufficient to replace systematic biopsy. Contrast-enhanced ultrasound imaging techniques that employ microbubble contrast agents represent an innovative approach to imaging of the neovascularity associated with prostate cancer. This review describes the application of contrast-enhanced ultrasound to improve detection and assessment of prostate cancer. [Rev Urol. 2006;8(suppl 1):S29-S37]

Prostate cancer Doppler Ultrasound Microbubble contrast agents