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Prostate cancer

All articles from this key word are listed below.

Volume 9, Number 1 Review Articles

Recent Progress in the Treatment of Advanced Prostate Cancer With Intermittent Dose-Intense Calcitriol (DN-101)

Treatment Update

Michael K Brawer

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]

Prostate cancer Vitamin D Calcitriol DN-101 Docetaxel

Volume 10, Number 4 Case Review

Management of Localized Prostate Cancer and an Incidental Ureteral Duplication With Upper Pole Ectopic Ureter Inserting into the Prostatic Urethra

Case Review

Bachir Taouli Michael D Stifelman Tracy P Marien Ellen Shapiro Jonathan Melamed Herbert Lepor

Ectopic ureters are rare congenital malformations of the renal system that most commonly present in females. It is extremely rare to encounter an ectopic ureter in an older man undergoing radical prostatectomy. We report herein a case of a 66-year-old man with prostate cancer and a complete duplication of the left renal collecting system, with an upper pole ectopic ureter and associated normal functioning renal parenchyma entering into the prostatic urethra. This anomaly was incidentally discovered on preoperative magnetic resonance imaging of the prostate. Open radical retropubic prostatectomy and a left ureteroureterostomy were performed. [Rev Urol. 2008;10(4):297-303]

Prostate cancer Prostatectomy Ectopic ureter Prostatic urethra

Volume 10, Number 4 Review Articles

Using Biopsy to Detect Prostate Cancer

Diagnostic Review

Shahrokh F Shariat Claus G Roehrborn

Transrectal ultrasound-guided systemic biopsy is the recommended method in most cases with suspicion of prostate cancer. Transrectal periprostatic injection with a local anesthetic may be offered as effective analgesia; periprostatic nerve block with 1% or 2% lidocaine is the recommended form of pain control. On initial biopsy, a minimum of 10 systemic, laterally directed cores is recommended, with more cores in larger glands. Extended prostate biopsy schemes, which require cores weighted more laterally at the base (lateral horn) and medially to the apex, show better cancer detection rates without increasing adverse events. Transition zone biopsies are not recommended in the first set of biopsies, owing to low detection rates. One set of repeat biopsies is warranted in cases with persistent indication. Saturation biopsy (=20 cores) should be reserved for repeat biopsy in patients who have negative results on initial biopsy but who are still strongly suspected to have prostate cancer. [Rev Urol. 2008;10(4):262-280]

Prostate cancer Biopsy Prostate-specific antigen Transrectal ultrasound Nomograms Anesthesia

Volume 10, Number 3 Review Articles

Nutraceuticals in Prostate Disease: The Urologist’s Role

Treatment Update

Daniel Shoskes Mark A Moyad Claus G Roehrborn J Curtis Nickel

Interest in and use of complementary and alternative therapies, especially nutraceuticals, is high in prostate disease. These therapies have shown potential in benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Some have produced results equal to or better than pharmaceuticals currently prescribed for BPH. In category III prostatitis, some nutraceuticals may offer relief to patients who get little from standard therapy. Because it is becoming apparent that inflammation may play a role in the progression of BPH and development of prostate cancer, nutraceuticals, which commonly have anti-inflammatory properties, may play a role. These therapies have also shown potential in prostate cancer treatment and prevention, especially those that also reduce cardiovascular events or risk. Nevertheless, uses of some nutraceuticals in prostate disease have had less desirable consequences, showing lack of efficacy, adulteration, and/or severe side effects or drug interactions. By ensuring that these therapies undergo careful study for effectiveness, quality, and safety, urologists can look forward to adding them to their evidence-based armamentarium for prostate disease. [Rev Urol. 2008;10(3):192-206]

Prostate cancer Benign prostatic hyperplasia Prostatitis Complementary or alternative medical therapy Nutraceuticals

Volume 10, Number 3 Review Articles

Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice

Diagnostic Update

Leonard S Marks David G Bostwick

A specific marker for early prostate cancer would fill an important void. In initial evaluations of the prostate cancer antigen 3 (PCA3) gene vis-à-vis serum prostate-specific antigen (PSA) levels, the gene offers great promise. At the cellular level, PCA3 specificity for cancer is nearly perfect because of the gross overexpression of the gene by cancer cells. As a clinical test for early prostate cancer, heightened specificity is also seen in urine containing prostate cells from men with the disease. PCA3 gene testing holds valuable potential in PSA quandary situations: (1) men with elevated PSA levels but no cancer on initial biopsy; (2) men found to have cancer despite normal levels of PSA; (3) men with PSA elevations associated with varying degrees of prostatitis; and (4) men undergoing active surveillance for presumed microfocal disease. [Rev Urol. 2008;10(3):175-181]

Prostate cancer Benign prostatic hyperplasia Prostate-specific antigen Prostatitis Watchful waiting Prostate cancer antigen 3 gene Microfocal disease

Volume 10, Number 2 Review Articles

Prostate Cancer in Elderly Men

Treatment Update

Matthias Waldert Anton Stangelberger Bob Djavan

Due to increasing life expectancy and the introduction of prostate-specific antigen (PSA) screening, a rising number of elderly men are diagnosed with prostate cancer. Besides PSA serum levels and Gleason score, age is considered to be a key prognostic factor in terms of treatment decisions. In men older than 70 years, treatment without curative intent may deprive the frail patient of years of life. Modern radical prostatectomy techniques are associated with low perioperative morbidity, excellent clinical outcome, and documented long-term disease control. Thus, radical prostatectomy should be considered because local treatment of organ-confined prostate cancer potentially cures disease. The huge extent of PSA screening programs may lead to overdiagnosis of prostate cancer. Not every man who is diagnosed with prostate cancer will develop clinically significant disease. This has led to the concept of expectant management for screen-detected, small-volume, low-grade disease, with the intention of providing therapy for those men with disease progression. [Rev Urol. 2008;10(2):111-119]

Prostate cancer Elderly men Screening Quality of life Prostate-specific antigen Overtreatment

Volume 10, Number 2 Review Articles

Managing Bone Loss and Bone Metastases in Prostate Cancer Patients: A Focus on Bisphosphonate Therapy

Treatment Update

Androgen deprivation therapy (ADT) and bone metastases are the most important risk factors for developing skeletal complications (eg, bone loss, pathologic fractures) in prostate cancer (PC) patients with locally advanced and metastatic disease. Bisphosphonates, which inhibit excessive osteoclast activity caused by ADT and bone metastases, have proven to be safe and effective in preventing skeletal complications and presently are the standard of care in patients with metastatic disease. Bisphosphonates should be considered for use in all PC patients with locally advanced disease initiating ADT for an intended duration of at least 1 year, especially those with a low baseline bone mineral density. [Rev Urol. 2008;10(2):99-110]

Prostate cancer Androgen deprivation therapy Skeletal-related events Bone metastasis Bone loss Bisphosphonates

Volume 11, Number 3 Meeting Reviews

New Findings in Prostate Cancer

Franklin E Kuehhas Bob Djavan

Highlights From the 24th Annual Congress of the European Association of Urology,March 17–21, 2009, Stockholm, Sweden[Rev Urol. 2009;11(3):169-172 doi:10.3909/riu0455]

Prostate cancer Erectile dysfunction Urinary incontinence Pelvic lymph node dissection Staging European Randomized Study of Screening for Prostate Cancer (ERSPC)

Volume 11, Number 3 Review Articles

Predictive Models for Newly Diagnosed Prostate Cancer Patients

Management Update

William T Lowrance Peter T Scardino

[Rev Urol.2009;11(3):117-126 doi: 10.3909/riu0456]2009 MedReviews®, LLC©Accurate risk assessment is of paramount importance to newly diagnosedprostate cancer patients and their physicians. Risk prediction models helpidentify those at high (or low) risk of disease progression and guide discussionsabout prognosis and treatment. Widely used, well-validated predictiontools are based on standard, readily available clinical and pathologic parameters,but do not include biomarkers, some of which may have an importantrole in predicting prognosis or determining therapeutic options. A newapproach, known as systems pathology, may improve the accuracy of traditionalprediction methods and provide patients with a more personalized riskassessment of clinically relevant outcomes. The ultimate goal of predictionmodels is to improve medical decision making.

Prostate cancer Prognosis Statistical model Nomogram

Volume 11, Number 2 Review Articles

Status of Radical Prostatectomy in 2009: Is There Medical Evidence to Justify the Robotic Approach?

Treatment Review

This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1- to 2-day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.[Rev Urol. 2009;11(2):61-70]

Prostate cancer Robotic-assisted Open radical retropubic prostatectomy