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Urology

Volume 8, Supplement 2, 2006

Volume 8, Supplement 2, 2006

Table of Contents

Prostate Cancer: Epidemiology, Screening, and Biomarkers 16th International Prostate Cancer Update
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]
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]
Treatment of Localized Prostate Cancer 16th International Prostate Cancer Update
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]
New Techniques and Management Options for Localized Prostate Cancer 16th International Prostate Cancer Update
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]
Monitoring Response, Prediction Methodology, Staging, and Imaging in Prostate Cancer 16th International Prostate Cancer Update
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]
Hormonal Therapy for Prostate Cancer 16th International Prostate Cancer Update
Updates on hormonal therapy in the treatment of prostate cancer are presented. The most common therapy is to reduce testosterone to castrate levels. A dosage of 1 mg diethylstilbestrol daily prolonged survival in patients with advanced prostate cancer. The leuteinizing hormone–releasing hormone agonists have essentially replaced surgical orchiectomy in the vast majority of clinical settings; however, a major problem with the leuteinizing hormone– releasing hormone agonists has been the surge and flare of testosterone levels. If hormonal therapy is initiated early, the risk of major complications is significantly decreased. Combined androgen blockade is better than monotherapy, although there is only a small clinical benefit. When androgen deprivation is used for a short time and the normal androgen milieu is re-established, the side effects and toxicity of androgen deprivation are decreased. The major complications of androgen deprivation include hot flushes, reduction of bone mineral density, osteoporosis, and anemia. Intermittent androgen blockade might have the same benefits of total androgen suppression with fewer side effects, increased duration of androgen dependence, and less cost. The 10 steps to take when advising patients about initiation of androgen deprivation therapy are reviewed. [Rev Urol. 2006;8(suppl 2):S35-S47]
The Treatment of Hormone-Refractory Prostate Cancer: Docetaxel and Beyond 16th International Prostate Cancer Update
Two randomized clinical trials demonstrated a survival benefit of 20% to 24% with docetaxel-based therapy when compared with survival with mitoxantrone and prednisone after failure of androgen ablation therapy. These studies supported the approval of docetaxel-based therapy for the treatment of metastatic hormone-refractory prostate cancer by the US Food and Drug Administration in May 2005. Clinical trials in hormone-refractory prostate cancer are now focused on building on the survival improvement seen with docetaxel-based therapy. This article presents a summary of some of the more promising treatments and regimens for advanced prostate cancer. [Rev Urol. 2006;8(suppl 2):S48-S55]
Treatment- and Disease-Related Complications of Prostate Cancer 16th International Prostate Cancer Update
One of the highlights of the 16th International Prostate Cancer Update was a session on treatment- and disease-related complications of prostate disease. It began with presentation of a challenging case of rising prostate-specific antigen levels after radical prostatectomy, followed by an overview of the use of zoledronic acid in prostate cancer, a review of side effects of complementary medicines, an overview of complications of cryotherapy, an assessment of complications of brachytherapy and external beam radiation therapy, and a comparison of laparoscopy versus open prostatectomy. [Rev Urol. 2006;8(suppl 2):S56-S67]