Prostate Cancer and Prostatic Diseases: From the Editor

08 June 2018

Obesity is all around us.  Over 30% of all Americans are obese. We know obesity is linked with many medical problems – heart disease, diabetes, hypertension, and of course cancer. Indeed, over a dozen different cancers have been linked with obesity. In regards to prostate cancer, while obesity may lower the risk of low-grade indolent cancer, it unequivocally increases the risk of high-grade aggressive disease. Many explanations have been put forward: alterations in insulin levels, changes in sex steroid hormone levels, higher cholesterol,

14 May 2018

This compelling study revisits the concept of neoadjuvant adjuvant deprivation therapy (ADT) prior to radical prostatectomy. A small series of randomized clinical trials (RCTs) performed almost 20 years ago failed to demonstrate substantial benefits in patients with localized prostate cancer who received ADT before surgery. Based on these data, the American Urological Association and the European Association of Urology recommend against ADT prior to prostatectomy outside the setting of a clinical trial.

02 April 2018

Molecular risk tools are being increasingly utilized in men with localized prostate cancer to help in clinical decision making around the need for surgery or radiation vs. active surveillance, and for the need for salvage radiation after surgery.  The Decipher Genomic Classifier has recently been demonstrated to predict distant metastases in men undergoing radical prostatectomy, using biopsy or surgical tissue, and may provide a greater level of prognostic discrimination than current NCCN or CAPRA risk groups. 

01 February 2018

Urethral strictures do not tend to be at the forefront of most clinicians’ minds when considering the adverse effects of radiotherapy for prostate cancer. Quite correctly, the first considerations would be for those associated with any collateral damage to the rectum or bladder. But all urologists are well aware of radiation-related urethral strictures because the great majority would have these patients in their clinical workload. They are ‘heavy’ patients in that they need a lot of counseling and often require a lot of work to ‘manage’ their disease.  It is often a case of where a few patients as such can

02 January 2018

Race, family history, and age.  Those are the three classic risk factors for prostate cancer that are etched in stone in every textbook and course taught. While absolutely true, the challenge is that none of these are modifiable.  We can’t change our race.  We can’t grow younger and as much as some of us would like, we can’t change our parents. As such, we are stuck.  Our risk is our risk.  Or is it?  Are there modifiable risk factors for prostate cancer? It is now clear that obesity and smoking are modifiable risk factors for fatal prostate cancer. While avoiding obesity and not smoking sound like overall good advice, is there more specific advice we can give to our patients or to men at risk who don’t want to become patients in the first place. 

11 December 2017

Active surveillance (AS) provides a safe management option for men with low-risk and selected men with intermediate-risk prostate cancer. However, concerns persist that African American (AA) men pursuing AS are at increased risk of adverse clinical outcomes relative to other races. 

These investigators undertook a systematic review of studies of AA men with low-risk prostate cancer and AS. They identified eleven studies focused on pathologic features at time of surgery and five on other clinical outcomes. Further, they reviewed genetic characteristics of prostate cancer and the AA population. They did not

17 November 2017

Enzalutamide is a second generation AR inhibitor that engages AR through the ligand binding domain, inhibiting DNA binding and AR activity. In the PREVAIL study, enzalutamide improved overall survival in chemotherapy naïve men with mCRPC, and enzalutamide is presently a standard of care for these men, with greater activity observed when used prior to docetaxel as compared to following docetaxel.  While most men respond to enzalutamide in this setting, all men develop treatment resistance between 1-3 years. This present article explores how men progress on enzalutamide, using data from the PREVAIL trial.

17 October 2017

PSA screening has allowed for the detection of prostate cancer at curable clinical stages, and accordingly, there has been a reduction in prostate cancer-specific mortality in the PSA era.  Criticisms of PSA based screening and its utilization for decision making regarding biopsy have focused on its sensitivity, and lack of specificity for prostate cancer.  Use of PSA alone can lead to unnecessary initial and repeat biopsies, and to the detection of indolent prostate cancer, all of which cause health and economic burdens.

29 September 2017

Metabolic syndrome is a constellation of conditions including obesity, diabetes, hypertension, and alterations in serum lipids. It was originally defined as a syndrome that is linked with increased risk of heart disease. As the obesity epidemic has swept through the Western world, the rates of metabolic syndrome have likewise risen dramatically. As many of the conditions that constitute the metabolic syndrome have individually been linked with cancer, there is growing interest in the role of the metabolic syndrome with cancer. 

15 September 2017

Recently, there has been a great deal of interest in prostate specific membrane antigen (PSMA) as a basis for positron emission tomography (PET) imaging of prostate cancer. As recently as a few years ago, there were only handfuls of abstracts on this subject matter at the major international urology conferences.  Over the past couple of years, there has literally been an explosion of clinical abstracts, particularly in the evaluation of Ga68 PSMA PET/CT as a staging tool at diagnosis and in the setting of evaluating biochemical recurrence following primary definitive treatment of localised disease.

06 September 2017

Hot flashes.  Loss of Libido.  Impotence.  Fatigue.  Osteoporosis. Weight gain. Diabetes. Loss of muscle mass.  Gain in fat mass. Testicular shrinkage. Cardiovascular disease (still controversial). What do these all have in common?  No, they are not the rare side effects that may occur from a drug that you hear on a TV commercial.  These are all real and common side effects of androgen deprivation therapy (ADT) for prostate cancer. 

29 June 2017

Androgen deprivation therapy (ADT) causes a host of well-recognized side effects. Recent epidemiological and clinical evidence suggests that ADT may also be associated with dementia and cognitive impairment. Potential physiological explanations for these observations include altered neuron growth and axonal regeneration, increased ß-amyloid protein levels, and exacerbation of cardio-metabolic disease (including but not limited to cerebrovascular disease), all of which may occur in an androgen-deprived state.

01 June 2017

Radium-223 is a novel alpha emitting radiopharmaceutical with bone tropism, now FDA approved for men with symptomatic bone-metastatic castration-resistant prostate cancer.  Approval was based on the survival benefit observed in the phase 3 ALSYMPCA trial over best supportive care, which included oral steroids or hormonal therapies, bone anti-resorptive therapy, and palliative radiation.

01 May 2017

In an era when all men got radiation or surgery, there was no need for risk stratification. However, as newer options became introduced, risk stratification became essential. Towards that effort, PSA, tumor grade, and stage have been the backbone of prostate cancer risk stratification for over 20 years. However, in an era of active surveillance for low-risk disease and multi-modal therapy for high-risk disease, it is clear that they are often not good enough. 

29 March 2017

PSA screening is the backbone of early prostate cancer detection in the United States and increasingly in other parts of the world too. Due to concerns about over-detection and over-treatment of indolent disease (i.e. harms), PSA screening is controversial, despite level 1 evidence that screening vs. no screening can reduce the risk of death from prostate cancer (i.e. benefits).