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American Journal of Health-system... Feb 1996The staging, screening and diagnosis, and treatment of prostate cancer are discussed. Prostate cancer kills about 40,000 men in the United States each year. Signs and... (Review)
Review
The staging, screening and diagnosis, and treatment of prostate cancer are discussed. Prostate cancer kills about 40,000 men in the United States each year. Signs and symptoms range from dysuria to features of advanced metastatic disease. The American Urological System of staging prostate cancer designates four stages, A through D. The tumor is graded histologically with the Gleason scale. Methods used in the screening and diagnosis of prostate cancer include digital rectal examination, the prostate-specific antigen (PSA) assay, biopsy, transrectal ultrasonography, and determination of PSA density, velocity, and age specificity. The value of screening and treatment remains controversial because tumors are generally slow-growing and conclusive data showing an effect on survival time are lacking. Treatment methods consist of prostatectomy, radiation therapy, and hormonal drug therapy or bilateral orchiectomy. The choice is influenced primarily by the stage of the disease but also by the patient's age, physical condition, and response to prior therapy. Patients with stage A or B disease are considered for prostatectomy or radiation therapy. The primary treatment for stage C disease is radiation therapy. For stage D, the main approaches are watchful waiting and bilateral orchiectomy or hormonal drug therapy to reduce androgenic stimulation of prostate tissue. Long-term survival rates are high for stages A and B and considerably lower for stages C and D. Prostate cancer responds to estrogens, but adverse effects are frequent and potentially severe. Luteinizing hormone-releasing hormone agonists (leuprolide and goserelin) are as effective as estrogens but have less toxicity; a disadvantage of these agents is an initial flaring of the disease. Other hormonal agents used include antiandrogens-progestins, flutamide, and bicalutamide. Secondary hormonal treatments (aminoglutethimide and ketoconazole) are less effective than initial hormonal therapy. Antineoplastic agents have little or no effectiveness in prostate cancer. Although the value of screening for and treating prostate cancer continues to be debated, many experts recommend annual screening for all men over 50. Research to identify more effective drugs for treating advanced disease continues.
Topics: Androgen Antagonists; Antineoplastic Agents; Humans; Male; Prostatic Neoplasms
PubMed: 8673658
DOI: 10.1093/ajhp/53.4.381 -
Immunotherapy Feb 2018Prostate cancer (PC) is a common malignancy among elderly males and is noncurable once it becomes metastatic. In recent years, a number of antigen-delivery systems have... (Review)
Review
Prostate cancer (PC) is a common malignancy among elderly males and is noncurable once it becomes metastatic. In recent years, a number of antigen-delivery systems have emerged as viable and promising immunotherapeutic agents against PC. The approval of sipuleucel-T by the US FDA for the treatment of males with asymptomatic or minimally symptomatic castrate resistant PC was a landmark in cancer immunotherapy, making this the first approved immunotherapeutic. A number of vaccines are under clinical investigation, each having its own set of advantages and disadvantages. Here, we discuss the basic technologies underlying these different delivery modes, we discuss the completed and current human clinical trials, as well as the use of vaccines in combination with immune checkpoint inhibitors.
Topics: Humans; Immunotherapy; Male; Prostate; Prostatic Neoplasms
PubMed: 29421982
DOI: 10.2217/imt-2017-0123 -
The Prostate Feb 2020The 2019 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Prostate Cancer Research: The Next Generation," was held 20 to 23 June, 2019, in Los Angeles, California. (Review)
Review
INTRODUCTION
The 2019 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Prostate Cancer Research: The Next Generation," was held 20 to 23 June, 2019, in Los Angeles, California.
METHODS
The CHPCA Meeting is an annual conference held by the Prostate Cancer Foundation, that is uniquely structured to stimulate intense discussion surrounding topics most critical to accelerating prostate cancer research and the discovery of new life-extending treatments for patients. The 7th Annual CHPCA Meeting was attended by 86 investigators and concentrated on many of the most promising new treatment opportunities and next-generation research technologies.
RESULTS
The topics of focus at the meeting included: new treatment strategies and novel agents for targeted therapies and precision medicine, new treatment strategies that may synergize with checkpoint immunotherapy, next-generation technologies that visualize tumor microenvironment (TME) and molecular pathology in situ, multi-omics and tumor heterogeneity using single cells, 3D and TME models, and the role of extracellular vesicles in cancer and their potential as biomarkers.
DISCUSSION
This meeting report provides a comprehensive summary of the talks and discussions held at the 2019 CHPCA Meeting, for the purpose of globally disseminating this knowledge and ultimately accelerating new treatments and diagnostics for patients with prostate cancer.
Topics: Animals; Humans; Male; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant
PubMed: 31825540
DOI: 10.1002/pros.23934 -
NMR in Biomedicine Jan 2014The standard approach for the detection of prostate cancer--prostate-specific antigen (PSA) screening followed by transrectal ultrasonography (TRUS)-guided biopsy--has... (Review)
Review
The standard approach for the detection of prostate cancer--prostate-specific antigen (PSA) screening followed by transrectal ultrasonography (TRUS)-guided biopsy--has low sensitivity and provides limited information about the true extent and aggressiveness of the cancer. Improved methods are needed to assess the extent and aggressiveness of the cancer and to identify patients who will benefit from therapy. In recent years, there has been tremendous development of acquisition and processing tools for physiological and metabolic MRI techniques which play a potential role in the detection, localization and characterization of prostate cancer, such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI) and/or proton MR spectroscopic imaging ((1)H MRSI). The standard protocol for prostate MRI without the use of a contrast agent involves multi-planar T1 -weighted MRI, T2 -weighted MRI and DW-MRI. This review discusses the potential role of MRI in the detection of prostate cancer, specifically describing the status of MRI as a tool for guiding targeted prostate biopsies and for detecting cancer in the untreated and treated gland. In addition, future areas of MRI research are briefly discussed. Groups conducting clinical trials should consider the recommendations put forward by the European Consensus Meeting, which state that the minimum requirements for prostate MRI are T1 -weighted MRI, T2 -weighted MRI, DCE-MRI (which involves the use of a contrast agent) and DW-MRI with a pelvic phased-array coil and propose the use of transperineal template mapping biopsies as the optimal reference standard.
Topics: Humans; Magnetic Resonance Imaging; Male; Prostate; Prostatic Neoplasms
PubMed: 23495081
DOI: 10.1002/nbm.2934 -
Cancer Control : Journal of the Moffitt... 2022Prostate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage...
PURPOSE
Prostate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage diagnosis, treatment delays, and poor survival among patients. We analyzed the availability and use of prostate cancer screening, diagnostic and treatment guidelines, procedures, and costs in few SSA countries to determine factors for consideration in the development of prostate cancer screening guidelines for SSA.
METHODS
We applied mixed methods approaches to collect data through an electronic survey administered to clinicians (oncologists, urologists, pathologists, nurses, and radiation oncologists) providing prostate cancer screening, diagnosis, and treatment services in multiple sub-Saharan countries.
RESULTS
Inconsistencies in respondents' understanding of the availability and use of prostate cancer screening guidelines in their countries were noted. Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) were the most commonly available screening modalities. Available diagnostic procedures included a combination of prostate biopsies, transrectal ultrasonography, and DRE. Our study's data suggest that PSA and DRE exams are available for early diagnosis and screening procedures. Availability of treatment modalities with curative intent and costs for prostate cancer related procedures varied between and within countries.
CONCLUSIONS
PSA and DRE are available for detecting prostate cancer and may detect aggressive cancers early, leading to improved outcomes. However, PSA screening is also associated with overdiagnosis and over-treatment. National prostate cancer policies should consider health systems, evidence-based guidelines, population characteristics and healthcare financing to ensure access to clinically relevant and safe prostate cancer related care.
Topics: Early Detection of Cancer; Humans; Male; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Ultrasonography
PubMed: 35350915
DOI: 10.1177/10732748221084932 -
Clinical Imaging Apr 2022Despite advances in diagnosis and treatment, prostate cancer remains the second leading cause of cancer related mortality in men. Prognosis is variable and dependent on...
Despite advances in diagnosis and treatment, prostate cancer remains the second leading cause of cancer related mortality in men. Prognosis is variable and dependent on several clinical and genetic factors, including BRCA gene mutations. Recent clinical studies have reported that BRCA-associated prostate cancer is a more aggressive subtype with a higher probability of nodal involvement and distant metastases at the time of diagnosis, but radiological findings have not been described. Accurate recognition of those tumors could help guide clinical management and prompt testing and counseling for BRCA mutations. We have recently encountered four patients with BRCA-associated prostate cancer who underwent multiparametric MRI. The MRI appearances of these tumors, which were generally locally advanced and aggressive in appearance, are presented to facilitate recognition of BRCA-associated prostate cancer and guide potential genetic testing and counseling.
Topics: Humans; Magnetic Resonance Imaging; Male; Mutation; Prognosis; Prostatic Neoplasms
PubMed: 35217282
DOI: 10.1016/j.clinimag.2022.02.007 -
Prostate Cancer and Prostatic Diseases Nov 2018
Topics: Disease Management; History, 21st Century; Humans; Male; Meta-Analysis as Topic; Neoplasm Metastasis; Neoplasm Staging; Outcome Assessment, Health Care; Prostatic Neoplasms; Translational Research, Biomedical
PubMed: 30279577
DOI: 10.1038/s41391-018-0100-7 -
Cancer Causes & Control : CCC Aug 2013Prostate cancer is the most frequently diagnosed malignancy in men. However, African American/Black men are 60 % more likely to be diagnosed with and 2.4 times more... (Review)
Review
Prostate cancer is the most frequently diagnosed malignancy in men. However, African American/Black men are 60 % more likely to be diagnosed with and 2.4 times more likely to die from prostate cancer, compared to Non-Hispanic White men. Despite the increased burden of this malignancy, no evidence-based recommendation regarding prostate cancer screening exists for the high-risk population. Moreover, in addition to screening and detection, African American men may constitute a prime population for chemoprevention. Early detection and chemoprevention may thus represent an integral part of prostate cancer control in this population. Importantly, recent research has elucidated biological differences in the prostate tumors of African American compared to European American men. The latter may enable a more favorable response in African American men to specific chemopreventive agents that target relevant signal transduction pathways. Based on this evolving evidence, the aims of this review are threefold. First, we aim to summarize the biological differences that were reported in the prostate tumors of African American and European American men. Second, we will review the single- and multi-target chemopreventive agents placing specific emphasis on the pathways implicated in prostate carcinogenesis. And lastly, we will discuss the most promising nutraceutical chemopreventive compounds. Our review underscores the promise of chemoprevention in prostate cancer control, as well as provides justification for further investment in this filed to ultimately reduce prostate cancer morbidity and mortality in this high-risk population of African American men.
Topics: Black or African American; Humans; Male; Prostatic Neoplasms
PubMed: 23737026
DOI: 10.1007/s10552-013-0241-x -
Current Opinion in Oncology May 2007This review highlights the most important developments in the diagnosis, prevention, and treatment of prostate cancer published in the medical literature over the past... (Review)
Review
PURPOSE OF REVIEW
This review highlights the most important developments in the diagnosis, prevention, and treatment of prostate cancer published in the medical literature over the past year.
RECENT FINDINGS
Recent research has revealed a relatively high rate of prostate specific antigen screening in elderly men regardless of comorbidity status. Other findings include data that finasteride may increase the sensitivity of prostate specific antigen to detect prostate cancer. In terms of use of androgen deprivation therapy as part of primary therapy, a randomized trial has demonstrated that immediate therapy for locally advanced prostate cancer improves overall survival. There is growing literature, however, confirming the risks associated with this treatment, including an increased incidence of cardiovascular events and diabetes. New randomized trial data of adjuvant radiotherapy for high-risk disease have not demonstrated a survival benefit over observation. For patients who experience disease relapse following local therapy, definitions of biochemical failure following prostatectomy and radiation therapy are proposed. In more advanced disease, immunotherapy has preliminarily demonstrated survival benefit in a randomized trial.
SUMMARY
Data reported over the last year have significant implications for those involved in the management of prostate cancer, ranging from primary care physicians to medical oncologists, urologists, and radiation oncologists.
Topics: Chemoprevention; Humans; Male; Prostatic Neoplasms
PubMed: 17414641
DOI: 10.1097/CCO.0b013e3280ad43bd -
Current Opinion in Oncology May 1999The causes of prostate cancer reflect a complex interaction between environmental and genetic factors. Improvement in screening has reduced the incidence of prostate... (Review)
Review
The causes of prostate cancer reflect a complex interaction between environmental and genetic factors. Improvement in screening has reduced the incidence of prostate cancer, and risk assessment schemata have enhanced therapy, both for localized disease and for locally recurrent prostate cancer. The use of hormone therapy has been further evaluated, as primary therapy for locally advanced cancers, for lymph node-positive cancers, and for de novo metastatic cancer. Modest inroads have been made in the treatment and understanding of androgen-independent prostate cancer. Advances have been made in the understanding of the risk factors, genetic and environmental, associated with the development and progression of prostate cancer; in screening; and in optimizing therapy for localized, locally recurrent, and advanced disease. This article reviews the most salient observations reported between November 1, 1997 and October 31, 1998.
Topics: Aged; Humans; Male; Mass Screening; Middle Aged; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiotherapy, Conformal
PubMed: 10328599
DOI: 10.1097/00001622-199905000-00016