Prostate Cancer: Diagnosis and Clinical Management

✍ Scribed by Ashutosh K. Tewari (editor), Peter Whelan (editor), John D. Graham (editor)

• Publisher: Wiley-Blackwell
• Year: 2014
• Tongue: English
• Leaves: 363
• Edition: 1
• Category: Library

✦ Synopsis

Do you manage patients with prostate cancer? 

Could you use an expert guide examining all possible management options?

Prostate Cancer: diagnosis and clinical management providesurologists and oncologists of all levels with up-to-date, evidence-based guidance to the diagnosis, treatment and clinical management of a disease which accounts for a quarter of all cancers affecting men.

Designed to be as practical and accessible as possible, leading experts discuss key issues in prostate cancer management and examine how to deliver best practice in the clinical care of their patients.  Topics covered include:

• What must be considered when counseling newly-diagnosed cancer patients
• Radical surgery options for prostate cancer
• Novel therapies for localized prostate cancer
• How should metastatic prostate cancer be diagnostic and managed
• What are the best methods of administering end of life care for the patient

Brought to you by a highly experienced editor team, and containing key points, management algorithms, practice tips and the latest AUA and EAU clinical guidelines, this is the ideal consultation tool for doctors both on the wards and in the office.

✦ Table of Contents

Prostate Cancer: Diagnosis and clinical management
Contents
Contributors
Preface
CHAPTER 1 Prostate Cancer Epidemiology
United States—recent trends in incidence and mortality
Incidence
Mortality and survival
Advancing age
Race/ethnicity
Family history
Hormonal factors
Androgens
Insulin-like growth factor-1
Lifestyle decisions
Smoking cigarettes
Alcohol
Diet
Obesity
Fats
Vitamins/minerals/trace elements
Vitamin D/calcium
Vitamin E
Genetics
Single-nucleotide polymorphisms (8q24 region)
BRCA1/BRCA2 mutations
Natural history of prostate cancer
Watchful waiting
References
CHAPTER 2 Diagnosis and Screening
Symptoms
First line investigations
Prostate-specific antigen
Transrectal ultrasound
Transrectal ultrasound-guided biopsy
Evaluating population screening for prostate cancer
Screening studies
Screening recommendations from international health organizations
USA screening guidelines
European and international screening guidelines
References
CHAPTER 3 Understanding the Histopathology
Histological variants of prostate cancer
Histology of the prostate and immunohistochemistry
Prostate cores
Gleason score
Volume of cancer in cores
Perineural invasion
Core quality
Reporting errors
Transurethral resection specimens
Radical prostatectomies
Fresh specimens for tumor banking
Processing the radical prostatectomy specimens
Radical prostatectomy data
Location and multiplicity
Gleason score
Volume
Stage
Perineural invasion and vascular invasion
Margin status
Lymph nodes
Prognostic markers
Conclusion
References
CHAPTER 4 Markers in Prostate Cancer
Tumor markers
Currently available markers for prostate cancer
Total PSA
Problems with the PSA test
Serum or whole-blood biomarkers
Percent free PSA
PSAV and PSADT
Inactive PSA
Precursor forms of PSA (PROPSAS) (protein)
PSA isoforms
ProPSA (protein)
[–2]ProPSA
Nucleic acid detection immunoassay (NADIA) ProsVue (protein: PSA immuno-polymerase chain reaction)
Human glandular kallikrein 2
Urokinase plasminogen activator
Transforming growth factor-beta 1
Interleukin-6 and its receptor
Insulin-like growth factor and insulin-like growth binding protein
Molecular urine markers
RNA markers in urine
Prostate cancer antigen 3 (RNA) PROGENSA®
TMPRSS2:ERG fusion gene or ERG (RNA)
GOLPH2
SPINK1
Telomerase activity
DNA-based urine biomarkers
Protein markers in urine
Annexin A3
Matrix metalloproteinases 9
Microseminoprotein-beta gene
Metabolite urine markers
N-methylglycine
Genetic markers
Nucleotide polymorphism
Cellular markers
Cytokeratin
p63
Alpha-methylacyl-coenzyme A racemase
PTEN and loss of heterozygosity (e.g., loss of PTEN)
Cyclin-dependent kinase inhibitor 1B (p27)
Ki-67
Prostate-specific membrane antigen
Chromosome 8p22 loss and 8q24 (c-myc) gain
Prostate stem cell antigen
Circulating tumor cells
Conclusions
References
CHAPTER 5 Imaging
Introduction
Role of imaging in prostate cancer
Detection and diagnosis
Multiparametric magnetic resonance imaging
Biopsy new techniques
Staging and treatment determination
Preamble
T stage—TRUS and mpMRI
N stage
M stage
Choline-based nuclear medicine studies in staging
Modifying treatment by image-derived stage (over clinical stage)
Imaging in men planned for active surveillance
Imaging in men planned for surgery
Imaging in men planned for DXT
Follow-up of known cancer under treatment
Active surveillance—see above Follow-up after radical therapy (biochemical recurrence)
Focal therapies [126,127]
Prediction—prostate paradigm
References
CHAPTER 6 Counseling the Patient with Newly Diagnosed Prostate Cancer, Stage by Stage
Decision-making complicated by lack of level one evidence
Factors that influence decision-making
Stage of disease, chance of cure, and risk of recurrence
Age and co-morbidity
Patient beliefs, misconceptions, and reasons for treatment choice in localized disease
Concern about potential treatment-induced morbidity
Family and friends
Physician recommendation and bias
Financial issues (patient and clinician)
Application and development of patient decision aids
Role of clinical nurse specialist and primary care physician
Clinical practice guidelines
Localized prostate cancer
Locally advanced disease
Conclusions
References
CHAPTER 7 Active Surveillance in the Management of Low-Risk Prostate Cancer
Introduction
Patient selection
Patient monitoring
Current results of AS with delayed treatment
Future improvements in selection and monitoring of patients offered AS
Conclusions
References
CHAPTER 8 Radical Surgery
Introduction
Types of surgery
Patient selection
Preoperative workup
Instrumentation
Port access
Robotic instruments
Conventional instruments (disposable)
Positioning
Port placement
Surgical technique
Postoperative management
Complications
Outcomes
References
CHAPTER 9 Radiation Therapy in the Management of Prostate Cancer
Introduction
External beam radiotherapy
Dose escalation
Androgen deprivation therapy and nodal irradiation
Adjuvant or salvage radiotherapy following radical surgery
Hypofractionation
Stereotactic body radiotherapy
Proton therapy
Brachytherapy
Patient selection for brachytherapy
LDR seed brachytherapy alone
Brachytherapy in combination with EBRT
HDR (PDR) brachytherapy alone
Procedure
Results
LDR permanent seed brachytherapy
HDR temporary brachytherapy alone
Brachytherapy in combination with EBRT
Side effects of brachytherapy
Acute toxicity
Late effects
Summary
References
CHAPTER 10 Novel Therapies for Localized Prostate Cancer
Introduction
Minimally invasive treatment
Focal therapy
Defining success and failure after minimally invasive therapy
Cryotherapy
Technology
Whole-gland results
Focal therapy results
HIFU
Technology
Whole-gland results
Focal therapy results
Photodynamic therapy
Irreversible electroporation
Laser photothermal therapy
Conclusions
Acknowledgments
References
CHAPTER 11 Posttherapy Follow-up and First Intervention
Introduction
Evidence acquisition
Evidence synthesis
Monitoring tools
Oncological follow-up after different therapies for PCa
Functional follow-up after different therapies for PCa
First intervention against treatment failure
Conclusion
References
CHAPTER 12 Managing Rising PSA in Naive and Posttherapy Patients
Introduction
Rising PSA in treatment naive patients
Rising PSA in post-RP patients
Natural history
SRT for biochemical recurrent PCa
Rising PSA in post-RT patients
Natural history and risk stratification
SRP
Salvage cryosurgical ablation of the prostate for radiation failures
Salvage high-intensity focused ultrasound
Hormonal treatment for PSA recurrence after RP/RT
Summary
References
CHAPTER 13 Diagnosis and Management of Metastatic Prostate Cancer
Introduction
Proper diagnosis of metastases: when and how?
When is bone imaging required?
Present and future imaging technologies
Initial treatment of bone metastases
Androgen deprivation therapy: 60 years of existence and still so much to learn
The role of bone-targeted agents in first-line treatment of metastatic PCa
Future therapeutic strategies
Summary overview
References
CHAPTER 14 New Therapies in Hormone Relapsed Disease
Introduction
Targeting androgen receptor signaling
CYP17 inhibition
Abiraterone acetate
Next-generation antiandrogens
Enzalutamide
Mechanisms of resistance to targeting the androgen receptor
Immune targeting in advanced prostate cancer
Sipuleucel-T
Ipilimumab
Bone-targeting agents in advanced prostate cancer
Alpharadin
Cabozantinib
Second-line chemotherapy
Cabazitaxel
Conclusion
References
CHAPTER 15 End of Life Care in Prostate Cancer
Introduction
Bone metastases
Bone pain
Spinal cord compression
Bone-targeted radio-isotopes
Management of end-stage prostate cancer
Quality of life and coping strategies
Palliative and supportive care
Summary
References
CHAPTER 16 The Long Perspective: Prostate Cancer as a Chronic Disease
References
CHAPTER 17 The Future: What’s in the Toolkit for Prostate Cancer Diagnosis and Treatment?
Introduction
The future of diagnosis
A soluble problem: serum biomarkers
Genetic markers of familial and sporadic prostate cancers
Chemoprevention
Heterogeneity and prostate cancer treatments
Should biology drive treatment strategies rather than vice versa?
Conclusions: how soon will the future come?
Acknowledgments
References
Index
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