Open Access

EDITORIAL

Laurence H. Klotz, Yves Fradet
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 1-1, 2005
Abstract This article has no abstract. More >

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Fritz H. Schröder
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 2-6, 2005
Abstract The European Randomized Study of Screening for Prostate Cancer (ERSPC) is a large, randomized controlled trial of screening versus control, conducted in eight European countries (Belgium, Finland, France, Italy, the Netherlands, Spain, Sweden, and Switzerland). This article focuses on important aspects relating to recent findings from the ERSPC about two topics: first, leadtime and overdiagnosis, and second, prostate-specific antigen (PSA) as a test for repeated screening.
The ERSPC together with the prostate cancer arm of the Prostate, Lung, Colon and Ovary (PLCO) screening trial of the National Cancer Institute in the United States are set to… More >

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ARTICLE

Wolfgang Horninger¹, Andreas Berger¹, Alexandre Pelzer¹, Helmut Klocker¹, Wilhelm Oberaigner², Dieter Schönitzer³, Gianluca Severi⁴, Chris Robertson⁴, Peter Boyle⁴, Georg Bartsch¹
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 7-13, 2005
Abstract Objectives: The aim of this study was to monitor the impact of prostate cancer screening in a natural experiment by comparing prostate cancer mortality in Tyrol, Austria, where prostate-specific antigen (PSA) testing was made available at no charge, with the rest of Austria, where this screening was not introduced.
Methods: In 1993, PSA testing was made freely available to men aged 40 to 79 years old living in the Federal State of Tyrol, Austria. In the first 10 years of this study, at least 70% of all men in this age range had PSA tests done at… More >

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Neil Fleshner
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 14-17, 2005
Abstract Defining men at high risk for prostate cancer treatment failure and death continues to evolve. Identifying these men allows for better disease prognostication, patient decision treatment making and facilitates accrual for appropriate clinical trials. Men at traditional high risk for prostate cancer progression and death include men with advanced clinical stage, higher levels of PSA and Gleason pattern 4. Utilizing accepted methods of risk stratification including nomograms can aid in case identification. Softer risk factors such as obesity, race, socioeconomic status, and genetic polymorphisms are increasingly being studied. Ultimately high-throughput genomics will aid in identification More >

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Woei Yun Siow, Christopher Cheng
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 18-23, 2005
Abstract Penile cancer remains a formidable challenge in many developing countries because of its high incidence and the advanced disease stage at diagnosis.
For early penile cancer, surgery alone offers a high cure rate. Penile sparing therapies are proposed as alternative treatment options for select patients with the added advantages of preservation of body image and improved quality of life.
The optimal management of lymph node disease remains controversial. The role of the sentinel lymph node biopsy, lymphatic mapping, prophylactic lymphadenectomy and the template for lymph node dissection are discussed.
For advanced, metastatic penile cancer, more effectiveand less More >

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Jonathan Izawa¹, Daniel Kedar¹, Franklin Wong², Curtis A. Pettaway¹
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 24-29, 2005
Abstract Introduction: Defining the presence or absence of microscopic metastases in the inguinal lymph nodes in patients with invasive penile squamous carcinoma and no palpable adenopathy remains crucial but difficult short of performing inguinal lymphadenectomy.
Methods: We reviewed the results of less invasive procedures such as traditional sentinel node biopsy and contemporary dynamic sentinel node biopsy aided by intraoperative lymphatic mapping (IOLM) to determine their role in the management of patients without palpable inguinal adenopathy.
Results: Inguinal node biopsy directed to the sentinel node area or region although initially promising was associated with a recurrence rate of 16% (24/150)… More >

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Antonio Carlos Lima Pompeo
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 30-36, 2005
Abstract Introduction and objective: There are many controversies regarding the optimal management of the inguinal nodes in patients with penile cancer. The inflammatory response of the draining regional lymph nodes can cause enlargement without implying the presence of metastases. On the other hand, 20% of patients with clinically non-suspicious nodes contain micrometastases. We studied the dissemination risk factors of the primary lesion in penile cancer, the preferential lymphatic pathways, and the extension of lymphadenectomies, in order to understand how to better control this cancer.
Patients and methods: In this prospective study of 50 patients (aged 21-73; median age 54)… More >

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Jerome P. Richie
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 37-39, 2005
Abstract Testicular cancer has become one of the most curable solid malignancies. Although chemotherapy can rescue patients with advanced disease, accurate staging of the retroperitoneum has been a mainstay of effectiveness of treatment. Retroperitoneal lymph node dissection via open technique has been and remains the gold standard for pathologic staging of the retroperitoneum as well as effective therapy for patients with minimal nodal involvement. Retroperitoneal lymphadenectomy has resulted in a 99.5% tumor survival for patients with clinical stage I or early stage II disease.
Alternatives to open retroperitoneal lymph node dissection include laparoscopic retroperitoneal lymph node dissection, More >

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Fred Saad
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 40-43, 2005
Abstract PSA elevation is the most common indication for urologic referral to rule out the presence of prostate cancer. Recently PSA screening and its usefulness in suggesting the presence of clinically significant prostate cancer has been put into doubt. PSA has limitations in detecting significant cancers even when elevated and on the other hand significant cancers are found in the presence of low PSA levels. In order to better predict patients at risk of harboring prostate cancer new diagnostic tests are required. A promising novel approach is based on the molecular detection of prostate cancer cells… More >

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Bob Djavan, Shirin Milani, Mesut Remzi
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 44-48, 2005
Abstract Biochemical parameters and pathological features as well as biopsy related morbidity of prostate cancer detected on second, third and fourth repeat prostate biopsy in men with a serum total PSA level between 4 ng/mL and 10 ng/mL were evaluated and compared to those cancers detected on initial prostate biopsy.
In a prospective European Prostate Cancer Detection study, 1051 men with a total PSA level between 4 ng/ mL and 10 ng/mL underwent transrectal ultrasound (TRUS)–guided sextant biopsy and two additional transition zone biopsies. All subjects whose biopsy samples were negative for prostate cancer (CaP) underwent a… More >

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Z. Dovey¹, C. M. Corbishley², R. S. Kirby¹
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 49-52, 2005
Abstract Prostatic Intraepithelial Neoplasia (PIN) is an increasingly common finding at ultrasound guided prostate biopsy, with the high grade form (HGPIN) thought to be “precancerous”. With the more widespread use of extended biopsy protocols, taking sometimes up to 14 cores or more, the incidence of HGPIN can be up to 25%. Histologically, it has many features in common with cancer of the prostate and has been shown to be both associated with cancer at the time of its finding and predictive for the development of prostate cancer in the future. Basic science research has demonstrated genes More >

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Laurence H. Klotz
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 53-57, 2005
Abstract Purpose: To summarize the case for active surveillance for good risk prostate cancer with selective delayed intervention for rapid biochemical or grade progression, and review the results of a large phase II experience using this approach.
Materials and methods: A prospective phase II study of active surveillance with selective delayed intervention was initiated in 1995. Patients were managed initially with surveillance; those who had a PSA DT of 2 years or less, or grade progression on rebiopsy were offered radical intervention. The remainder were closely monitored.
Results: The cohort consists of 299 patients with good risk prostate cancer,… More >

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Sophie G. Fletcher, Dan Theodorescu
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 58-61, 2005
Abstract Introduction: To date, randomized trials comparing radiotherapy to surgery for adenocarcinoma of the prostate are few. Lacking, are randomized comparisons between treatment modalities for the patient with high-risk locally advanced disease. Hence, there is a need to determine which approach offers superior results in these patients who comprise a significant proportion of those dying of prostate cancer. In this short review we highlight key studies that may provide interim answers while awaiting definitive results from randomized studies.
Material and methods: A MEDLINE literature review was performed of studies evaluating current treatment modalities for high-risk (TNM stage >T2b,… More >

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Abdullah M. Al Ghamdi, Michael A. S. Jewett
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 62-65, 2005
Abstract For patients with clinical stage I nonseminomatous germ cell tumor (NSGCT), the therapeutic options after orchiectomy are retroperitoneal lymphadenectomy, surveillance, and chemotherapy. Ideally the option selected will be based on an individualized assessment of the estimated risk of progression based on prognostic factors, so called risk-adapted treatment, to reduce overall burden of therapy while maintaining survival. It is possible to identify patients at low risk of progression who can be followed by active surveillance initially. Prognostic factors for high risk, while well defined, do not identify all patients at risk and those that are destined More >

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Andrea Mancuso, Cora N. Sternberg
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 66-70, 2005
Abstract Renal cell carcinoma accounts for approximately 3% of adult malignancies and 90%-95% of neoplasms arising from the kidney. It is characterized by a lack of early warning signs, diverse clinical manifestations, resistance to radiation and chemotherapy, and infrequent but reproducible responses to immunotherapy with agents such as interferon alpha (IFN-α) and interleukin 2 (IL-2). International studies have shown objective response rates of < 15% in patients with advanced and metastatic disease, with 5-year disease-specific survival ranging between 0-20%. Considering these poor outcomes, renal cancers’ very vascular nature and overexpression of receptors for vascular endothelial growth More >

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Fred Saad
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 71-76, 2005
Abstract Modern medicine offers multiple treatment options to prolong the survival of patients with prostate cancer. However, in the absence of adequate supportive care, the systemic effects of prostate cancer and therapies such as androgen deprivation therapy (ADT) can undermine skeletal integrity, resulting in skeletal complications. Skeletal morbidity contributes to the erosion in quality of life in patients with prostate cancer. These patients are at risk for fractures from cancer treatment-induced bone loss and, later on, pathologic fractures from bone metastases, which may occur during the progression of prostate cancer. Several supportive care options are available More >

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Hideyuki Akaza
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 77-80, 2005
Abstract Two decades have passed since the concept of Maximal Androgen Blockade (MAB) was first applied to the clinical treatment of prostate cancer. The theory is that by cutting off the supply of androgen from the adrenal gland, androgen blockade of the prostate could be made more complete. However, to date the clinical benefit of MAB has failed to live up to the theoretically expected effect. Having said that, fundamental research and clinical trials in recent years do indicate that the benefit of MAB is not merely an illusion. More >

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H. Van Poppel
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 81-85, 2005
Abstract Introduction: Treatment of hormone refractory prostate cancer (HRPC) has generally aimed at increasing symptom free survival in asymptomatic patients and improving quality of life in symptomatic patients. However, recent randomized studies might be shifting the paradigm towards achieving an improved overall survival.
Methods: Two large randomized controlled studies were conducted using mitoxantrone plus prednisone as a control arm compared to docetaxel-based regimens.
Results: In the TAX 327 trial, 3-weekly docetaxel plus prednisone proved significantly superior to mitoxantrone plus prednisone (an established reference regimen) in extending survival, reducing levels of prostate specific antigen (PSA), controlling pain and improving quality… More >

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Laurence H. Klotz¹, Yves Fradet²
Canadian Journal of Urology, Vol.12, Suppl.1, pp. 86-91, 2005
Abstract At the first Global Urologic Oncology Congress — which was held in conjunction with the SIU meeting in Honolulu, Hawaii, on October 2-3, 2004 — a total of 250 urologists from nine regions throughout the world participated in working groups to develop consensus statements about the management of prostate cancer patients. The focus was on two areas of prostate cancer: first, screening and detection — including when to do a biopsy, and how to manage low-risk patients — and second, management of high-risk patients.
Conclusion: Overall, there is marked global diversity of beliefs about optimal screening More >

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