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GUEST EDITORIAL

Fred Saad, Neil Fleshner
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 1-1, 2005
Abstract This article has no abstract. More >

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ARTICLE

Neil Fleshner, Rami Al Azab
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 2-4, 2005
Abstract Introduction: If an agent can slow the growth of existing prostate cancer cells, it remains plausible that it may be effective as an adjunct to surgery, radiation or chemotherapy.
Discussion: Level-1 evidence will be needed in order to definitively prove the efficacy of agents as chemoprevention strategies for prostate cancer. Currently, only finasteride fulfills this criterion. Two major trials are underway that will assess the role of soy, vitamin E and selenium in prostate cancer prevention.
Conclusion: Tantalizing prospects for effective of prostate cancer exist. Fortunately, well-conducted randomized trials will allow us to answer many of these questions More >

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ARTICLE

Pierre I. Karakiewicz, Paul Perrotte, Mike McCormack, François Peloquin, Jean-Paul Perreault, Philippe Arjane, Hughes Widmer, Fred Saad
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 5-8, 2005
Abstract Introduction: Prostate biopsy strategies have greatly evolved over the past 2 decades.
Methods: We performed a literature review which addressed the initial and repeat biopsy schemes, pathologic risk factors for a positive repeat biopsy, and the ideal timing as well as the number of repeat biopsy sessions.
Results: Extended biopsy schemes (11-13 cores) should be used at initial and repeat biopsy. In the era of extended biopsy schemes, high-grade prostatic intraepithelial neoplasia no longer represents an independent predictor of prostate cancer on repeat biopsy. Conversely, the risk is appreciably increased with atypical small acinar proliferation, and its presence More >

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Fred Saad¹, Paul Perrotte¹, François Bénard¹, Michael McCormack¹, Pierre I. Karakiewicz^1,2
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 9-15, 2005
Abstract With current treatments, men usually survive many years after being diagnosed with prostate cancer. However, the systemic effects of prostate cancer and therapies such as androgen deprivation therapy (ADT) can undermine skeletal integrity, resulting in skeletal complications that may erode quality of life (QOL). Prostate cancer patients are at risk for fractures from cancer treatment-induced bone loss. In addition, they are also at risk for pathologic fractures, severe bone pain, and other sequelae from bone metastases, which almost invariably occur during the progression of prostate cancer. This review investigates the incidence and pathophysiology of bone More >

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Th. H. Van der Kwast, R. Postma, R. F. Hoedemaeker, G. J. L. H. van Leenders, F. H. Schröder
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 16-20, 2005
Abstract Introduction: Prostate-specific antigen (PSA) testing of asymptomatic men may lead to the detection of "minimal" prostate cancers that are less likely to be associated with morbidity or mortality.
Objective: To examine the significance of various diagnostic outcomes from needle biopsies of the prostate in an asymptomatic population of men.
Methods: Prostatic needle biopsy findings were matched with those from radical prostatectomy specimens using data from the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC). Men, aged between 55 and 75 years, with elevated PSA levels underwent lateralized sextant needle biopsies. In corresponding radical… More >

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Laurence H. Klotz
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 21-24, 2005
Abstract Background: Many newly diagnosed patients with prostate cancer have "good risk" disease. The challenge is to identify the minority of these patients with aggressive disease and offer them curative treatment, while sparing the remainder the morbidity of unnecessary treatment.
Purpose: To examine the results of active surveillance with selective delayed intervention in good risk prostate cancer patients.
Materials and methods: This was a prospective phase II study of active surveillance of 299 patients. Eighty percent (239 patients) met the criteria for good risk disease: PSA < 10 ng/mL, Gleason ≤ 6, T ≤ 2a. Twenty percent of patients,… More >

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Judd W. Moul¹, Fred Saad²
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 25-27, 2005
Abstract We currently lack a prospective, randomized, multicenter trial, to reassure low-risk prostate cancer patients, especially younger ones, that watchful waiting is a legitimate treatment. To better manage these patients, we need to: first, confirm that the patient has low-risk prostate cancer; second, adapt the treatment to the risk (i.e., if therapy is chosen over watchful waiting, it should be monotherapy not multiple therapy); third, be aware of age migration; fourth, know that radical prostatectomy and radiation were shown to be very effective for these patients at 10-year follow-up; and lastly, make an effort to better More >

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REVIEW

M. Skala, T. Rosewall, P. Warde
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 28-32, 2005
Abstract The term high-risk prostate cancer has been coined to encompass a group of patients with a poor prognosis (clinical stage T3/T4, or T1/T2 with PSA > 20 ng/ml or GS ≥ 8). It is estimated that 20% of patients in Canada present with high-risk disease, which translates into approximately 4000 new cases each year. The optimal management approach is unclear but the standard of care in North America for this group of patients is radiation therapy (RT) with prolonged adjuvant hormonal therapy. Current clinical trials are evaluating the role of local therapy, the value of More >

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H. Azzouz, J. J. M. C. H. de la Rosette
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 33-37, 2005
Abstract Objective: Different treatment modalities are considered in treating locally advanced prostate cancer in men. This review discusses the long-term follow-up data of patients who underwent radical prostatectomy with or without adjuvant therapy. The value of an (extended) pelvic lymphadenectomy in these patients is also discussed.
Methods: Relevant information was identified through a literature search of published studies and review articles.
Results: Radical prostatectomy alone in locally advanced prostate cancer seems to produce acceptable results. A nerve-preserving procedure in these patients, however, is not an option. Pretreatment with hormonal therapy does not seem to result in prolonged, progression-free or More >

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Celestia S. Higano
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 38-41, 2005
Abstract Introduction: Men with advanced prostate cancer now have many treatment options which include first and second-line hormonal therapy, chemotherapy, radiation therapy, (either directed external beam or systemic radio-isotope), and investigational agents on protocols. Additional adjunctive therapy with the bisphosphonate, zoledronic acid, to reduce skeletal complications should be considered.
Discussion: This review will discuss appropriate timing of many of these options and summarize the randomized trials demonstrating survival benefit for docetaxel and decreased skeletal morbidity for zoledronic acid.
Conclusion: The clinical trials conducted to date do not address the question of when to give chemotherapy in the course of More >

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Andrew J. Armstrong, Michael A. Carducci
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 42-47, 2005
Abstract The demonstration of a survival benefit with docetaxel for the treatment of metastatic hormone refractory prostate cancer (HRPC) is an important step forward in advancing treatment options for advanced prostate cancer. While docetaxel-based therapy has demonstrated improvement in symptomatic and quality-of-life endpoints, certainly there is a pressing need for improvement in outcomes. A number of novel agents are in basic and clinical development for advanced prostate cancer, some of which are specific to mechanisms that may be important in the development and spread of prostate cancer. Novel approaches including novel cytotoxics, immunotherapy, PSMA targeted monoclonal More >

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William Parker, Horacio Patrocinio
Canadian Journal of Urology, Vol.12, Suppl.3, pp. 48-52, 2005
Abstract Introduction: From a radiation treatment planner perspective, in the treatment of prostate cancer, inverse-planned intensity-modulated radiation therapy (IMRT) differs considerably from conventional, conformal, and forward-planned IMRT. In this work we aim to discuss the rationale behind the use of inverse-planned IMRT for the treatment of prostate cancer, as well as some of the practical aspects, including the differences in planning strategies, dose fractionation and issues in plan evaluation.
Discussion: The primary motivation behind the use of inverse-planned IMRT for prostate cancer radiotherapy is to attempt further dose escalation while maintaining critical structure and healthy tissue sparing at… More >

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