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Fred Saad, Neil Fleshner
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 1-1, 2006
Abstract This article has no abstract. More >

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Robert K. Nam¹, Ants Toi², Laurence H. Klotz¹, John Trachtenberg³, Michael A. S. Jewett³, Andrew Loblaw⁴, Greg R. Pond¹, Marjan Emami¹, Linda Sugar⁵, Joan Sweet⁶, Steven A. Narod⁷
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 2-10, 2006
Abstract Background: There is a large amount of confusion in interpreting prostate specific antigen (PSA) values for prostate cancer. More precise risk assessments for prostate cancer detection are needed for men faced with an abnormal PSA.
Methods: We studied a sample of 2637 men who underwent a prostate biopsy for an abnormal digital rectal exam (DRE) or PSA. Using factors including age, ethnicity, family history of prostate cancer, previous negative biopsy, presence of voiding symptoms, prostate volume, DRE and PSA, we constructed nomograms to predict the probability of prostate cancer at biopsy.
Results: Of the 2637 men, 1282 men… More >

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Rebecca L. O’Malley, Samir S. Taneja
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 11-17, 2006
Abstract The relationship between obesity and prostate cancer is currently a hotly debated topic, but despite the number of publications devoted to the topic, the actual nature of the relationship remains uncertain. Obesity has been shown to have a direct relationship with the incidence of prostate cancer in a number of studies but an equal number of studies have shown no association. The relationship is further obscured with recent findings that obesity in younger obese men may actually be protective against prostate cancer. Confounding factors include the lack of correlation of body mass index (BMI) as… More >

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Pierre I. Karakiewicz^1,2, Felix K.-H. Chun^2,3, Alberto Briganti², Paul Perrotte¹, Michael McCormack¹, François Bénard¹, Luc Valiquette¹, Markus Graefen³, Fred Saad¹
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 18-25, 2006
Abstract Introduction: Several nomograms have been developed to predict PCa related outcomes. Neural networks represent an alternative.
Methods: We provide a descriptive and an analytic comparison of nomograms and neural networks, with focus on PCa detection.
Results: Our results indicate that nomograms have several advantages that distinguish them from neural networks. These are both quantitative and qualitative.
Conclusion: In the field of PCa detection, nomograms appear to outweigh the benefits of neural networks. However, the neural network methodology represents a valid alternative, which should not be underestimated. More >

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Jarad Martin¹, George Rodrigues², Shawn Malone³, Gerard Morton⁴, Holly Campbell⁵, Juanita Crook¹
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 26-33, 2006
Abstract Background and purpose: Annual genitourinary radiation oncology meetings aim to assist in the dissemination of knowledge that may affect current practice. We aim to measure changes in practice approaches that have occurred while these meetings have been conducted.
Materials and methods: A previously published survey from 2002 was sent to all genitourinary radiation oncologists in Ontario. Six prostate cancer patient scenarios were used: three definitive (low risk, intermediate risk, high risk), and three post-operative (extracapsular extension, margin positive, slowly rising PSA). There were 21 responders from seven cancer centers.
Results: Using biological equivalent dose (BED), there is significant dose… More >

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Michael Lock¹, Charles Catton²
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 34-36, 2006
Abstract In January 2006, physicians with an interest in urologic cancers met to discuss patient care at the 4th Annual Current Problems in Urology Conference. A portion of the meeting was focused on technical issues in prostate cancer radiotherapy. This portion of the meeting sought to answer the questions: where are we going? And how can we get there? Work performed at the Princess Margaret Hospital (PMH) and the London Regional Cancer Program (LRCP) served as the basis for discussion and to present examples of options for implementation of new techniques. The response to the first… More >

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Fritz H. Schröder
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 37-42, 2006
Abstract Introduction: Early detection of prostate cancer is possible; overdetection of early disease that may never surface clinically during a lifetime is likely. On the other hand, early detection measures will detect life-threatening disease of which some maybe amenable to cure, while otherwise it would kill the patient. Proof of effectiveness of early detection is unavailable. Those who decide to be screened and those who decide not to be screened take risks that are difficult to balance against each other. How do we deal with this situation? What do we tell our patients?
Discussion: Ongoing randomized studies are… More >

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Laurence H. Klotz
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 43-47, 2006
Abstract Uncertainty exists for clinicians and patients with respect to choosing the optimal therapy for patients with PSA recurrence. There is no consensus as to what the PSA cutpoint should be to define PSA failure after radical prostatectomy (RP) or radiation therapy (XRT). We do, however, have validated nomograms which allow the stratification of patients according to their risk of disease progression and cancer specific death. This is based in large part on PSA kinetics. A short PSA doubling time (PSA-DT) is associated with a marked increase in the risk of prostate cancer death in the More >

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Joseph L. Chin, Jonathan I. Izawa
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 48-51, 2006
Abstract Radiotherapy, both external beam and more recently, interstitial, have been therapeutic options for localized prostate cancer. Management of patients who have failed of local radiotherapy remains a challenge. Herein the current therapeutic options are reviewed. More >

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Fred Saad, Abdulhadi Al Dejmah, Paul Perrotte, Michael McCormack, François Bénard, Luc Valiquette, Pierre I. Karakiewicz
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 52-56, 2006
Abstract Over 60 years ago, Huggins and Hodges discovered androgen deprivation as an effective first-line therapy for metastatic prostate cancer. This leads to significant cancer control but in almost all men prostate cancer ultimately progresses to a hormone-refractory (HRPC) state resulting in significant morbidity and eventual death. In 2004, two landmark studies using docetaxel based chemotherapy demonstrated, for the first time, a survival advantage in HRPC. This has set a new standard of care for this disease. In addition, treatment with the bisphosphonate zoledronic acid has been shown to significantly reduce bone complications in metastatic HRPC. More >

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Ivar Bleumer¹, Pieter H. M. de Mulder², Peter F. A. Mulders¹
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 57-62, 2006
Abstract Renal cell carcinoma (RCC) presents as localized disease in 54% of the cases. For these patients, surgery is the primary curative treatment. Unfortunately, up to 65% of all patients show recurrent disease. For metastatic RCC non-specific immunotherapy is currently the treatment of choice. Nevertheless, several new modalities, e.g. WX-G250, oncophage and anti-angiogenic compounds like sunitinib and sorafenib are being explored with favorable results. Still, their place in the primary treatment of advanced RCC has yet to be determined. Because of the high percentage of recurrent disease, there is a need to identify these patients with… More >

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Jarad Martin, Robert Bristow, Padraig Warde
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 63-67, 2006
Abstract Risk categorization based on pre-treatment PSA, clinical stage and Gleason score is now widely used in the management of patients with localized prostate cancer. In patients with low-risk disease (cT1-T2a, PSA < 10 ng/ml and Gleason score ≤ 6) there is no role for the routine use of adjunctive hormonal therapy. In intermediate-risk patients (T1-T2, PSA < 20 ng/ml and Gleason ≤ 7) there is some evidence to suggest improved outcomes with neo-adjuvant hormonal therapy when low-dose external beam radiation therapy (EBRT) is used. However, with appropriate modern dose EBRT there is little data to More >

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Tom Pickles¹, Alan Pollack²
Canadian Journal of Urology, Vol.13, Suppl.2, pp. 68-71, 2006
Abstract Patients with intermediate-risk prostate cancer have a significant risk of biochemical failure after treatment with external beam radiation therapy. Two strategies to improve outcomes are radiation dose escalation and androgen deprivation therapy (ADT). This article discusses the evidence in favor of dose escalation.
The case for radiation dose escalation has been established by several randomized studies, which show improved biochemical control (bNED) rates. Although late toxicity was also increased, it remains at clinically acceptable levels. The use of more focal methods of radiation, such as proton therapy and intensity modulated radiation therapy (IMRT), allows safe dose More >

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