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Laurence H. Klotz, Richard Choo, Gerard Morton, Cyril Danjoux
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 2-7, 2002
Abstract The optimal management of clinically localized prostate cancer remains unresolved. Management options range from a conservative approach to definitive treatment. While evidence suggests that expectant management yields similar 10-year survival rates and quality-adjusted life years compared to definitive treatment, this approach alone will deprive some patients with potentially curable disease of the opportunity for curative therapy. Effective management of localized prostate cancer requires differentiation between patients with biologically aggressive disease, in whom curative therapy is strongly warranted, and those with indolent malignancy, in whom conservative management would be equally efficacious. A comparison of surveillance studies… More >

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Yves Fradet
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 8-13, 2002
Abstract Many methods exist to define high-risk prostate cancer. These include clinical stage, serum PSA, and pathological features such as Gleason score and the number of positive biopsies. Partin tables are widely used to stratify patients according to risk of adverse pathological features at surgery, and to identify those more likely to remain free of recurrent disease following surgery. The priority in most patients with localized prostate cancer remains the selection of a treatment that will provide them with the best chance for cure. While treatment-related morbidity is an important issue, we believe that side effects… More >

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Michael A.S. Jewett
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 14-17, 2002
Abstract In 2002, open retropubic radical prostatectomy remains the standard of care for localized carcinoma of the prostate. However, the laparoscopic approach offers several appealing advantages and is being practiced more widely. The more commonly performed technique is the transperitoneal "Montsouris" technique with defined steps which are described. There are a number of pointers that are learned with experience. The most remarkable aspect of laparoscopic prostatectomy is the relatively pain­free and trouble-free postoperative course. Patients can be discharged within 2 days, have very little analgesic requirement, and feel well faster. The catheter can be removed in… More >

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Armen G. Aprikian
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 18-20, 2002
Abstract Clinical outcomes in patients with localized prostate cancers are heterogeneous. In recent years, analyses of large datasets from multiple centres have yielded a better understanding of how to measure risk in localized prostate cancer. Regardless of whether patients are treated with prostatectomy, radiotherapy, brachytherapy, or expectant management, three factors appear correlated with clinical outcome: biopsy Gleason score, clinical T stage, and serum prostate-specific antigen (PSA). Partin Tables, derived from these parameters and recently updated and refined, may be used to estimate the risk of metastasis and to assess certain aspects of surgical management in clinically… More >

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D. Scott Ernst
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 21-25, 2002
Abstract The development of hormone resistance is an unfortunate final common pathway in most patients with advanced prostate cancer, resulting in a narrowing of therapeutic options for the clinician, and limited median survival of 10-12 months for the patient. While cytotoxic chemotherapy has been utilized for many years, its efficacy has been disappointing. Quality of life assessments are increasingly used in assessing response in hormone­resistant prostate cancer (HRPC), and PSA has emerged as an important surrogate marker of response in both local and advanced disease. Estramustine and the taxanes have been investigated, as monotherapy and in More >

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Himu Lukka
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 26-29, 2002
Abstract The Genito-Urinary Radiation Oncologists of Canada (GUROC) have produced a consensus statement on radiotherapy in prostate cancer. This paper summarizes the consensus statement with regard to risk grouping and the role of hormones and radiotherapy. Survival is the most important outcome in the assessment of patients treated with radiotherapy. Other outcomes of interest include disease­free survival, metastatic-free survival, local control, biochemical measures, toxicity, efficacy, and quality of life. Risk groupings based on prognostic data are increasingly used in the management of prostate cancer. These groupings have been correlated to prognosis in several studies, and are… More >

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Laurence H. Klotz¹, Yves Fradet²
Canadian Journal of Urology, Vol.9, Suppl.1, pp. 30-35, 2002
Abstract This consensus statement emerged from the 2^nd Canadian Ura-Oncology Congress, held January 16-20, 2002. The attendees at this meeting comprised approximately 125 urologists from across Canada, representing both community and academic perspectives. The group heard presentations by experts in the field addressing the spectrum of controversies in prostate cancer. After each session, the meeting broke into workshop sessions where attendees discussed the controversies raised by the speakers. Present in each workshop was a reporter who summarized the consensus of the group. These summaries were collected and integrated into a set of questions. At the end of More >

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