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 >

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 >

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 >

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 >

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 >

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 >

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 >

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 >

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 >

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 >