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 >

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 >

Laurence H. Klotz, Yves Fradet

Canadian Journal of Urology, Vol.12, Suppl.1, pp. 1-1, 2005

Abstract This article has no abstract. More >

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 >

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 >

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 >

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 >

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 >

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 >

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 >