Early Detection Of Prostate Cancer An Issue Of Urologic Clinics

PSA screening remains highly controversial due to several important disadvantages. More PSA is produced with prostatic enlargement and in other benign conditions such as urinary tract infections. False positive tests can then lead to unnecessary diagnostic workup with invasive prostate biopsy. Another major problem with screening programs in general is overdiagnosis of cancers that would not have caused harm during the patient's lifetime. For example, many prostate cancers have a relatively indolent behavior so may not require diagnosis or treatment in a patient with limited life expectancy. All forms of prostate cancer treatment have potential urinary and sexual side effects, so reducing overdiagnosis and overtreatment are critical public health issues. Because screening has many proven benefits but also significant harms, there are widely disparate guidelines on prostate cancer screening from major organizations worldwide. This issue of the Urologic Clinics will provide insights into the many different prostate cancer guidelines and related policy issues.

PSA screening remains highly controversial due to several important disadvantages. More PSA is produced with prostatic enlargement and in other benign conditions such as urinary tract infections. False positive tests can then lead to unnecessary diagnostic workup with invasive prostate biopsy. Another major problem with screening programs in general is overdiagnosis of cancers that would not have caused harm during the patient's lifetime. For example, many prostate cancers have a relatively indolent behavior so may not require diagnosis or treatment in a patient with limited life expectancy. All forms of prostate cancer treatment have potential urinary and sexual side effects, so reducing overdiagnosis and overtreatment are critical public health issues. Because screening has many proven benefits but also significant harms, there are widely disparate guidelines on prostate cancer screening from major organizations worldwide. This issue of the Urologic Clinics will provide insights into the many different prostate cancer guidelines and related policy issues.

Dr. Samir Taneja, Consulting Editor, is stepping into the Guest Editor role for this issue of Urologic Clinics devoted to Prostate Cancer. He has assembled top experts to address the latest advances in the diagnosis and treatment of prostate cancer. Articles are devoted to the following topics: Whom to Biopsy: Pre-Diagnostic Risk Stratification with Biomarkers, Nomograms, and Risk Calculators; How to Biopsy: Transperineal vs. Tranrectal, Saturation vs. Targeted: What’s the Evidence; Pre-Diagnostic Risk and Assessment with Imaging and Image-guided Biopsy; Whom to treat: Post-Diagnostic Risk Assessment with Gleason score, Risk Models, and Genomic Classifier; Strategies for Staging and Utilization of Imaging; Contemporary Active Surveillance: Candidate Selection, Follow-up Tools, and Expected Outcomes; Focal Ablation of Early Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome; Extent of Lymphadenectomy at Time of Prostatectomy: An Evidence-based Approach; How to Radiate the Prostate: Hypofractionation, Sterotactic Body Radiation Therapy, and Conventional Intensity-Modulated Radiotherapy; Managing Relapse after Surgical Therapy: Adjuvant vs. Salvage Therapy; Newly diagnosed Metastatic Prostate Cancer – Has the Paradigm Changed; Role of Local therapy in Oligometastatic Prostate Cancer: Should we Expect Cure; Approaching the High-Risk Patient; and Castration-Resistant Prostate Cancer: An Algorithmic Approach. Readers will come away with state-of-the-art information on strategies for diagnosing, treating, and managing prostate cancer.

In this issue of Urologic Clinics, guest editors Leonard G. Gomella and Veda Giri bring their considerable expertise to the topic of Prostate Cancer Genetics: Changing the Paradigm of Care. Provides in-depth, clinical reviews on Prostate Cancer Genetics, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

An estimated 234,000 new cases of prostate cancer will be diagnosed in the United States this year, making it one of the most common cancers affecting American men; however, it can be a controversial disease to diagnose and treat now that there is research abounding for both “watchful waiting and aggressive treatments. Dr. Oh supplies balanced information, with articles on: Prostate Cancer: To Screen or Not To Screen?; High Intensity Focused Ultrasound: Ready for Primetime?; The Case for Open vs. Robotic Assisted Laparoscopic Radical Prostatectomy; Primary and Salvage Prostate Cancer Cryotherapy; and The Case for Open vs. Robotic Assisted Laparoscopic Radical Prostatectomy, to name a few. The state-of-the art information presented in this issue make is must-have for all urologists.

The past decade has been marked by the acceleration of our understanding of the molecular biology of cancer. Simultaneously, there have been increasing exigencies to diagnose, treat and follow cancer patients more economically. Biomarkers represent the marriage of science and economics. Biomarkers offer the potential to increase the precision of diagnosis, prognosis, and surveillance of urological malignancies. This issue presents the cutting-edge advances of biomarker technology to urologic oncology.

Castrate Resistant Prostate Cancer is advanced disease that has stopped responding to hormone therapy. This issue of the Urologic Clinics focuses on the various forms of therapy including immunotherapy, first line chemotherapy, and novel targeted agents. Articles on defining the diseae and palliative care are also included.