E. David Crawford, MD, Editor-in-Chief
LEARNING CENTERS
LATEST CONTENT
PCa Commentary | Volume 142 - January 2020Posted by Edward Weber | January 2020ANTI-TUMOR IMMUNE RESPONSE POTENTIATED by RADIOTHERAPY:A concept arising from pre-clinical studies is now clinically supported by the results of the ORIOLE trial.The ORIOLE TRIAL,...
Robert E. Donohue, MD, argues against urologists adhering to the National Comprehensive Cancer Network (NCCN) Prostate Cancer Screening and Early Detection Guidelines. He proposes his own definitive answers to controversial questions relating to the use of digital rectal exams and PSA tests in baseline evaluation, indications for biopsy and biopsy technique, the age for initiation and discontinuation of testing, the frequency of testing, screening in high-risk populations, and which biomarkers to use.
A. Karim Kader, MD, PhD, argues that although PSA-based prostate cancer screening is flawed, urologists should adhere to the National Comprehensive Cancer Network (NCCN) Prostate Cancer Screening and Early Detection Guidelines. He outlines how, in order to avoid overdiagnosis and other issues, urologists can be more judicious as to which patients are offered screening, biopsy, and treatment, while not abandoning the use of PSA as a marker for prostate cancer altogether.
Daniel Margolis, MD, discusses the evolving role of imaging in biopsy and focal therapy guidance. He reviews the advantages of current image-targeting techniques, including MRI/ultrasound fusion and MRI in-bore targeting.
David M. Nanus, MD, reviews the approvals for and evidence surrounding therapies to treat advanced prostate cancer. He focuses on taxane chemotherapy, androgen deprivation therapy, androgen receptor pathway inhibitors, bone-targeted therapy, and common approaches in tumor immunotherapy.
Michael Zelefsky, MD, discusses the need for advances in molecular imaging and radiomics and for integrating these techniques with precision radiation therapy in order to improve selective dose delivery for low- and intermediate-risk prostate cancer patients. He describes evolving methods of radiation delivery, dose planning, reducing radiation exposure to normal tissues, and delineation of the dominant intraprostatic lesion in this era of dose-escalation.
Curtis A. Pettaway, MD, Professor of Urology at the University of Texas, discusses how germline DNA mutations like BRCA1 & 2 can predispose men to aggressive prostate cancer as well as influence how men respond to different kinds of therapies. He notes the increased frequency of certain mutations in particular ethnic groups, but emphasizes that while testing for these important alterations is becoming common and guideline-based it is less commonly performed among African Americans and other minorities. Given the higher incidence and mortality of prostate cancer among African Americans, he notes the need for including these patients in research (including genetic sequencing, and collecting data on clinical and family history) that will define both the significance and types of genetic alterations that are important for patient care and family counseling.
This educational activity is based on a series of lectures on genetic testing for prostate cancer from the 2019 Philadelphia Prostate Cancer Consensus Conference. Further activities from this conference include:
Current Prostate Cancer Genetic Testing Capabilities and Considerations
A Urologist’s Perspective on Germline Testing
Integration of Germline Testing in Prostate Cancer Screening
