Nelson N. Stone, MD, discusses changes in urinary symptoms and erectile function, as measured by the International Prostate Symptom Score (IPPS), at 10 and 15 years following prostate brachytherapy. Subsequently, he advises clinicians on best practices in seed implantation and long-term management to optimize cancer control and minimize adverse symptoms.
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Richard G. Stock, MD, discusses advanced imaging for local, nodal, and distant recurrent prostate cancer, emphasizing positron emission tomography (PET) imaging. He specifically describes the mechanisms of action and advantages of the 18F-FACBC (fluciclovine) radiotracer for PET imaging.
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Gerald L. Andriole, MD, who served on the cause of death ascertainment committee for the Prostate Intervention Versus Observation Trials (PIVOT), discusses PIVOT and criticisms to the trial design. Additionally, he analyzes similar trials testing definitive versus non-definitive treatment in low-risk disease.
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M. Scott Lucia, MD, summarizes the changes in the clinical management of prostate cancer since 1990, specifically regarding PSA screening, active surveillance, targeted focal therapy, and pathology grading practices. Also, he analyzes whole-mount prostatectomy data from the past 16 years that has shown increasingly higher grade and volume tumors. He then discusses whether or not this is exclusively due to patient selection and over-grading.
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Peter A. Pinto, MD, argues that MRI can help select prostate cancer patients for active surveillance (AS). While MRI has some limitations, with proper application, it can reduce patient and urologist anxiety, repeat biopsies, and amount of cores taken during AS. Subsequently, this will reduce morbidity, bleeding, erectile dysfunction, and infections related to biopses.
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