John F. Ward, MD, FACS discusses patient selection in definitive prostate cancer treatment and avoiding over and undertreatment. He then analyzes the impact of the evolving United States Preventive Services Task Force (USPSTF) recommendations for PSA screening on prostate cancer incidence, over and undertreatment, and amount of biopsies performed in urologic practice.
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Mohit Khera, MD, MBA, MPH, discusses the correlation between low testosterone levels and PSA values and lower urinary tract symptoms (LUTS). He explains the prostate saturation model and testosterone as a marker for positive prostate cancer biopsy, as well as disease progression, severity, and biochemical progression.
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Juanita M. Crook, MD, FRCPC, reviews the radiobiologic rationale for high-dose-rate brachytherapy (HDR BT), its technical advantages, the evolution of HDR fractionation, and recent toxicity reports for both HDR BT boost and HDR BT monotherapy according to prescribed dose and fractionation.
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Juanita M. Crook, MD, FRCPC, discusses the challenges of assessing modalities for the management of high-risk prostate cancer in terms of quality of life (QOL) outcomes. She then reviews QOL data from the ProtecT trial, the efficacy and toxicity of presented for ASCENDE-RT trial, and data from two large, mature prospective databases. She also shares her opinion on the “tri-modality” approach.
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Juanita M. Crook, MD, FRCPC, argues that focal brachytherapy is one of the most effective and least invasive treatments for prostate cancer. She discusses patient selection for focal therapy, technical limitations, efficacy data, and best practices in post-focal-therapy monitoring.
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