The role of genetic testing for prostate cancer risk is a rapidly changing area. Experts debate the indications of sending a patient on to genetic counseling for further potential screening for inherited prostate cancer risk. One major issue that needs to be addressed in the urology community today is recognizing the frequency of inherited mutations that are affecting prostate cancer patients. About 1-2% of prostate cancer patients have mutations in BRCA 1 and 2, among a long list of other mutations that are quite common in metastatic prostate cancer.
Around the world, men die an average of 6 years earlier than women, and the mortality rate for men is higher than for women in 12 out of 15 leading causes of death. Health outcomes among boys and men are substantially worse than among girls and women. Men engage in riskier behavior, are less likely to practice preventative health measures, and are more likely to avoid important screenings.
As a result of an increasing amount of clinical data, interest in focal ablation for the treatment of localized prostate cancer has grown immensely over the last fifteen years. We are Drs. Arvin George, Abhinav Sidana, and Jonathan S. Fainberg, urologic surgeons with research interests in using minimally-invasive, image-guided treatments of prostate cancer. As editors of the Grand Rounds in Urology Next Generation Focal Therapy Learning Center, we have created an educational resource that will help you develop an effective approach to focal prostate ablation in your practice, including diagnosis, patient selection, treatment technologies, and patient follow-up. These will include curated lectures on a range of focal therapy topics, original presentations, expert discussions, interviews with leaders in the field, and procedural training, and will be regularly updated as this treatment modality continues to evolve.
There is an abundance of evidence that the human microbiome plays an important and nuanced role in controlling human health, including metabolism, immunity, pain, psychological state, and cancer. The recent discovery of the human genitourinary microbiome’s existence has led to the investigation of its role in mediating the pathogenesis of urinary tract infections, urologic pain syndromes, lower urinary tract symptoms, urolithiasis, and genitourinary malignancies like bladder, kidney, and prostate cancers.
One of the major treatments for prostate cancer is androgen-deprivation therapy (ADT), and about 50% of prostate cancer patients are treated with ADT at some point in their disease. ADT is used most frequently for patients with local but advanced prostate cancer or metastatic prostate cancer. The rate of ADT use in the USA increased in the 1990s and continues to be high today.
Section Editor: Kevin T. McVary, MD
Loyola University Medical Center
In 2002, the International Continence Society (ICS) defined nocturia as “waking up at night at least once to void,” however, clinically relevant nocturia is generally accepted among urologists to indicate two or more voids that are preceded and followed by sleep. Neither definition accounts for the patient’s degree of bother from nocturia, though waking twice or more from sleep to void has been associated with impaired quality of life.
Section Editor: Seth P. Lerner, MD
Baylor College of Medicine
Upper tract urothelial carcinoma (UTUC) is cancer of the transitional urothelial cells that line the upper urothelial tract of the renal pelvis and ureter. This type of cancer accounts for between 5% and 10% of urothelial cancer cases. It’s the fourth most common cancer in men, but less common in women. In UTUC, the mean age of a patient diagnosed is 73 years. It can occur 3% of the time in both upper tracts (ureters or renal pelvis).
Cancer diagnosis and therapy is becoming more focused toward a patient-specific approach to therapy, particularly prostate cancer. The role of imaging is paramount in this evolution by providing physicians with accurate information on both the presence and extent of prostate cancers. Developments in molecular imaging are paving the way for more physicians to diagnose cancer and apply relevant therapy.
Latest prostate cancer research is turning its focus on the M0 space. M0 prostate cancer is a stage where the disease is non-metastatic but has become resistant to hormone therapy. Many therapeutic options for castration-resistant prostate cancer are approved and used for metastatic castration-resistant prostate cancer (mCRPC), but fewer options exist for those with non-metastatic (NM) CRPC.