Mohit Khera, MD, MBA, MPH, reviews the literature surrounding the safety of testosterone replacement therapy (TRT) following prostate cancer treatment, including after brachytherapy, EBRT, and radical prostatectomy (RP). He also discusses the concept of bipolar androgen therapy (BAT) and the importance of TRT for erectile preservation post-RP.
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M. Scott Lucia, MD, discusses patient selection for targeted focal therapy (TFT) for prostate cancer, methods for accurately assessing tumors, as well as a pathological approach to monitoring the efficacy of TFT. Specifically, he reviews the accuracy of transperineal template-guided mapping biopsies (TTMB), Multiparametric MRI (mpMRI), and biomarkers.
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Seth R. Blacksburg, MD, MBA, explains the rationale for hypofractionation for prostate cancer and reviews the modality’s biochemical control, toxicity, and cost-effectiveness through prospective and randomized trials. He also discusses stereotactic body radiation therapy (SBRT) as an alternative treatment option.
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Daniel P. Petrylak, MD, provides his perspective on optimal drug sequencing for castration resistant prostate cancer (CRPC) and metastatic CRPC (mCRPC). He reviews the literature regarding available and emerging immunotherapeutic, hormonal, cytotoxic, and DNA damaging treatment options and when to time each drug.
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Matt T. Rosenberg, MD, reviews treatment options for nocturia, such as patient counseling, medications, and newly available molecules that can safely control urine excretion from the kidneys. He also discusses quality of life burden nocturia poses on patients, as well as differentiating between nocturia and nocturnal polyuria.
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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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Richard G. Stock, MD, compares long-term overall survival and morbidity outcomes of brachytherapy alone versus a brachytherapy/ external beam combination in intermediate and high risk prostate cancer. He also discusses factors that could affect those outcomes, such as the patient’s intermediate-risk features, duration of androgen deprivation therapy (ADT), and technique of seed implantation.
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Seth Blacksburg, MD, MBA, argues that intensity-modulated radiation therapy (IMRT), brachytherapy, hypofractionation, and stereotactic body radiotherapy (SBRT) all have similar efficacy and safety for treating low and intermediate risk prostate cancer. However, patient and physician factors impact which modality will result in optimal outcomes in individual cases.
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Laurence Klotz, MD, FRCSC, discusses causes of adverse effects of androgen deprivation therapy (ADT) treatment for prostate cancer and approaches to reducing these side effects. Specifically, Dr. Klotz advises physicians about patient counseling, prescribing innocuous drugs like bisphosphonates and metformin, targeting the adrenal pathway, and utilizing intermittent ADT.
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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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