Topic: Prostate Cancer

Prostatectomy: What is the Future?

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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Long-Term Outcomes of HDR

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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Long-Term Outcomes of Permanent Brachytherapy

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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Minimizing Morbidity and Maximizing Outcomes with ADT

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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Neuroendocrine Tumors | Not so Rare?

Josh Mailman, MBA, the president of NorCal CarciNET, discusses the management of neuroendocrine tumors (NETs) through a patient’s perspective. He reports on overall patients’ attitudes toward Gallium Ga 68-DOTATATE imaging and the newly-approved Lutetium Lu 177 Dotatate therapy, as well as advocacy in the NETs patient community.

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Does Radiation Therapy Favor Radical Prostatectomy in Long-Term QOL?

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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NET Background and Therapy

Arturo Loaiza-Bonilla, MD, MSEd, FACP, explains the basic scientific concepts behind neuroendocrine tumors (NETs), as well as classifying and staging these cancers. He then discusses the rationale behind targeting somatostatin receptors in NETs, therapy options, and future research in this setting.

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Focal Brachytherapy

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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