Prostate Cancer Screening Practices in Europe
Monique Roobol, PhD, discusses prostate cancer screening protocols across different European countries.
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2024
Implementing Changes in Patient Behavior
Jason M. Hafron, MD, provides guidance on implementing changes in ADT patient behavior and motivating compliance with lifestyle adjustments. He begins by reviewing the body composition changes which result from ADT.
Dr. Hafron discusses how these changes in body composition, along with other adverse effects of ADT, led to the creation of the Prostate Cancer 360 (PC36) Working Group. This interdisciplinary group developed monitoring and management recommendations intended to mitigate or prevent ADT-associated adverse events in a PC360 Handbook, which includes pre-ADT counseling on lifestyle changes.
He presents the benefits of different levels of physical exercise for patients on ADT. He examines data demonstrating the impact of standardized exercise on ADT patient QoL, noting that physical exercise has significant benefits.
Dr. Hafron concludes with guidance on patient nutrition. He notes that diet has a significant influence on prostate cancer survival rate, with a typical Western diet significantly increasing the mortality rate for patients on ADT.
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NCCN Guidelines for Early Detection of Prostate Cancer 2023
Preston C. Sprenkle, MD outlines the 2023 NCCN Guidelines for Early Detection of Prostate Cancer, emphasizing the importance of these guidelines in standardizing prostate cancer screening and improving patient outcomes. These guidelines aim to balance the benefits of early cancer detection with the risks of overdiagnosis and overtreatment.
The guidelines advocate for shared decision-making between physicians and patients, emphasizing the importance of informed discussions about the benefits and harms of prostate-specific antigen (PSA) testing. Dr. Sprenkle also underscores the role of multiparametric MRI (mpMRI), particularly for men with elevated PSA levels or abnormal digital rectal exams. He discusses the incorporation of novel biomarkers, such as the Prostate Health Index (PHI) and the 4Kscore, which provide additional information to guide biopsy decisions.
Dr. Sprenkle explains that identifying high-risk individuals allows for more personalized screening strategies and early intervention. The guidelines provide criteria for selecting patients for active surveillance and outline protocols for monitoring, including periodic PSA testing, mpMRI, and repeat biopsies.
Advanced Prostate Cancer: Sequencing of Treatment
Arnulf Stenzl, MD, discusses the challenges of appropriately sequencing advanced prostate cancer treatment and presents possible solutions. In his presentation, he addresses:
Recent and Anticipated Changes in Advanced Prostate Cancer Treatment
The Issue of Physician Information Overload
The Lack of Easily Accessible Comparative Data Between Agents
Possible Applications of Artificial Intelligence in Literature Searches
The Microbiome and Prostate Cancer
Michael A. Liss, MD, PhD, MAS, FACS explores the relationship between various microbiomes and prostate cancer diagnosis and treatment. He begins with a brief summary of the history of microbes in medicine and the role of various microbiomes in the human body.
Dr. Liss then explores the relationships between the genitourinary microbiome, the gut microbiome, the prostate microbiome, and prostate cancer. He notes the direct relationship between the genitourinary and prostate microbiomes and prostate cancer, focusing on the interactions of specific microbes with prostate tissue and their potential predictive value in determining prostate cancer prognosis.
Dr. Liss concludes with an overview of the indirect relationship between the microbiome of the gut and prostate cancer. He focuses on the deleterious interactions of specific gut microbes on prostate cancer treatments like ADT and the potential use of certain gut microbes in combating urologic cancers.
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