Race is a complex topic in any setting, but in healthcare, it is particularly challenging given the influence of social, lifestyle, and structural determinants associated with racial populations. Make no mistake, race matters in cancer outcomes; in prostate cancer, in particular, year after year black men consistently die at nearly 2.5 times the rate of white men with the same disease.1
Memorial Day weekend is soon, so I can’t resist the barbeque analogy. Honestly, have you ever seriously messed up grilling pork ribs? All you need to do is slather on some barbeque sauce, place them on a medium-low heat grill and crack open a beer. The last part is optional but regardless they almost always come out tasting great. A rack of lamb, by contrast, will have you minding over it, jockeying constantly between the flame and simmer and back again to perfect that crusty surface and juicy medium rare center.
Contrary to your initial reaction, the title for this blog is not an illusion to that ingenious remake of the stationary bike. The vicious cycle I am referring to is instead the positive feedback loop between prostate adenocarcinoma cells and osteocytes resulting in growth of both cellular compartments and ultimately the formation of bone metastases.  While metastases can occur in many organ systems, there is a disproportionate frequency and number of bone metastases in prostate cancer, which drive much of the morbidity of this disease. For many patients, bone metastases are the only site of disease spread, and the vicious cycle is likely the culprit for this pattern. 
“We must learn to live together as brothers or we will all perish together as fools.” ― Martin Luther King Jr.

Most recent data from SEER reveal that black men in the US have 1.5 times greater chance of developing prostate cancer than white men, and are 2.2 times more likely to die from the disease.1
There are many features that distinguish prostate cancer from other common solid tumors, but one of the more frustrating for researchers has been the difficulty transplanting human tumors into laboratory mice. For most solid tumors, transplantation across species varies in yield, despite the use of immune-incompetent mice and support of various growth factors; but prostate cancer stands out as being of particularly low yield.
At the 2018 meeting of the European Society of Medical Oncology (ESMO), Matthew Smith, MD, PhD, presented the highly anticipated results of ERA-223, a phase III trial of abiraterone acetate prednisone (AAP) combined with radium-223 or placebo in men with asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer (mCRPC)1. Radium-223 is the alpha-
As a physician, I probably don’t think about my own health as much as you might guess, but last month I underwent an executive physical (full disclosure: my wife signed me up and my Duke benefits covered it, otherwise I would not be talking about this). Labs, physical, stress test, bone and muscle density testing; nutrition, exercise and stress counseling, the whole gamut.
Last month we saw the final published data from the PROSPER study1, and coupled with the earlier published SPARTAN study2, we now have two complete and large phase III studies detailing the clinical activity of androgen-receptor inhibitors, enzalutamide and apalutamide in so-called “non-metastatic” castrate-resistant prostate
For those of us who are responsible for treating men with metastatic castration-resistant prostate cancer (mCRPC), we’ve all seen the ravages that this disease bestows on its victims – bone pain, weakness, anorexia/weight loss, anemia and other cytopenias and fatigue, profound fatigue.

Normally, we can see this coming – both in terms of the symptoms progressing through the last year or year and a half of life, as well as the tumor burden. Until recently, it has been hard to quantify these factors.
How many times has a patient with advanced prostate cancer said to you, “I have bone cancer?” 

In the past, I would smile politely and correct them by saying, “actually what you have is prostate cancer that has spread to your bones.” But, what if they are right? I mean, many of these patients have previously undergone a prostatectomy or radiation therapy, and have no evidence of local disease. Sure, the patient may have an elevated prostate-specific antigen (PSA) level, but does that alone really make this prostate cancer? 
Our ability to offer a multitude of effective therapies for the advanced prostate cancer patient continues forward, enhancing patient outcomes while minimizing quality of life untoward effects. Radium 223 (Xofigo), approved in May 2013, is the most recently approved and efficacious advanced prostate cancer (PCa) treatment, receiving level one guidelines endorsements from AUA, EAU, ASCO, ESMO, and NCCN. This addition of CRPC Bone Metastases: Center of Excellence, highlights 3 important publications, each with novel information which supports the clinician responsible for advanced PCa patients with bone metastases burden, the predominant site of metastatic location with well documented meta-analyses for advanced PCa patients worldwide. 
Welcome to the Center of Excellence on Castration-Resistant Prostate Cancer (CRPC) with Bone Metastases. I am Dr. Neal Shore, MD, FACS, CPI, Director of the Carolina Urologic Research Center (CURC), Atlantic Urology Clinics, Myrtle Beach, South Carolina. Founded in 1998, CURC is currently supported by 13 Urologists, 3 Radiation Oncologists, 1 Pathologist, 10 Advanced Practice Providers, and a team of 10 fulltime research and administrative CURC personnel.

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