Localized Prostate Cancer: Screening, Risk, Surveillance, and Treatment

Matt Cooperberg | November 20, 2019

As most who find their way to UroToday.com doubtless already know, prostate cancer remains by far the most common non-cutaneous cancer diagnosed, and the second leading cause of cancer death among American men. Worldwide, prostate cancer is steadily rising in both incidence and mortality, with over a 1.1 million new diagnoses and 300,000 deaths annually. In the United States, in the era of PSA-based early detection efforts,

incidence rates have waxed and waned with shifting guidelines and prevalence of PSA testing. Age-adjusted mortality rates have fallen over 50%—the steepest decline of any cancer except lung cancer—and the best statistical models attribute a substantial majority of this decline to screening and to improvements in treatment for localized disease.

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Matthew R. Cooperberg, MD, MPH

Matthew R. Cooperberg, MD, MPH graduated from Dartmouth College, where he finished summa cum laude with a major in English. He earned his MD and MPH degrees at Yale University and completed residency in Urology and fellowship in Urologic Oncology at UCSF. At the end of his training, Dr. Cooperberg joined the faculty at UCSF, where he maintains busy clinical practices at the UCSF Helen Diller Family Comprehensive Cancer Center and the San Francisco VA Medical Center. He also holds a secondary appointment in the Department of Epidemiology & Biostatistics. He is actively engaged in research approaching the challenges of prostate cancer from many interrelated angles, from molecular analyses to health system-wide research. He has written or contributed to over 350 research articles. Early in 2013 Dr. Cooperberg co-authored a proposal for a national urology registry which served as the basis for the AUA Quality (AQUA) Registry, a project for which he now serves as Senior Physician Advisor. In 2015 he won the AUA Gold Cystoscope Award, and in 2016 was awarded his first R01 grant as Principal Investigator from the National Cancer Institute, to develop and validate novel miRNA-based biomarker signatures for refined prostate cancer prognosis. He lives in San Francisco with his wife, Jacqueline Dolev (a derm-atologist and fellow Yale Medical School alum), where they work primarily to keep up with their children, Jake and Sarah.

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Written by Neal D. Shore, MD, FACS, and Michael S. Cookson, MD, MMHC
October 12, 2020
The COVID-19 pandemic has resulted in numerous physical and psychological adjustments for clinicians, patients, and their families—wearing personal protective equipment, adopting telemedicine, adjusting clinic workflow, etc. The ensuing uncertainty and attendant anxiety from the fluidity of information and healthcare policy debate has augmented the need for enhanced communication
Written by Neal D. Shore, MD, FACS, Medical Director of the Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, South Carolina, and Michael S. Cookson, MD, MMHC, Professor and Chairman, Department of Urology, Donald D. Albers Endowed Chair in Urology, Stephenson Cancer Center, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
June 24, 2020
Despite the recent disruptions in health care delivery due to the COVID-19 pandemic, patients at risk for developing prostate cancer as well as those diagnosed with prostate cancer still deserve timely and optimal decision making.
Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
April 20, 2020
Currently, there is a global pandemic surrounding the spread of betacoronavirus SARS-CoV-2 leading to Coronavirus Disease 2019 (COVID-19). The rapid spread to all corners of the globe has had tremendous health and economic implications, including the appropriate allocation of healthcare resources.
Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
April 17, 2020
The rapid spread of Coronavirus Disease 2019 (COVID-19) throughout the world, caused by the betacoronavirus SARS-CoV-2, has had dramatic effects on health care systems with impacts far beyond the patients actually infected with COVID-19. Patients who manifest severe forms of COVID-19 requiring respiratory support typically require this for prolonged durations, with a mean of 13 days of respiratory support reported by the China Medical Treatment Expert Group for Covid-19.1
Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
March 19, 2020
Radiographic imaging has played a key role in the diagnosis and staging of patients with prostate cancer for decades. Today, transrectal ultrasound and multiparametric magnetic resonance imaging are important in diagnosis and local staging of the primary tumor while axial imaging and molecularly targeted positron emission tomography
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Recent data from conferences worldwide
Presented by Jim Hu, MD, MPH
(UroToday.com) The Society of Urologic Oncology (SUO) held a virtual meeting on Saturday, July 18, 2020, in place of the usual meeting held at the American Urological Association (AUA) annual meeting. This virtual meeting was divided into sessions on bladder cancer, kidney cancer, and prostate cancer. In the session on prostate cancer, Jim Hu, MD, MPH, discussed the Study of Prostate Ablation Related Energy Devices (SPARED) Collaboration.
Presented by Ivo Schoots, MD, PhD
San Francisco, CA  (UroToday.com)  Dr. Ivo Schoots from the Netherlands discussed the optimal use of multiparametric MRI in the management of localized prostate cancer.
Presented by Laurence H. Klotz, MD, FRCSC
Washington, DC (UroToday.com) The recipient of this year’s Huggins Medal is Dr. Laurence Klotz from the University of Toronto and Sunnybrook Medical Centre. Dr. Klotz has 470
Presented by Matthew R Cooperberg, MD, MPH, FACS
Washington, DC (UroToday.com) In the first prostate cancer session at the 2019 Society for Urologic Oncology meeting in Washington, DC, Dr. Matthew Cooperberg highlighted the similarities
Presented by Ganesh S. Palpattu, MD, FACS
Athens, Greece (Urotoday.com) In today’s medical environment of the growing number of patients, increasing complexity of patient problems, an ever-growing body of literature
Presented by Derya Tilki, MD
Athens, Greece (Urotoday.com) In this talk, Dr. Tilki reviewed several prognostic biomarkers in the setting of localized prostate cancer management. 
Presented by Andre Abreu, MD
Athens, Greece (UroToday.com) Cryoablation involves freezing of the targeted prostate tissue in two cycles, reaching minus 40 degrees Celsius, with the following histological changes:
Presented by Professor Christopher Parker
Barcelona, Spain (UroToday.com) Men who undergo surgery as definitive therapy for their localized prostate cancer generally only receive subsequent radiation therapy
Presented by Claire Vale, PhD
Barcelona, Spain (UroToday.com) There are three randomized trials, RADICALS,1 GETUG-AFU 17 and RAVES; recently presented at ASTRO 2019, that have compared adjuvant radiotherapy with a policy of salvage radiotherapy
Presented by Zachary Kornberg, Staff Research Associate
Chicago, IL (UroToday.com) Dr. Kornberg presented his talk on- A 17-gene Genomic Prostate Score as a Predictor of Adverse Pathology for Men on Active Surveillance. The Oncotype DX® Genomic Prostate Score (GPS) test is an RNA expression assay that can be performed on needle-core biopsies from men with prostate cancer (PCa).
Presented by Zachary Klaassen, MD, MSc
Barcelona, Spain (UroToday.com) At the Active Surveillance vs Focal Therapy in Prostate Cancer session at EAU 2019, Dr. Francesco Giganti and colleagues from the United Kingdom presented results of their use of the PRECISE recommendations and outcome of men on active surveillance for prostate cancer. 
Presented by Roderick van den Bergh, MD
Barcelona, Spain (UroToday.com) Dr. van den Bergh presented on the current and future role of active surveillance in prostate cancer. Approximately 350 studies on active surveillance have been published per year in the last 5 years. This therapeutic strategy has been incorporated into all major urological guidelines
Presented by Guan Hee Tan, Clinical Fellow
Barcelona, Spain (UroToday.com) Active Surveillance (AS) for prostate cancer (PCa) is the standard of care of men with low-risk PCa. However, approximately 30-40% of men on AS will eventually progress to treatment – either due to choice or due to progression. Progression can either be due to grade or volume progression
Presented by Monique J. Roobol, PhD., MSc
Prague, Czech Republic (UroToday.com) As part of the ESOU 2019 prostate cancer session there was a discussion regarding the appropriate treatment of Gleason 3+4 disease. Dr. Monique Roobol discussed the possible utilization of active surveillance for these patients.
Presented by Nicolas Mottet, MD, Ph.D
Prague, Czech Republic (UroToday.com) It is good news for both patients and physicians that there has been wider adoption of appropriate utilization of active surveillance (AS) among patients with prostate cancer. Dr. Nicolas Mottet presented risk stratification for active surveillance.
Presented by Laurence Klotz, MD, FRCSC
Toronto, Ontario (UroToday.com) Dr. Laurence Klotz presented on the current status of active surveillance for prostate cancer. Through the years there has been greater recognition of the overtreatment problem of prostate cancer patients, and the concept of active surveillance has been more accepted.