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One of the biggest misconceptions in all of cancer care and oncology is the notion that a solid tumor ‘recurs’ after local therapy. If, as is often stated, ‘we got it all’ during surgery, then how can a cancer recur? The answer of course is that it was there all along. But that’s only the beginning of the story.
Cancer can limit one’s physical activity. Can physical activity limit one’s cancer? I’ve become a convert to thinking that it is possible that it can. I’m not convinced yet, but a few years ago I decided that it was worth my time and effort to study it. Compelling patient stories stick with us. I’ll never forget the story of a patient of mine who died several years ago. Let’s call him Dan.
Cell Free DNA analysis may improve the scalability of genomics for prostate cancer.  The management of CRPC has long been plagued by the inability of clinicians to get an accurate sense of the underlying biology of the tumor that they are treating. 
The flurry of media recently in reaction to Senator John McCain’s diagnosis of glioblastoma multiforme, a highly malignant brain tumor, touched right at the heart of where cancer fits in the American psyche:  That it is a battle to be won.
I write today not from the files of the Jimmy Buffet musical collection, nor from a Caribbean Margaritaville-esque cabana, as the reference might suggest (for the unfamiliar, I have been humming his song “Changes in Latitude, Changes in Attitude…for about 2 weeks now)  but rather as a dispatch on the latest development in clinical trials in prostate cancer.  The topic:  Data from the Latitude study that was presented at ASCO by Karim Fizazi and simultaneously published in the New England Journal of Medicine.
It is becoming increasingly well known that about 25% of CRPC tumors harbor some form of a mutation in BRCA1, 2, ATM or other such genes. Colin Pritchard and others have done some really excellent work on this topic by giving us genomic snapshots of the disease (you can see me interview him in St Gallen on this topic here on UroToday: link).1 The efficacy of Parp inhibitors in this setting is being tested in a number of trials at the moment. 
I have been struck in the past few weeks by the number of patients in my practice who have advanced metastatic CRPC who were diagnosed more than 15 years ago and had, on their original biopsy specimen, ONLY a Gleason 6 pattern prostate carcinoma.

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