Prostate Cancer and Prostatic Diseases: From the Editor

18 October 2018

This comprehensive review summarizes important clinical concepts in the rapidly advancing field of positron emission tomography/computed tomography (PET/CT) for prostate cancer. The authors reviewed 18F-NaF-, choline-, fluciclovine- and prostate-specific membrane antigen (PSMA)-based modalities in primary disease staging and assessment of biochemical recurrence. The most thoroughly studied modality to date is choline PET/CT.

11 September 2018

Prostate cancer is known to be an immune evasive tumor, often coexisting with areas of inflammation in the primary site, but without over-expression of the traditional PD-1/PD-L1 immune checkpoint, unlike many other cancer subtypes.  While certain prostate cancer subsets like microsatellite high (MSI high) and CDK12 deleted disease may respond well to single agent PD-1 pathway inhibitors, in most (>90%) of prostateadenocarcinomas, other immunosuppressive molecules and pathways are likely to be of greater importance and have yet to be adequately targeted.  Here is where B7-H3 may be relevant.

02 August 2018

The proof of concept for the utility of urinary biomarkers to predict biopsy outcome was published in 2003 by Hessels et al, which subsequently led to the launch of the PCA3 test in 2007.  The test was mostly used for repeat biopsy decisions, to which also the FDA approval in 2012 was confined. The potential utility in active surveillance settings was suggested by many and in their recent paper Tosoain et al study the value of a first PCA3 outcome (fPCA3) and a subsequent PCA3 test (sPCA3) to predict Grade Reclassification (GR) in men on active surveillance.

10 July 2018

A large number of studies on ⁶⁸Ga PSMA PET/CT are coming out of Australia due to the ready access to this technology.  To give some background, PET/CT imaging has long been registered with the Australian Therapeutic Goods Administration (TGA) and with this has come the approval to use any radionuclide tracer.  With it being unnecessary to apply for additional registration to use new tracers, this has allowed uptake of 68Ga PSMA PET/CT into routine clinical practice throughout Australia and to the extent that it is rapidly replacing conventional radionuclide bone scans and CT scan of the abdomen and pelvis as imaging for the staging of prostate cancer. 

08 June 2018

Obesity is all around us.  Over 30% of all Americans are obese. We know obesity is linked with many medical problems – heart disease, diabetes, hypertension, and of course cancer. Indeed, over a dozen different cancers have been linked with obesity. In regards to prostate cancer, while obesity may lower the risk of low-grade indolent cancer, it unequivocally increases the risk of high-grade aggressive disease. Many explanations have been put forward: alterations in insulin levels, changes in sex steroid hormone levels, higher cholesterol,

14 May 2018

This compelling study revisits the concept of neoadjuvant adjuvant deprivation therapy (ADT) prior to radical prostatectomy. A small series of randomized clinical trials (RCTs) performed almost 20 years ago failed to demonstrate substantial benefits in patients with localized prostate cancer who received ADT before surgery. Based on these data, the American Urological Association and the European Association of Urology recommend against ADT prior to prostatectomy outside the setting of a clinical trial.

02 April 2018

Molecular risk tools are being increasingly utilized in men with localized prostate cancer to help in clinical decision making around the need for surgery or radiation vs. active surveillance, and for the need for salvage radiation after surgery.  The Decipher Genomic Classifier has recently been demonstrated to predict distant metastases in men undergoing radical prostatectomy, using biopsy or surgical tissue, and may provide a greater level of prognostic discrimination than current NCCN or CAPRA risk groups.