the risk of developing skeletal metastases or local recurrence.

Size: px
Start display at page:

Download "the risk of developing skeletal metastases or local recurrence."

Transcription

1 Original Article SERUM PSA AND CLINICAL RECURRENCE AFTER RRP FOR LOCALIZED PROSTATE CANCER HAUKAAS et al. Is preoperative serum prostate-specific antigen level significantly related to clinical recurrence after radical retropubic prostatectomy for localized prostate cancer? SVEIN A. HAUKAAS, OLE J. HALVORSEN*, LARS DAEHLIN, JENS HOSTMARK and LARS A. AKSLEN* Department of Surgical Sciences, University of Bergen, *Section for Pathology, The Gade Institute, and Section of Urology, Haukeland University Hospital, Bergen, Norway Accepted for publication 12 August 2005 OBJECTIVE To evaluate the influence of preoperative serum prostate-specific antigen (PSA) level and other clinicopathological variables on the probability of biochemical failure and clinical recurrence after radical prostatectomy (RP) for localized prostate cancer. PATIENTS AND METHODS The study was a retrospective survival analysis in 211 patients undergoing retropubic RP for clinically localized prostate cancer in the period Survival was estimated using the Kaplan-Meier method; survival endpoints were biochemical failure, defined as a PSA level of ng/ml or clinical recurrence consisting of palpable tumours in the prostatic fossa or distant metastases. In 58 patients with biochemical failure after surgery, we assessed the impact of the doubling time of serum PSA level (PSADT) on the risk of developing skeletal metastases or local recurrence. RESULTS The median (range) observation period was 66 (9 160) months. Biochemical failure occurred in 92 patients (44%) of whom 39 (42%) had local recurrence or skeletal metastases. There was a highly significant association (P < 01) between clinical T stage, histological grade, capsular penetration, surgical margin status, seminal vesicle invasion, preoperative serum PSA level and the probability of biochemical failure-free survival. By contrast there was no statistically significant association between preoperative serum PSA level, clinical T stage, surgical margin status, and clinical recurrence. There was a significant relationship between age (P = 21), histological grade (P = 25), capsular penetration (P = 18), seminal vesicle invasion (P = 0014), and clinical recurrence. Cox regression analysis showed that only histological grade and seminal vesicle invasion were independent predictors of clinical recurrence. In a subgroup of 58 patients with a rising serum PSA level after RP, a PSADT of 12.8 months conferred a significantly higher risk (P = 15) of developing skeletal metastases than a PSADT of >12.8 months. CONCLUSION In the present patients undergoing RP the preoperative serum PSA level was not associated with the clinical outcome, whereas it was significantly related to biochemical failure rate. The probability of skeletal metastases was significantly associated with the PSADT after biochemical failure. KEYWORDS prostate cancer progression, radical prostatectomy, PSA, PSA doubling time INTRODUCTION Radical prostatectomy (RP) is a treatment option for clinically localized carcinoma of the prostate in patients with a life-expectancy of years. When counselling men with prostate cancer whether to undergo surgery, the serum PSA level is important in the decision because it can be used to predict pathological stage and biochemical failure after RP [1 3]. There are conflicting data implying only a weak relationship between morphological features of prostate cancer and preoperative serum PSA level [4]. In large volume cancers, preoperative serum PSA level has failed to predict biochemical failure [5]. Since the advent of PSA testing there has been a tendency towards lower serum PSA levels in patients advised to undergo RP. However, up to about half of men treated by RP for clinically localized prostate cancer will eventually have biochemical failure [6]. Although a detectable serum PSA level after surgery is commonly taken as an early indication of recurrent or persistent cancer, the disease course after biochemical failure is largely unknown [6 9]. Thus in the present study we assessed the influence of preoperative serum PSA level and other prognostic factors on the clinical outcome of localized prostate cancer after RP. PATIENTS AND METHODS The study was designed as a retrospective review of 211 patients treated with RP for clinically localized prostate cancer in the period at Haukeland University Hospital, Bergen, Norway. The patient series was consecutive, albeit that since the mid- 1990s at least half of the patients, who were good candidates for surgery, opted for external beam radiotherapy (EBRT). Patient age at surgery, clinical stage (2002 TNM classification) and serum PSA level before and after surgery were obtained from hospital records. The median (range) patient age was 61 (40 72) years. Before RP the median (range) serum PSA level was 10 ( 70) ng/ml. The histological grade (WHO system) and pathological stage, including seminal vesicle invasion, capsular penetration and surgical margins, were included. The pathology after RP was based 2006 BJU INTERNATIONAL 97, doi:1111/j x x 51

2 HAUKAAS ET AL. on totally embedded surgical specimens. One pathologist specialized in uropathology (O.J.H.) examined all the surgical specimens. Clinical stage T1/T2 disease, a negative bone scan and general good health with years of life-expectancy were the prerequisites for offering patients retropubic RP. Whenever possible a nerve-sparing operation was attempted, but 63% of the tumours were clinically stage T2 and the neurovascular bundle on one or both sides had to be removed in an effort to achieve tumour-free surgical margins. The outcome data were collected from the outpatient office charts, with attention to serum PSA level and local or distant recurrence. At the follow-up, serum PSA level was determined every third month in the first year, semi-annually for another 2 years and annually thereafter, when the serum PSA level remained undetectable. Biochemical failure was defined as persistent or rising serum PSA level of ng/ml. A palpable tumour in the prostatic fossa or evidence of distant disease on bone scan, X-ray or MRI was recorded as clinical recurrence. The doubling time of serum PSA level (PSADT) was calculated according to Patel et al. [10]. The PSADT was calculated using the two first detectable serum PSA values measured after surgery as: PSADT = time (months) log e (2)/ [log e (PSA2) log e (PSA1)] TABLE 1 Univariate analysis (Kaplan-Meier method) of time to biochemical failure and clinical recurrence in 211 patients with prostate cancer Biochemical failure Clinical recurrence Variables N Events P* Events P* Age, years > Clinical T stage <01 15 T1b T1c T2a T2b T2c Histological grade (WHO) <01 25 Well Moderate Poor Capsular penetration <01 18 Absent Present Surgical margins <01 70 Negative Positive Seminal vesicle invasion <01 14 Negative Positive Preoperative PSA, ng/ml < > *log-rank test; Upper quartile. PSADT could be calculated in 58 of 92 men with detectable levels of serum PSA after RP. During the follow-up, 47 of 92 patients (51%) received antiandrogen treatment; 27 of these patients were treated early after biochemical failure, whilst 20 received deferred treatment. Salvage EBRT was delivered to eight patients with local recurrence. The follow-up was complete until May The time to biochemical failure or clinical recurrence after surgery was calculated using the product-limit method (Kaplan-Meier), with the log-rank test for differences between categories of each variable. Variables were categorized by quartiles and tertiles. The Cox proportional hazards method was applied for multivariate survival analyses, including only significant variables (P = 5) from univariate analyses, and tested by the likelihood ratio test. Model assumptions were examined by log log plots. Variables with a significant outcome in the first multivariate model (P = ) were analysed in a second (final) multivariate model. RESULTS The median (range) observation time was 66 (9 160) months, during which there was a rising serum PSA level in 92 patients (44%), of whom 39 (42%) developed clinical recurrence. Biochemical failure occurred at a mean of 33 (1 112) months, whilst the mean time to clinical recurrence was 54 (7 138) months. Eighteen patients had metastases and 21 developed local recurrence as the sole clinical manifestation of recurrence. Ten patients died from prostate cancer and 19 from unrelated causes. There was a highly significant association between clinical T stage, histological grade, capsular penetration, surgical margin status, seminal vesicle invasion, preoperative serum PSA level, and the probability of biochemical failure-free survival (Table 1). Biochemical failure-free rates at 3 and 5 years in patients categorized according to various clinicopathological variables are shown in Table 2. Preoperative serum PSA level, clinical T stage and surgical margin status did not correlate significantly with clinical recurrence (Table 1). The 5- and 10-year freedom from clinical recurrence in patients stratified into different risk groups are also shown in Table 2. There was a 91% probability of clinical recurrence-free survival at 10 years for men with well-differentiated cancer, whilst those with poorly differentiated tumours only had a 47% probability of being free of clinical recurrence. Being younger at surgery was associated with a lower risk of clinical recurrence after RP than when older (Table 1) BJU INTERNATIONAL

3 SERUM PSA AND CLINICAL RECURRENCE AFTER RRP FOR LOCALIZED PROSTATE CANCER TABLE 2 The 3-and 5-year biochemical failure-free and the 5-and 10-year clinical recurrence-free survival after RP Biochemical failure-free rate, % Clinical recurrence-free rate, % Variables 3-year (95% CI) 5-year (95% CI) 5-year (95% CI) 10-year (95% CI) Histological grade (WHO) Well 97 (92 99) 85 (68 97) 91 (74 100) 91 (74 100) Moderate 71 (63 79) 64 (56 73) 87 (81 94) 72 (60 83) Poor 50 (34 66) 32 (16 49) 76 (62 91) 47 (26 68) Capsular penetration Absent 86 (79 92) 76 (65 86) 87 (79 96) 84 (74 95) Present 57 (47 67) 46 (36 56) 84 (76 91) 60 (48 72) Seminal vesicle invasion Absent 80 (74 87) 71 (62 79) 88 (75 94) 77 (68 87) Present 41 (31 55) 28 (14 41) 79 (67 91) 49 (30 68) Surgical margins Negative 83 (76 90) 77 (67 86) Positive 60 (51 70) 46 (36 57) FIG. 1. Survival free from: a, skeletal metastases, and b, local recurrence (Kaplan-Meier method) in 58 of 92 patients with a rising serum PSA level after RP. PSADT >12.8 (>upper tertile); PSADT 12.8 (<upper tertile). Number of events in parenthesis. a Proportion free from skeletal metastases b Proportion free from local recurrences 0 P = 15 Log rank test PSADT 12.8 n = 39 (15) P = 98 Log rank test PSADT > 12.8 n = 19 (0) PSADT 12.8 n = 39 (10) PSADT > 12.8 n = 19 (4) Months after PSA recurrence In the subset of patients with detectable levels of serum PSA who did not have early postoperative endocrine treatment or salvage EBRT due to adverse histological features, the FIG. 2. Cancer-specific and overall survival (Kaplan- Meier method) in 211 men after RP. Cumulative survival 0 20 Cancer-specific Overall Months after surgery median PSADT was 9.6 months. For the upper tertile (66.7%) and upper quartile (75%) the PSADT was 12.8 and 14.7 months, respectively. A PSADT of 12.8 months (upper tertile) after biochemical failure inferred a significantly higher risk of skeletal metastases than a PSADT of >12.8 months (Fig. 1a). There was a trend (P = 98) to a greater risk of developing local recurrence with a shorter than a longer PSADT after biochemical failure (Fig. 1b). The 5- and 10-year cancer-specific survival rates (95% CI) in the series were 98 (96 100)% and 89 (82 97)%, respectively, with an overall survival at 5 and 10 years of 94 (90 97)% and 75 (66 84)%, respectively (Fig. 2). In Cox regression analyses, histological grade (well-moderate vs poorly), capsular penetration, seminal vesicle invasion, surgical margins, clinical T stage (T 2 vs T 1) and preoperative serum PSA level (PSA > 20 vs <20 ng/ml) were included as covariates if there was a statistically significant prognostic influence in univariate analyses. The preoperative serum PSA levels were available for 205 patients. As shown in Table 3 all covariates, except capsular penetration, remained independent predictors of biochemical failure, whereas only histological grade and seminal vesicle invasion were identified as independent predictors of clinical recurrence. DISCUSSION PSA has become an important marker in the diagnosis, staging and follow-up of prostate cancer. PSA recurrence-free survival is in general use as a surrogate endpoint for outcome after RP. The use of PSA testing started in Norway in the mid-1990s, and most of the cancers in the present series were clinical stage T2 and only a third stage T1c. Consequently, the prevalence of adverse prognostic factors like capsular penetration, positive surgical margins and invasion of the seminal vesicles is higher than in more contemporary series. The present study corroborates the prognostic importance of such risk factors for biochemical failure after RP. In all, 44% of the patients had biochemical failure at a mean follow-up of 2.8 years after RP. The high proportion of patients with a detectable serum PSA level after RP reflects the high prevalence of adverse prognostic factors in the present series (Table 1). In comparison, 879 (31%) of 2809 men undergoing RP for localized prostate cancer in the period had detectable serum PSA levels at a median of 2.9 years after surgery [11]. The preoperative serum PSA level is generally held to be an important prognostic factor either alone or combined with other factors of biochemical failure-free survival after RP [1,12]. In large-volume cancers ( 6 ml) the preoperative serum PSA level did not correlate well with biochemical failure-free survival rates [5]. Interestingly, when biochemical failure has occurred, further progression of prostate cancer seems less dependent on the preoperative serum PSA level [10,11]. Jhavieri et al. [13] found in 1132 consecutive patients that the 10-year overall survival for those with high serum PSA levels after RP was equivalent to those with no increasing serum PSA level. This seemingly contradictory 2006 BJU INTERNATIONAL 53

4 HAUKAAS ET AL. TABLE 3 Multivariate Cox regression analysis of time to biochemical failure and clinical recurrence after RP in 211 patients Biochemical failure Clinical recurrence Variables/categories HR (95% CI) P* HR (95% CI) P* N Histological grade (WHO) Well/moderately Poorly differentiated 2.2 ( ) 2.0 ( 4.0) Seminal vesicle invasion Absent Present 2.2 ( ) 2.0 ( 3.8) Surgical margins Negative 49 Positive 1.6 ( 2.5) Clinical T stage T1 09 T2 2.1 ( ) Preoperative PSA, ng/ml > ( ) HR, hazard ratio; *Likelihood ratio test. Information on preoperative serum PSA levels not available for six patients. Although the present median follow-up was only 5.5 years, interestingly the median 89 (82 97)% 10-year cancer-specific survival rate is comparable to that reported after RP for clinically localized prostate cancer [3,18,19]. In conclusion, in the present study the preoperative serum PSA level was not significantly associated with clinical recurrence after RP, whilst it was significantly related to the biochemical failure rate. However, the probability of skeletal metastases was significantly associated with the PSADT after RP. Morphological features such as histological grade and pathological stage were significantly related to the risk of clinical progression, but there is an urgent need for better preoperative prognostic variables to predict the long-term outcome after RP. Molecular markers obtained from the biopsy could be incorporated into prognostic models to improve the ability to predict the long-term risk of clinical progression after radical treatment of localized prostate cancer. CONFLICT OF INTEREST observation may be a result of the putative innocuous nature of detectable serum PSA level in some patients in whom there is no further increase in serum PSA level even in the presence of adverse prognostic factors [6 8]. In a series of 1997 patients undergoing RP [14], 315 (15%) had biochemical failure after surgery; only a third developed distant metastases after a median follow-up of 8 years from the time when serum PSA became detectable. In the present study the 10 men who developed metastases did so at a median of 8 years, which is comparable with the time to distant metastases in the earlier study [14]. The mean follow-up in both studies was only 5 years, and biochemical failure and clinical recurrence may occur even after 5 years free of disease [9]. Emerging data support the prognostic importance of PSADT for metastasis-free survival following biochemical failure after RP [9,10,11,15]. In a multivariate analysis the PSADT performed better as a predictor of time to clinical recurrence than preoperative serum PSA level, pathological stage and Gleason score [10,16]. The likelihood of a patient developing metastases was significantly related to the following factors; <2 years from surgery to the initial increase in serum PSA level, Gleason score >7 and PSADT <10 months [14]. In the present univariate analysis, metastasis-free survival was significantly different in patients with a PSADT of 12.8 months than in those with a PSADT of >12.8 months (Fig. 1a). None of the patients with a PSADT of >12.8 months developed metastases during the follow-up, whilst 10 patients with a PSADT of 12.8 months had distant metastases at a median (95% CI) of 8 (7 10) years. The median PSADT of 9.6 months in the present study is accordance with the median PSADT of 9 months reported by Pruthi et al. [15]. The risk of developing metastases with highgrade tumours is corroborated in the present study, as the probability of 10-year clinical recurrence-free survival was 91% for welldifferentiated tumours, in contrast to 47% for poorly differentiated prostate cancer (Table 2). The influence of age on the behaviour of localized prostate cancer is controversial. In a recent review, age had no prognostic significance for the outcome of localized prostate cancer [17]. However, in the present study of patients treated by RP, a more favourable prognosis was suggested for men aged 57 years (upper quartile) at RP than for men aged >57 years (Table 1). None declared. REFERENCES 1 Kupelian P, Katcher J, Levin H, Zippe C, Klein E. Correlation of clinical and pathologic factors with rising prostatespecific antigen profiles after radical prostatectomy for clinically localised prostate cancer. Urology 1996; 48: Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003; 169: Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with prostatectomy alone in 1,000 consecutive patients. J Urol 2002; 167: Stamey TA, Johnstone IM, McNeal JE, Lu AY, Yemoto CM. Preoperative serum prostate specific antigen between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml. J Urol 2002; 167: Noguchi M, Stamey TA, McNeal JE, BJU INTERNATIONAL

5 SERUM PSA AND CLINICAL RECURRENCE AFTER RRP FOR LOCALIZED PROSTATE CANCER Yemoto CM. Preoperative serum prostate specific antigen does not reflect biochemical failure rates after radical prostatectomy in men with large volume cancers. J Urol 2000; 164: Djavan B, Moul JW, Zlotta A, Remzi M, Ravery V. PSA progression following radical prostatectomy and radiation therapy: new standards in the new millennium. Eur Urol 2003; 43: Moul JW. Prostate specific antigen only progression of prostate cancer. J Urol 2000; 163: Shinghal R, Yemoto C, McNeal JE, Brooks JD. Biochemical recurrence without PSA progression characterizes a subset of patients after radical prostatectomy. Urology 2003; 61: Ward JF, Blute ML, Slezak J, Bergstralh EJ, Zincke H. The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003; 170: Patel A, Dorey F, Franklin J, dekernion JB. Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol 1997; 158: Roberts SG, Blute ML, Bergstralh EJ, Slezak JM, Zincke H. PSA doubling time as a predictor of clinical progression after biochemical failure following radical prostatectomy for prostate cancer. Mayo Clin Proc 2001; 76: D Amico AV, Whittington R, Malkowicz SB et al. Predicting prostate specific antigen outcome preoperatively in the prostate specific antigen era. J Urol 2001; 166: Jhaveri FM, Zippe CD, Klein EA, Kupelian PA. Biochemical failure does not predict overall survival after radical prostatectomy for localized prostate cancer: 10-year results. Urology 1999; 54: Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: Pruthi RS, Johnstone I, Tu IP, Stamey TA. Prostate-specific antigen doubling times in patients who have failed radical prostatectomy. correlation with histologic characteristics of the primary cancer. Urology 1997; 49: Cannon GM Jr, Walsh PC, Partin AW, Pound CR. Prostate-specific antigen doubling time in the identification of patients at risk for progression after treatment and biochemical recurrence for prostate cancer. Urology 2003; 62 (Suppl. 1): Parker CC, Gospodarowicz M, Warde P. Does age influence the behavior of localized prostate cancer. BJU Int 2001; 87: Lu-Yao GL, Yao SL. Population based study of long-term survival in patients with clinically localised prostate cancer. Lancet 1997; 349: Barry MJ, Albertsen PC, Bagshaw MA et al. Outcomes for men with clinically non-metastatic prostate carcinoma managed with radical prostatectomy, external beam radiotherapy, or expectant management: a retrospective analysis. Cancer 2001; 91: Correspondence: Svein A. Haukaas, Haraldsplass Deaconess Hospital, Ulriksdal 8, N-5009 Bergen, Norway. Abbreviations: RP, radical prostatectomy; EBRT, external beam radiotherapy; PSADT, PSA doubling time BJU INTERNATIONAL 55

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Prostatectomy, pelvic lymphadenect. Med age 63 years Mean followup 53 months No other cancer related therapy before recurrence. Negative.

Prostatectomy, pelvic lymphadenect. Med age 63 years Mean followup 53 months No other cancer related therapy before recurrence. Negative. Adjuvante und Salvage Radiotherapie Ludwig Plasswilm Klinik für Radio-Onkologie, KSSG CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTS 1983 1998 Clinical stage T1 and T2 Mean

More information

Prostate Cancer What Are the Outcomes of Radical Prostatectomy for High-risk Prostate Cancer?

Prostate Cancer What Are the Outcomes of Radical Prostatectomy for High-risk Prostate Cancer? Prostate Cancer What Are the Outcomes of Radical Prostatectomy for High-risk Prostate Cancer? Stacy Loeb, Edward M. Schaeffer, Bruce J. Trock, Jonathan I. Epstein, Elizabeth B. Humphreys, and Patrick C.

More information

Role of Radiation after Radical Prostatectomy Review of Literature

Role of Radiation after Radical Prostatectomy Review of Literature Vol. 9, No: 1 Jan - Jun 2013. Page 1-44 Role of Radiation after Radical Prostatectomy Review of Literature S.K. Raghunath, N. Srivatsa Abstract Biochemical relapse after radical prostatectomy occurs in

More information

A Gene Expression Test to Predict Prostate Cancer Aggressiveness. Use Prolaris as a guide in your medical and surgical management

A Gene Expression Test to Predict Prostate Cancer Aggressiveness. Use Prolaris as a guide in your medical and surgical management A Gene Expression Test to Predict Prostate Cancer Aggressiveness Use Prolaris as a guide in your medical and surgical management What is Prolaris? A direct molecular measure of prostate cancer tumor biology

More information

In 2006 approximately 234,000 men were diagnosed with

In 2006 approximately 234,000 men were diagnosed with Long-Term Survival in Men With High Grade Prostate Cancer: A Comparison Between Conservative Treatment, Radiation Therapy and Radical Prostatectomy A Propensity Scoring Approach Ashutosh Tewari,*, George

More information

Prostate cancer volume at biopsy vs. findings at Prostatectomy

Prostate cancer volume at biopsy vs. findings at Prostatectomy Prostate cancer volume at biopsy vs. findings at Prostatectomy May 2005 By Shelly Smits, RHIT, CCS, CTR Ian Thompson, MD Data Source: Cancer registry data of prostate cancer treated with prostatectomy

More information

Prognostic factors in locally advanced prostate cancer as determined by biochemistry, imaging studies and pathology

Prognostic factors in locally advanced prostate cancer as determined by biochemistry, imaging studies and pathology Prognostic factors in locally advanced prostate cancer as determined by biochemistry, imaging studies and pathology Authors Key words C.Y. Hsu, S. Joniau, R. Oyen, T. Roskams, H. Van Poppel Prognostic

More information

Historical Basis for Concern

Historical Basis for Concern Androgens After : Are We Ready? Mohit Khera, MD, MBA Assistant Professor of Urology Division of Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Historical

More information

It is difficult to counsel men who are interested in delaying or

It is difficult to counsel men who are interested in delaying or 69 Nomogram Incorporating PSA Level to Predict Cancer- Specific Survival for Men With Clinically Localized Prostate Cancer Managed Without Curative Intent Michael W. Kattan, PhD 1 Jack Cuzick, PhD 2 Gabrielle

More information

Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical

Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical Summary. 111 Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical recurrence (BCR) is the first sign of recurrent

More information

Does my patient need more therapy after prostate cancer surgery?

Does my patient need more therapy after prostate cancer surgery? Does my patient need more therapy after prostate cancer surgery? Contact the GenomeDx Patient Care Team at: 1.888.792.1601 (toll-free) or e-mail: client.service@genomedx.com Prostate Cancer Classifier

More information

Surrogate End Point for Prostate Cancer Specific Mortality After Radical Prostatectomy or Radiation Therapy

Surrogate End Point for Prostate Cancer Specific Mortality After Radical Prostatectomy or Radiation Therapy Surrogate End Point for Prostate Cancer Specific Mortality After Radical Prostatectomy or Radiation Therapy Anthony V. D Amico, Judd W. Moul, Peter R. Carroll, Leon Sun, Deborah Lubeck, Ming-Hui Chen Background:

More information

Review. Active surveillance: towards a new paradigm in the management of early prostate cancer

Review. Active surveillance: towards a new paradigm in the management of early prostate cancer Prostate cancer surveillance Review Active surveillance: towards a new paradigm in the management of early prostate cancer Chris Parker Prostate cancer is the only human cancer that is curable but which

More information

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology Oncology Annual Report: Prostate Cancer 25 Update By: John Konefal, MD, Radiation Oncology Prostate cancer is the most common cancer in men, with 232,9 new cases projected to be diagnosed in the U.S. in

More information

J Clin Oncol 23:6992-6998. 2005 by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 23:6992-6998. 2005 by American Society of Clinical Oncology INTRODUCTION VOLUME 23 NUMBER 28 OCTOBER 1 2005 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Predictors of Prostate Cancer Specific Mortality After Radical Prostatectomy or Radiation Therapy Ping Zhou,

More information

Early stage prostate cancer: biochemical recurrence after treatment

Early stage prostate cancer: biochemical recurrence after treatment REVIEW ARTICLE Vol. 40 (2): 137-145, March - April, 2014 doi: 10.1590/S1677-5538.IBJU.2014.02.02 Early stage prostate cancer: biochemical recurrence after treatment Danielle A. Zanatta, Reginaldo J. Andrade,

More information

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma.

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma. Prostate Cancer OVERVIEW Prostate cancer is the second most common cancer diagnosed among American men, accounting for nearly 200,000 new cancer cases in the United States each year. Greater than 65% of

More information

Quality of Life After Radical Prostatectomy

Quality of Life After Radical Prostatectomy Quality of Life After Radical Prostatectomy Bernard H. Bochner, MD FACS Attending Surgeon, Urology Service Vice Chairman, Department of Surgery Memorial Sloan-Kettering Cancer Center Quality of Life After

More information

SERUM PSA AND CURE PERSPECTIVE FOR PROSTATE CANCER IN MALES WITH NONPALPABLE TUMOR

SERUM PSA AND CURE PERSPECTIVE FOR PROSTATE CANCER IN MALES WITH NONPALPABLE TUMOR Clinical Urology PSA AND CURE OF PROSTATE CA IN NONPALPABLE TUMOR International Braz J Urol Official Journal of the Brazilian Society of Urology Vol. 31 (5): 437-444, September - October, 2005 SERUM PSA

More information

THE PROSTATE gland is the most common cancer site in

THE PROSTATE gland is the most common cancer site in Prognostic Significance of Visible Lesions on Transrectal Ultrasound in Impalpable Prostate Cancers: Implications for Staging By Herbert Augustin, Markus Graefen, Jüri Palisaar, Jakob Blonski, Andreas

More information

In the absence of data from randomized trials men with

In the absence of data from randomized trials men with 13-Year Outcomes Following Treatment for Clinically Localized Prostate Cancer in a Population Based Cohort Peter C. Albertsen,* James A. Hanley, David F. Penson, George Barrows and Judith Fine From the

More information

Understanding the. Controversies of. testosterone replacement. therapy in hypogonadal men with prostate cancer. controversies surrounding

Understanding the. Controversies of. testosterone replacement. therapy in hypogonadal men with prostate cancer. controversies surrounding Controversies of testosterone replacement therapy in hypogonadal men with prostate cancer Samuel Deem, DO CULTURA CREATIVE (RF) / ALAMY Understanding the controversies surrounding testosterone replacement

More information

Adjuvant radiation therapy for recurrent PSA after radical prostatectomy in T1±T2 prostate cancer

Adjuvant radiation therapy for recurrent PSA after radical prostatectomy in T1±T2 prostate cancer Adjuvant radiation therapy for recurrent after radical prostatectomy in T1±T2 prostate cancer Prostate Cancer and Prostatic Diseases (1998) 1, 321±325 ß 1998 Stockton Press All rights reserved 1365±7852/98

More information

JAMA. 1998;280:969-974

JAMA. 1998;280:969-974 Original Contributions Biochemical Outcome After Radical Prostatectomy, Radiation Therapy, or Interstitial for Clinically Localized Prostate Cancer Anthony V. D Amico, MD, PhD; Richard Whittington, MD;

More information

Prostate Cancer Pathologic Stage pt2b (2002 TNM Staging System): Does It Exist?

Prostate Cancer Pathologic Stage pt2b (2002 TNM Staging System): Does It Exist? Clinical Urology Prostate Cancer Pathologic Stage pt2b International Braz J Urol Vol. 32 (1): 43-47, January - February, 2006 Prostate Cancer Pathologic Stage pt2b (2002 TNM Staging System): Does It Exist?

More information

Prostate cancer. Christopher Eden. The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing.

Prostate cancer. Christopher Eden. The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing. Prostate cancer Christopher Eden The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing. Screening Screening men for PCa (prostate cancer) using PSA (Prostate Specific Antigen blood

More information

Therapies for Prostate Cancer and Treatment Selection

Therapies for Prostate Cancer and Treatment Selection Prostatic Diseases Therapies for Prostate Cancer and Treatment Selection JMAJ 47(12): 555 560, 2004 Yoichi ARAI Professor and Chairman, Department of Urology, Tohoku University Graduate School of Medicine

More information

Published Ahead of Print on June 17, 2013 as 10.1200/JCO.2012.47.0302. J Clin Oncol 31. 2013 by American Society of Clinical Oncology INTRODUCTION

Published Ahead of Print on June 17, 2013 as 10.1200/JCO.2012.47.0302. J Clin Oncol 31. 2013 by American Society of Clinical Oncology INTRODUCTION Published Ahead of Print on June 17, 2013 as 10.1200/JCO.2012.47.0302 The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/jco.2012.47.0302 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E

More information

The 4Kscore blood test for risk of aggressive prostate cancer

The 4Kscore blood test for risk of aggressive prostate cancer The 4Kscore blood test for risk of aggressive prostate cancer Prostate cancer tests When to use the 4Kscore Test? Screening Prior to 1 st biopsy Prior to negative previous biopsy Prognosis in Gleason 6

More information

Department of Urology, Erasmus MC, 3015 CE Rotterdam, The Netherlands

Department of Urology, Erasmus MC, 3015 CE Rotterdam, The Netherlands Advances in Urology Volume 2012, Article ID 612707, 6 pages doi:10.1155/2012/612707 Research Article The Role of Adjuvant Hormonal Treatment after Surgery for Localized High-Risk Prostate Cancer: Results

More information

Remis Tps Dbl PSA VAv3 7/02/08 16:26 Page 1. PSA doubling time and its calculation. A. Ruffion, X. Rebillard, S. Oudard

Remis Tps Dbl PSA VAv3 7/02/08 16:26 Page 1. PSA doubling time and its calculation. A. Ruffion, X. Rebillard, S. Oudard Remis Tps Dbl PSA VAv3 7/02/08 16:26 Page 1 PSA doubling time and its calculation A. Ruffion, X. Rebillard, S. Oudard Remis Tps Dbl PSA VAv3 7/02/08 16:26 Page 2 Introduction In addition to the various

More information

Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?

Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment? Journal of Cancer Therapy, 2012, 3, 256-262 http://dx.doi.org/10.4236/jct.2012.34036 Published Online August 2012 (http://www.scirp.org/journal/jct) Treatment of Incidental Prostate Cancer Diagnosed during

More information

PROTON THERAPY FOR PROSTATE CANCER: THE INITIAL LOMA LINDA UNIVERSITY EXPERIENCE

PROTON THERAPY FOR PROSTATE CANCER: THE INITIAL LOMA LINDA UNIVERSITY EXPERIENCE doi:10.1016/j.ijrobp.2003.10.011 Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 2, pp. 348 352, 2004 Copyright 2004 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/04/$ see front

More information

Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology

Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology Prostate Cancer Epidemiology: 2009 Estimated new cases: 230,000 Estimated deaths:

More information

STATISTICAL CONSIDERATIONS WHEN ASSESSING OUTCOMES FOLLOWING TREATMENT FOR PROSTATE CANCER

STATISTICAL CONSIDERATIONS WHEN ASSESSING OUTCOMES FOLLOWING TREATMENT FOR PROSTATE CANCER 0022-5347/99/1622-043910 THE JOURNAL OF UROLOGY Copyright 0 1999 by AMERICAN UROLOCICAL ASSOCIATION, INC. Vol. 162,439-444, August 1999 Printed in USA. STATISTICAL CONSIDERATIONS WHEN ASSESSING OUTCOMES

More information

NATURAL HISTORY OF CLINICALLY STAGED LOW- AND INTERMEDIATE-RISK PROSTATE CANCER TREATED WITH MONOTHERAPEUTIC PERMANENT INTERSTITIAL BRACHYTHERAPY

NATURAL HISTORY OF CLINICALLY STAGED LOW- AND INTERMEDIATE-RISK PROSTATE CANCER TREATED WITH MONOTHERAPEUTIC PERMANENT INTERSTITIAL BRACHYTHERAPY doi:1.116/j.ijrobp.9..1 Int. J. Radiation Oncology Biol. Phys., Vol. 76, No., pp. 349 354, 1 Copyright Ó 1 Elsevier Inc. Printed in the USA. All rights reserved 36-316/1/$ see front matter CLINICAL INVESTIGATION

More information

A New Biomarker in Prostate Cancer Care: Oncotype Dx. David M Albala, MD Chief of Urology Crouse Hospital Syracuse, NY

A New Biomarker in Prostate Cancer Care: Oncotype Dx. David M Albala, MD Chief of Urology Crouse Hospital Syracuse, NY A New Biomarker in Prostate Cancer Care: Oncotype Dx David M Albala, MD Chief of Urology Crouse Hospital Syracuse, NY Learning Objectives Review the current challenges in the prediction and prognosis of

More information

OBJECTIVE RESULTS CONCLUSION

OBJECTIVE RESULTS CONCLUSION Urological Oncology INSURANCE STATUS AND OUTCOMES AFTER RADICAL PROSTATECTOMY GALLINA et al. Health-insurance status is a determinant of the stage at presentation and of cancer control in European men

More information

Neoadjuvant and Adjuvant Hormone Therapy: How and When?

Neoadjuvant and Adjuvant Hormone Therapy: How and When? european urology supplements 7 (2008) 747 751 available at www.sciencedirect.com journal homepage: www.europeanurology.com Neoadjuvant and Adjuvant Hormone Therapy: How and When? Hein Van Poppel * Department

More information

Saturation Biopsy for Diagnosis and Staging of Prostate Cancer. Original Policy Date

Saturation Biopsy for Diagnosis and Staging of Prostate Cancer. Original Policy Date MP 7.01.101 Saturation Biopsy for Diagnosis and Staging of Prostate Cancer Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date /12/2013 Return to Medical Policy

More information

PCa Commentary. Volume 73 January-February 2012 PSA AND TREATMENT DECISIONS:

PCa Commentary. Volume 73 January-February 2012 PSA AND TREATMENT DECISIONS: 1101 Madison Street Suite 1101 Seattle, WA 98104 P 206-215-2480 www.seattleprostate.com PCa Commentary Volume 73 January-February 2012 CONTENTS PSA SCREENING & BASIC SCIENCE PSA AND TREATMENT 1 DECISIONS

More information

Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC)

Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC) Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC) FDA Presentation ODAC Meeting September 14, 2011 1 Review Team Paul G. Kluetz,

More information

Individual Prediction

Individual Prediction Individual Prediction Michael W. Kattan, Ph.D. Professor of Medicine, Epidemiology and Biostatistics, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Chairman, Department

More information

Coding for Prostate Cancer

Coding for Prostate Cancer Coding for Prostate Cancer Tracy L. Burney, M.D. Health First Physicians Urology September 19, 2012 Prostate Cancer Basics What is the Prostate and What Does it do? Walnut sized organ found only in men.

More information

Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy

Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy Louis L. Pisters,*, Dan Leibovici, Michael Blute, Horst Zincke, Thomas

More information

Clinical Trials and Radiation Treatment. Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto

Clinical Trials and Radiation Treatment. Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto Clinical Trials and Radiation Treatment Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto What I will cover.. A little about radiation treatment The clinical trials

More information

Gleason Score. Oncotype DX GPS. identified for. about surveillance. time to get sophisticated

Gleason Score. Oncotype DX GPS. identified for. about surveillance. time to get sophisticated patient: MARK SMITH PSA 6.2 Gleason Score 6 Oncotype DX GPS 8 identified for active surveillance time to get sophisticated about surveillance Accurate prediction of prostate cancer risk is needed at the

More information

J Clin Oncol 25:4178-4186. 2007 by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 25:4178-4186. 2007 by American Society of Clinical Oncology INTRODUCTION VOLUME 25 NUMBER 27 SEPTEMBER 20 2007 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Identification of Patients With Prostate Cancer Who Benefit From Immediate Postoperative Radiotherapy: EORTC

More information

PROSTATE CANCER UPDATE. Presenter: Bruce W. Porterfield, MD, PhD

PROSTATE CANCER UPDATE. Presenter: Bruce W. Porterfield, MD, PhD PROSTATE CANCER UPDATE DISCLOSURES I, BRUCE WAYNE PORTERFIELD HAVE NOTHING TO DISCLOSE. OBJECTIVES Epidemiology Early detection and screening Review of clinical disease states Treatment options by disease

More information

Local Salvage Therapies After Failed Radiation for Prostate Cancer. Biochemical Failure after Radiation

Local Salvage Therapies After Failed Radiation for Prostate Cancer. Biochemical Failure after Radiation Local Salvage Therapies After Failed Radiation for Prostate Cancer James Eastham, MD Memorial Sloan-Kettering Cancer Center New York, New York Biochemical Failure after Radiation ASTRO criteria 3 consecutive

More information

Beyond the PSA: Genomic Testing in Localized Prostate Cancer

Beyond the PSA: Genomic Testing in Localized Prostate Cancer Beyond the PSA: Genomic Testing in Localized Prostate Cancer Kelvin A. Moses, MD, PhD Vanderbilt University Medical Center Wednesday, December 2, 2015 5:00 p.m. ET/2:00 p.m. PT About ZERO ZERO s mission

More information

Prostate Cancer Screening in Taiwan: a must

Prostate Cancer Screening in Taiwan: a must Prostate Cancer Screening in Taiwan: a must 吳 俊 德 基 隆 長 庚 醫 院 台 灣 醫 學 會 105 th What is the PSA test? The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally

More information

SRO Tutorial: Prostate Cancer Treatment Options

SRO Tutorial: Prostate Cancer Treatment Options SRO Tutorial: Prostate Cancer Treatment Options May 7th, 2010 Daniel M. Aebersold Klinik und Poliklinik für Radio-Onkologie Universität Bern, Inselspital Is cure necessary in those in whom it may be possible,

More information

Robert Bristow MD PhD FRCPC

Robert Bristow MD PhD FRCPC Robert Bristow MD PhD FRCPC Clinician-Scientist and Professor, Radiation Oncology and Medical Biophysics, University of Toronto and Ontario Cancer Institute/ (UHN) Head, PMH-CFCRI Prostate Cancer Research

More information

Original Article. Cancer March 1, 2009 981

Original Article. Cancer March 1, 2009 981 Time to Prostate-Specific Antigen Nadir Independently Predicts Overall Survival in Patients Who Have Metastatic Hormone-Sensitive Prostate Cancer Treated With Androgen-Deprivation Therapy Toni K. Choueiri,

More information

Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer

Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer Citation: Prostate Cancer Working Group and Ministry of Health. 2015. Guidance on Using Active Surveillance to Manage Men

More information

Prostate Cancer Treatment Comparison

Prostate Cancer Treatment Comparison Prostate Cancer Treatment Comparison Treatment Comparative Data Outcome Comparison: Surgery vs. Radiotherapy Outcome Radical Prostatectomy* Radiation** Survival duration compared to conservative disease

More information

Management of Localized Prostate Cancer. Treatment Options

Management of Localized Prostate Cancer. Treatment Options Management of Localized Prostate Cancer Surgery James A. Eastham, MD Chief, Urology Service Memorial lsloan Kettering Cancer Center Treatment Options 1. Active surveillance/watchful waiting 2. Focal therapy

More information

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40. A.D.A.M. Medical Encyclopedia. Prostate cancer Cancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score Last reviewed: October 2, 2013. Prostate cancer is cancer that starts in the prostate

More information

Advances in Diagnostic and Molecular Testing in Prostate Cancer

Advances in Diagnostic and Molecular Testing in Prostate Cancer Advances in Diagnostic and Molecular Testing in Prostate Cancer Ashley E. Ross MD PhD Assistant Professor Urology, Oncology, Pathology Johns Hopkins School of Medicine September 24, 2015 1 Disclosures

More information

doi:10.1016/j.ijrobp.2006.07.1382 CLINICAL INVESTIGATION

doi:10.1016/j.ijrobp.2006.07.1382 CLINICAL INVESTIGATION doi:10.1016/j.ijrobp.2006.07.1382 Int. J. Radiation Oncology Biol. Phys., Vol. 67, No. 1, pp. 57 64, 2007 Copyright 2007 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/07/$ see front matter

More information

LEARNING CURVE OF ROBOTIC RADICAL PROSTATECTOMY

LEARNING CURVE OF ROBOTIC RADICAL PROSTATECTOMY LEARNING CURVE OF ROBOTIC RADICAL PROSTATECTOMY Muhammed Ersagun Arslan, 1 *Abdullah Erdem Canda, 2 Ali Fuat Atmaca, 2 Mevlana Derya Balbay, 3 Ziya Akbulut, 2 Serkan Altinova, 1 Ahmet Tunc Ozdemir 4 1.

More information

Intraobserver and Interobserver Reproducibility of WHO and Gleason Histologic Grading Systems in Prostatic Adenocarcinomas

Intraobserver and Interobserver Reproducibility of WHO and Gleason Histologic Grading Systems in Prostatic Adenocarcinomas International Urology and Nephrology 28 (1), pp. 73-77 (1996) Intraobserver and Interobserver Reproducibility of WHO and Gleason Histologic Grading Systems in Prostatic Adenocarcinomas $. O. OZDAMAR,*

More information

Use of Androgen Deprivation Therapy (ADT) in Localized Prostate Cancer

Use of Androgen Deprivation Therapy (ADT) in Localized Prostate Cancer Use of Androgen Deprivation Therapy (ADT) in Localized Prostate Cancer Adam R. Kuykendal, MD; Laura H. Hendrix, MS; Ramzi G. Salloum, PhD; Paul A. Godley, MD, PhD; Ronald C. Chen, MD, MPH No conflicts

More information

Facing Prostate Cancer?

Facing Prostate Cancer? The Enabling Technology: The da Vinci Surgical System Your doctor is one of the growing number of surgeons worldwide offering da Vinci Surgery for a range of complex conditions. The da Vinci Surgical System

More information

2 Natural History of Prostate Cancer

2 Natural History of Prostate Cancer Chapter 2 / Natural History of Prostate Cancer 25 2 Natural History of Prostate Cancer Peter C. Albertsen, MD CONTENTS INTRODUCTION THE SIGNIFICANCE OF HISTOLOGY THE SIGNIFICANCE OF VOLUME AS ASSESSED

More information

A918: Prostate: adenocarcinoma

A918: Prostate: adenocarcinoma A918: Prostate: adenocarcinoma General facts of prostate cancer The prostate is about the size of a walnut. It is just below the bladder and in front of the rectum. The tube that carries urine (the urethra)

More information

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,

More information

Natural History of Biochemical Recurrence after Radical Prostatectomy: Risk Assessment for Secondary Therapy

Natural History of Biochemical Recurrence after Radical Prostatectomy: Risk Assessment for Secondary Therapy european urology 51 (2007) 1175 1184 available at www.sciencedirect.com journal homepage: www.europeanurology.com Review Prostate Cancer Natural History of Biochemical Recurrence after Radical Prostatectomy:

More information

PROSTATE CANCER. Get the facts, know your options. Samay Jain, MD, Assistant Professor,The University of Toledo Chief, Division of Urologic Oncology

PROSTATE CANCER. Get the facts, know your options. Samay Jain, MD, Assistant Professor,The University of Toledo Chief, Division of Urologic Oncology PROSTATE CANCER Get the facts, know your options Samay Jain, MD, Assistant Professor,The University of Toledo Chief, Division of Urologic Oncology i What is the Prostate? Unfortunately, you have prostate

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Harshman, LC, Wang X, Nakabayashi M, et al. Statin use at the time of initiation of androgen deprivation therapy and time to progression in patients with hormone-sensitive

More information

J Clin Oncol 23:6149-6156. 2005 by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 23:6149-6156. 2005 by American Society of Clinical Oncology INTRODUCTION VOLUME 23 NUMBER 25 SEPTEMBER 1 2005 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Outcome Analysis for Patients With Elevated Serum Tumor Markers at Postchemotherapy Retroperitoneal Lymph Node

More information

Prostate Cancer In-Depth

Prostate Cancer In-Depth Prostate Cancer In-Depth Introduction Prostate cancer is the most common visceral malignancy among American men. In the year 2003, there are expected to be 220,000 new cases and nearly 29,000 deaths in

More information

Saturation Biopsy vs. 3D Spatial Biopsy vs. Free Hand Ultrasound biopsy for Targeted Prostate Cancer Therapies

Saturation Biopsy vs. 3D Spatial Biopsy vs. Free Hand Ultrasound biopsy for Targeted Prostate Cancer Therapies Saturation Biopsy vs. 3D Spatial Biopsy vs. Free Hand Ultrasound biopsy for Targeted Prostate Cancer Therapies John F. Ward, MD Assistant Professor University of Texas M. D. Anderson Cancer Center Ablation

More information

The 4Kscore blood test for risk of aggressive prostate cancer

The 4Kscore blood test for risk of aggressive prostate cancer The 4Kscore blood test for risk of aggressive prostate cancer Early detection of aggressive prostate cancer Challenges Serum PSA has a high false positive rate Over 1 million prostate biopsies performed

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

Cancer in Primary Care: Prostate Cancer Screening. How and How often? Should we and in which patients?

Cancer in Primary Care: Prostate Cancer Screening. How and How often? Should we and in which patients? Cancer in Primary Care: Prostate Cancer Screening How and How often? Should we and in which patients? PLCO trial (Prostate, Lung, Colorectal and Ovarian) Results In the screening group, rates of compliance

More information

BREAST CANCER IN YOUNG AGE ( 40 YEARS): THE UNIVERSITY OF TENNESSEE MEDICAL CENTER AT KNOXVILLE 10 YEAR EXPERIENCE

BREAST CANCER IN YOUNG AGE ( 40 YEARS): THE UNIVERSITY OF TENNESSEE MEDICAL CENTER AT KNOXVILLE 10 YEAR EXPERIENCE BREAST CANCER IN YOUNG AGE ( 40 YEARS): THE UNIVERSITY OF TENNESSEE MEDICAL CENTER AT KNOXVILLE 10 YEAR EXPERIENCE Snyder D, Heidel RE, Panella T, Bell J, Orucevic A University of Tennessee Medical Center

More information

Use Of Testosterone In Men With Prostate Cancer. Traditional view: T is dangerous for PCa

Use Of Testosterone In Men With Prostate Cancer. Traditional view: T is dangerous for PCa Use Of Testosterone In Men With Prostate Cancer Abraham Morgentaler, MD, FACS Director, Men s s Health Boston Associate Clinical Professor of Urology Harvard Medical School Boston, USA Traditional view:

More information

Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward

Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward 33 rd Annual Internal Medicine Update December 5, 2015 Ryan C. Hedgepeth, MD, MS Chief of

More information

4/8/13. Pre-test Audience Response. Prostate Cancer 2012. Screening and Treatment of Prostate Cancer: The 2013 Perspective

4/8/13. Pre-test Audience Response. Prostate Cancer 2012. Screening and Treatment of Prostate Cancer: The 2013 Perspective Pre-test Audience Response Screening and Treatment of Prostate Cancer: The 2013 Perspective 1. I do not offer routine PSA screening, and the USPSTF D recommendation will not change my practice. 2. In light

More information

Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins

Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins The American Journal of Surgery 190 (2005) 521 525 George Peter s Award Winner Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins Heather R. MacDonald,

More information

CYBERKNIFE RADIOSURGERY FOR EARLY PROSTATE CANCER Rationale and Results. Alan Katz MD JD Flushing, NY USA

CYBERKNIFE RADIOSURGERY FOR EARLY PROSTATE CANCER Rationale and Results. Alan Katz MD JD Flushing, NY USA CYBERKNIFE RADIOSURGERY FOR EARLY PROSTATE CANCER Rationale and Results Alan Katz MD JD Flushing, NY USA Prostate Ablative Therapy Over the last 10 years our therapy has improved bned rates for LDR/HDR

More information

Evidence for the role of obesity in prostate cancer progression Elizabeth A. Platz, ScD, MPH

Evidence for the role of obesity in prostate cancer progression Elizabeth A. Platz, ScD, MPH Evidence for the role of obesity in prostate cancer progression Elizabeth A. Platz, ScD, MPH Professor and Martin D. Abeloff, MD Scholar in Cancer Prevention Johns Hopkins Bloomberg School of Public Health

More information

PSA After Radiation for Prostate Cancer

PSA After Radiation for Prostate Cancer Review Article [1] May 01, 2004 By Deborah A. Kuban, MD [2], Howard D. Thames, PhD [3], and Larry B. Levy, MS [4] The introduction of prostate-specific antigen (PSA) as a reliable tumor marker for prostate

More information

HOW I DO IT. Introduction

HOW I DO IT. Introduction HOW I DO IT Transrectal implantation of electromagnetic transponders following radical prostatectomy for delivery of IMRT Daniel Canter, MD, 1 Alexander Kutikov, MD, 1 Eric M. Horwitz, MD, 2 Richard E.

More information

A new score predicting the survival of patients with spinal cord compression from myeloma

A new score predicting the survival of patients with spinal cord compression from myeloma A new score predicting the survival of patients with spinal cord compression from myeloma (1) Sarah Douglas, Department of Radiation Oncology, University of Lubeck, Germany; sarah_douglas@gmx.de (2) Steven

More information

For further information on screening and early detection of prostate cancer, see the Section entitled Screening for Prostate Cancer.

For further information on screening and early detection of prostate cancer, see the Section entitled Screening for Prostate Cancer. Prostate Cancer For many older men, prostate cancer may be present but never cause symptoms or problems and many men will die with their prostate cancer rather than of their prostate cancer. Yet it remains

More information

What Does Failure After Surgery or Radiation Mean?

What Does Failure After Surgery or Radiation Mean? european urology supplements 7 (2008) 410 415 available at www.sciencedirect.com journal homepage: www.europeanurology.com What Does Failure After Surgery or Radiation Mean? Noel W. Clarke * Christie and

More information

MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT

MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT KEYWORDS: Prostate cancer, PSA, Screening, Radical Prostatectomy LEARNING OBJECTIVES At the end of this clerkship, the medical student will be able to:

More information

Local Coverage Determination (LCD): MolDX: Genomic Health Oncotype DX Prostate Cancer Assay (L36153)

Local Coverage Determination (LCD): MolDX: Genomic Health Oncotype DX Prostate Cancer Assay (L36153) Local Coverage Determination (LCD): MolDX: Genomic Health Oncotype DX Prostate Cancer Assay (L36153) Contractor Information Contractor Name Palmetto GBA LCD Information Document Information LCD ID L36153

More information

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH 9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing

More information

Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma

Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma 窑 Original Article 窑 Chinese Journal of Cancer Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma Zhi Ling Zhang,2, Yong Hong Li,2, Yong Hong Xiong 3, Guo Liang Hou,2,

More information

Prostate Cancer 2014

Prostate Cancer 2014 Prostate Cancer 2014 Eric A. Klein, M.D. Chairman Glickman Urological and Kidney Institute Professor of Surgery Cleveland Clinic Lerner College of Medicine Incidence rates, US Men Mortality Rates, US Men

More information

DIAGNOSIS OF PROSTATE CANCER

DIAGNOSIS OF PROSTATE CANCER DIAGNOSIS OF PROSTATE CANCER Determining the presence of prostate cancer generally involves a series of tests and exams. Before starting the testing process, the physician will ask questions about the

More information

Stage IV Prostate Cancer: Survival Differences in Clinical T4, Nodal and Metastatic Disease

Stage IV Prostate Cancer: Survival Differences in Clinical T4, Nodal and Metastatic Disease Stage IV Prostate Cancer: Survival Differences in Clinical T4, Nodal and Metastatic Disease Wayland Hsiao,* Kelvin A. Moses,* Michael Goodman, Ashesh B. Jani,* Peter J. Rossi* and Viraj A. Master*, From

More information

SIOG Guidelines Update 2014 Prostate Cancer. Dr Helen Boyle Centre Léon Bérard SIOG meeting 25 October 2014,Lisbon

SIOG Guidelines Update 2014 Prostate Cancer. Dr Helen Boyle Centre Léon Bérard SIOG meeting 25 October 2014,Lisbon SIOG Guidelines Update 2014 Prostate Cancer Dr Helen Boyle Centre Léon Bérard SIOG meeting 25 October 2014,Lisbon Droz JP, Aapro M, Balducci L, Boyle H, Van den Broeck T, Cathcart P, Dickinson L, Efstathiou

More information

Radical Prostatectomy versus Intensity Modulated Radiation Therapy in the Management of Localized Prostate Cancer

Radical Prostatectomy versus Intensity Modulated Radiation Therapy in the Management of Localized Prostate Cancer Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 10-19-2009 Radical Prostatectomy versus Intensity Modulated Radiation

More information

Localized Prostate Cancer

Localized Prostate Cancer 933 Localized Prostate Cancer Relationship of Tumor Volume to Clinical Significance for Treatment of Prostate Cancer Thomas A. Stamey, M.D.,* Fuad S. Freiha, M.D.,* John E. McNeal, M.D.,* Elise A. Redwine,

More information