Prostate Cancer: Science and Clinical Practice

Table of contents

• List of Contributors
• Preface
• Part I: Etiology, Pathology, and Tumor Biology
• Chapter 1: Population Screening for Prostate Cancer and Early Detection
• Abstract
• Introduction
• Specific criticisms of the USPSTF report
• Screening special at-risk populations
• Impact of age on prostate screening decisions
• Screening/risk assessment in young men
• Screening PSA in older men
• Conclusions
• Chapter 2: Inflammation and Infection in the Etiology of Prostate Cancer
• Abstract
• Introduction
• Histologic prostatic inflammation and prostate cancer
• Proliferative inflammatory atrophy
• Mechanisms of inflammatory carcinogenesis
• Clinical prostatitis and prostate cancer
• Infection
• Prostatic calculi and other physical or chemical irritants
• Changes in genes associated with infection/inflammation that increase the risk of PCA
• Diet and prostate cancer risk
• Biomarkers for inflammation and prostate cancer
• Chemoprevention with ASA or NSAIDs
• Conclusions
• Chapter 3: Androgen Receptor
• Abstract
• Introduction
• Androgen receptor structure and function
• Androgen receptor and the prostate
• Androgen receptor activity in castration-resistant prostate cancer
• Conclusions
• Chapter 4: Novel Research on Fusion Genes and Next-Generation Sequencing
• Abstract
• Recurrent translocations in prostate cancer
• Spectrum of point mutation and copy number alterations in prostate cancer
• Conclusions
• Chapter 5: Should Gleason Score 6 Still Be Called Cancer?
• Abstract
• Introduction
• Molecular characteristic of Gleason pattern 3 versus 4
• Natural history of treated Gleason 6 cancer
• Natural history of untreated Gleason 6 cancer
• Undergrading
• Nomenclature
• Conclusions
• Chapter 6: High Grade Prostatic Intraepithelial Neoplasia and Atypical Glands
• Abstract
• Introduction
• High-grade prostatic intraepithelial neoplasia
• Atypical small acinar proliferation
• Conclusions
• Chapter 7: Prostate Cancer in the Elderly
• Abstract
• Introduction
• The magnitude of prostate cancer in elderly men
• Pathologic characteristics
• PSA screening and diagnosis with prostate biopsy
• Treatment
• Patient preferences and treatment practice patterns in the elderly with prostate cancer
• Fitness for prostate cancer treatment in the elderly
• Treatment of prostate cancer in elderly patients
• Conclusions
• Chapter 8: Prostate Cancer and Other Primary Malignancies
• Abstract
• Background
• Prostate cancer and bladder cancer
• Prostate cancer and kidney cancer
• Prostate cancer and colorectal cancer
• Treatment of multiple malignancies
• Chapter 9: Biopsy Prophylaxis, Technique, Complications, and Repeat Biopsies
• Abstract
• Biopsy prophylaxis
• Biopsy technique and specimen processing
• Complications
• Repeat biopsies
• Conclusions
• Chapter 10: Total and Free PSA, PCA3, PSA Density and Velocity
• Abstract
• Introduction
• PSA
• PSA Density
• PSA Velocity
• PCA3
• Chapter 11: Imaging in Localized Prostate Cancer
• Abstract
• Introduction
• Ultrasound
• Magnetic resonance imaging
• MR spectroscopic imaging
• PET/CT
• Conclusions
• Part II: Genetic Susceptibility and Hereditary Predisposition, Screening, and Counseling
• Chapter 12: Prostate Cancer Prevention: Strategies and Realities
• Abstract
• Introduction
• Chemoprevention
• Lifestyle factors in prostate cancer prevention
• The future of prostate cancer prevention
• Acknowledgment
• Chapter 13: Prostate-Specific Antigen Screening Guidelines
• Abstract
• What is PSA?
• What is the natural history of prostate cancer?
• Are prostate cancer treatments effective?
• Is prostate-specific antigen an effective screening test?
• Are there risks associated with PSA screening?
• What advice should physicians give their patients?
• Future directions and research needs
• Part III: Epidemiology
• Chapter 14: Cancer of the Prostate: Incidence in the USA
• Abstract
• Introduction
• Modern trends in prostate cancer diagnosis in the United States
• Risk factors for the development of prostate cancer
• Future of prostate cancer incidence in the United States
• Chapter 15: International Trends in Prostate Cancer
• Abstract
• Incidence rates of prostate cancer
• PSA screening
• Genetic links
• Mortality
• Conclusions
• Chapter 16: Race, Ethnicity, Marital Status, Literacy, and Prostate Cancer Outcomes in the United States
• Abstract
• Epidemiology
• Prostate cancer disparity in African-American men
• Marital status and prostate cancer outcomes
• The impact of literacy and numeracy
• Strategies to reduce disparity in high-risk populations
• Chapter 17: Hereditary Prostate Cancer
• Abstract
• Introduction
• Epidemiologic studies of family history and prostate cancer risk
• Segregation and linkage studies
• Genome-wide association studies in prostate cancer
• Next-generation sequencing in prostate cancer
• Direct to consumer genetic testing
• Conclusions
• Chapter 18: Neuroendocrine Prostate Cancer
• Abstract
• Introduction
• Neuroendocrine cells in the healthy prostate
• Neuroendocrine differentiation in prostate cancer
• Clinical challenges and opportunities
• Conclusions
• Chapter 19: Breast and Prostate Cancers: A Comparison of Two Endocrinologic Malignancies
• Abstract
• Introduction
• History
• Epidemiology
• Risk factors
• Screening
• Prevention
• Endocrinology
• Molecular cross talk
• Management
• Advanced disease
• Dormancy
• Discussion
• Part IV: Prevention of Prostate Cancer
• Chapter 20: Heart Healthy = Prostate Healthy and S.A.M. are the Ideal “Natural” Recommendations for Prostate Cancer
• Abstract
• Key points
• Introduction
• Primary prevention trials utilizing a pharmacologic agent – the untold story
• Notable dietary supplement cancer prevention trials – the untold story
• Multivitamins and other dietary supplements – less is more
• Lifestyle matters (heart healthy = prostate healthy)
• The importance of S.A.M. (statins, aspirin, and/or metformin) and prostate cancer
• Conclusions – solving the diet and supplement debate
• Chapter 21: Effects of Smoking, Alcohol, and Exercise on Prostate Cancer
• Abstract
• Introduction
• Cigarette smoking
• Alcohol
• Physical activity
• Conclusions
• Chapter 22: Environmental and Occupational Exposures and Prostate Cancer
• Abstract
• Introduction
• Agent Orange
• Pesticides and farming
• Endocrine disruptors
• Vitamin D and sunlight
• Metals
• Rubber manufacturing
• Whole body vibration
• Other exposures
• Conclusions
• Chapter 23: Level-1 Data From the REDUCE Study and the PCPT Data
• Abstract
• Introduction
• Incidence
• Factors for increased risk of prostate cancer
• 5-alpha-reductase inhibitors
• The Prostate Cancer Prevention Trial (PCPT)
• Reduction by Dutasteride of Prostate Cancer Events (REDUCE)
• The controversy
• Conclusions
• Part V: Conservative Management
• Chapter 24: Decision Support for Low-Risk Prostate Cancer
• Abstract
• Introduction
• Defining indolent prostate cancer
• Individualized predictions
• Which prediction model to use?
• Clinical applicability
• Future perspectives
• Conclusions
• Chapter 25: Active Surveillance: Rationale, Patient Selection, Follow-up, and Outcomes
• Abstract
• Introduction
• Background
• The rationale for surveillance: the natural history and molecular biology of low-grade prostate cancer
• Genetic features of low-grade prostate cancer
• Metastatic potential
• Who is a candidate?
• Surveillance follow-up protocols
• Conclusions
• Part VI: Surgery
• Chapter 26: Preoperative Risk Assessment
• Abstract
• Introduction
• Life expectancy
• Predictors of final pathology
• Partin Tables
• Preoperative predictors of biochemical recurrence
• D’Amico criteria
• CAPRA score
• Stephenson nomogram
• Preoperative predictors of mortality
• The use of pretreatment imaging to predict outcomes
• Conclusions
• Chapter 27: Is Surgery Still Necessary for Prostate Cancer?
• Abstract
• Stage migration: increased incidence of localized prostate cancer
• Comparative effectiveness research (CER) among different approaches
• Challenges to CER among treatments for localized PCa
• Risk stratification of localized PCa
• Comparing oncological outcomes: RCTs and observational studies
• Comparing HRQOL
• Comparing costs: who pays?
• High-risk disease and surgery as part of a multimodal approach
• Salvage RP
• Conclusions
• Chapter 28: Indications for Pelvic Lymphadenectomy
• Abstract
• Introduction
• Risk stratification for performing pelvic lymphadenectomy
• Anatomic extent of pelvic lymphadenectomy
• Does pelvic lymph node dissection confer a therapeutic benefit (i.e., a survival advantage)
• Can preoperative imaging aid the decision process to perform LND?
• Conclusions
• Chapter 29: The Surgical Anatomy of the Prostate
• Abstract
• The prostate
• Seminal vesicles
• Fasciae
• Pelvic musculature
• Neuroanatomy
• Vascular anatomy
• Chapter 30: Radical Retropubic Prostatectomy
• Abstract
• Introduction
• Indications and contraindications
• Operative technique
• Radical prostatectomy additional considerations
• Postoperative complications
• Outcomes
• Conclusions
• Chapter 31: Radiation-Resistant Prostate Cancer and Salvage Prostatectomy
• Abstract
• Radiotherapy for prostate cancer
• Detection of a recurrence after radiotherapy
• Postradiotherapy prostate biopsy when recurrence is strongly suspected
• Imaging studies to detect a recurrence after radiotherapy
• Salvage radical prostatectomy
• Complications and quality of life
• Conclusions
• Chapter 32: Postradical Prostatectomy Incontinence
• Abstract
• Introduction
• Epidemiology and pathophysiology of urinary incontinence after radical prostatectomy
• Evaluation of men with postprostatectomy incontinence
• Conservative therapy
• Surgical planning
• Urethral bulking agents
• Periurethral constrictors
• Continence balloon device
• Perineal slings
• Artificial urinary sphincter
• Stem cell therapy
• Conclusions
• Chapter 33: Prognostic Significance of Positive Surgical Margins and Other Implications of Pathology Report
• Abstract
• Introduction
• Positive surgical margins
• Tertiary Gleason pattern
• Lymphovascular invasion
• Seminal vesicle invasion
• Lymph node positive disease
• Conclusions
• Acknowledgment
• Chapter 34: Open Versus Robotic Prostatectomy
• Abstract
• Introduction
• Surgical technique
• Factors influencing outcomes
• Functional outcomes
• Cost consideration
• Conclusions
• Chapter 35: The Technique of Robotic Nerve-Sparing Prostatectomy
• Abstract
• Introduction
• Historical perspective
• Evolution of nerve-sparing with robotic surgery
• Vattikuti Institute prostatectomy
• Conclusions
• Chapter 36: Anterior Approach to Robotic Radical Prostatectomy
• Abstract
• Introduction
• Patient selection
• Patient setup
• Access
• Surgical steps
• Postop
• Conclusions
• Chapter 37: Posterior Approach to Robotic-Assisted Laparoscopic Radical Prostatectomy
• Abstract
• Introduction
• Relevant anatomy
• Posterior approach procedure
• Discussion
• Conclusions
• Chapter 38: The Technique of Robotic Nerve Sparing Prostatectomy: Extraperitoneal Approach
• Abstract
• Introduction
• The technique
• Special considerations
• Chapter 39: Clinical and Pathologic Staging of Prostate Cancer
• Abstract
• Introduction
• Clinical staging of prostate cancer
• Pathologic staging of prostate cancer
• Chapter 40: Management of Bladder Neck Contracture in the Prostate Cancer Survivor
• Abstract
• Introduction
• Epidemiology and pathophysiology
• Management of BNC
• Stress urinary incontinence after BNC therapy
• Conclusions
• Chapter 41: Reimbursement for Prostate Cancer Treatment
• Abstract
• Introduction
• Economics of open versus robotic radical prostatectomy
• Economics of radiation therapy for prostate cancer
• Conclusions
• Part VII: Radiation Therapy
• Chapter 42: Fundamentals of Radiation Treatment for Prostate Carcinoma – Techniques, Radiation Biology, and Evidence Base
• Abstract
• Introduction
• Fundamentals of radiotherapy
• Overview of radiation biology
• Treatment options in radiotherapy
• Acknowledgments
• Chapter 43: Radiation with Hormonal Therapy
• Abstract
• Introduction
• Types of androgen deprivation therapy used with radiation therapy
• Treatment of high-risk prostate cancer with radiation therapy
• The benefit of androgen deprivation therapy in combination with radiation therapy
• Dose-escalated radiotherapy and androgen deprivation therapy
• Androgen deprivation therapy and radiotherapy after prostatectomy
• Side effects of androgen deprivation therapy
• Conclusions
• Chapter 44: Brachytherapy for Prostate Cancer: An Overview
• Abstract
• Introduction
• Brief historical background of prostate brachytherapy
• Technical aspects and sequencing of brachytherapy for prostate cancer
• LDR-BT: clinical outcomes
• HDR-BT: clinical outcomes
• Follow-up after prostate brachytherapy
• Conclusions
• Chapter 45: Intensity Modulated Radiotherapy and Image Guidance
• Abstract
• Introduction
• Conformal radiation therapy: from conventional 2D to 3D-CRT to IMRT
• Dose escalation
• Target delineation
• Prostate motion
• Image guidance
• Conclusions
• Chapter 46: Proton Beam Therapy
• Abstract
• Introduction
• Historical perspective
• Physics rationale
• Clinical evidence
• Evolving applications and considerations
• Chapter 47: Radiotherapy After Radical Prostatectomy: Adjuvant Versus Salvage Approach
• Abstract
• Introduction
• Adjuvant radiotherapy
• Salvage radiotherapy
• Future directions
• Conclusions
• Chapter 48: Emerging Modalities in Radiation Therapy for Prostate Cancer
• Abstract
• Introduction
• Identification of patients for radiation therapy
• Target identification
• Hypofractionation
• Future combined modality treatment
• Adaptive radiation therapy
• New treatment modalities
• Part VIII: Clinical Dilemmas
• Chapter 49: Management of PSA Recurrences After Radical Prostatectomy
• Abstract
• Introduction
• Definition and natural history
• Diagnostic work-up
• Treatment options
• Conclusions
• Chapter 50: Salvage Therapy for Locally Recurrent Prostate Cancer After External Beam Radiation Therapy
• Abstract
• Introduction
• Evaluation
• Local salvage treatment options
• Investigational modalities
• Systemic therapy
• Conclusions
• Chapter 51: Management of Locally Advanced (Nonmetastatic) Prostate Cancer
• Abstract
• Introduction
• Treatment options
• Conclusions
• Acknowledgments
• Part IX: Advanced Prostate Cancer
• Chapter 52: Androgen Deprivation Therapy: Appropriate Patients, Timing to Initiate ADT, and Complications
• Abstract
• Introduction
• Androgen deprivation therapy
• Combination therapy
• Timing
• General complications of ADT
• Conclusions
• Chapter 53: Bone Health in Prostate Cancer
• Abstract
• Introduction
• Bone physiology and metabolism
• ADT-associated osteoporosis and fractures
• Detection and prevention of ADT-associated osteoporosis and fractures
• Biology of bone metastasis in prostate cancer
• Development of bone metastasis
• Imaging for bone metastasis
• Novel biomarkers for bone metastasis
• Prevention of bony metastasis
• Localized therapy with EBRT
• Management of bone pain
• Treatment and management of acute spinal cord compression and pathologic fractures
• Prevention of skeletal-related events in prostate cancer
• Bone-targeted agents
• Receptor activator of nuclear factor-kappa B (RANK) signaling pathway inhibitors
• Radiopharmaceuticals (systemic “bone-seeking” agents)
• Disease modifying agents
• Novel and emerging therapies
• American Urologic Association guideline recommendations for optimal bone health in prostate cancer
• Practical management for optimal bone health
• Chapter 54: Castration Resistant Prostate Cancer: Role of Chemotherapy
• Abstract
• Introduction
• FDA-approved chemotherapy regimens for mCRPC
• Other chemotherapy regimens for mCRPC
• When to start chemotherapy?
• Duration of chemotherapy
• The future of chemotherapy in mCRPC
• Conclusions
• Chapter 55: Antiandrogen Monotherapy in the Treatment of Prostate Cancer
• Abstract
• Introduction
• The androgen receptor
• Androgen-dependent and androgen-independent prostate growth
• Steroidal antiandrogens
• Nonsteroidal antiandrogens
• Antiandrogen monotherapy
• Commentary
• Conclusions
• Chapter 56: Sipuleucel-T – A Model for Immunotherapy Trial Development
• Abstract
• Introduction
• Elucidating the mechanism of action of sipuleucel-T
• Enhancing immunogenicity
• Interrogation of the neoadjuvant milieu
• Using the sipuleucel-T experience as a paradigm for immunotherapy development
• Incorporating sipuleucel-T in the clinical states paradigm
• Biomarkers of immune response
• Conclusions
• Chapter 57: Second-Line Hormonal for Castrate-Resistant Prostate Cancer
• Abstract
• Introduction
• First-generation antiandrogens
• Estrogens
• Cyproterone
• Megestrol acetate
• Ketoconazole
• Aminoglutethimide
• Corticosteroids
• Second-generation antiandrogens
• Abiraterone
• Conclusions
• Part X: Cryoablation, HIFU and Focal Therapy
• Chapter 58: Salvage Cryoablation of the Prostate
• Abstract
• Introduction
• Detection of radiorecurrent prostate cancer
• History of cryosurgery
• Patient selection for salvage cryoablation
• Oncological efficacy of salvage cryoablation
• Focal cryotherapy
• Complications
• Conclusions
• Chapter 59: High-Intensity Focused Ultrasound
• Abstract
• Introduction
• How HIFU works
• Histopathologic changes associated with HIFU
• Guidelines for the use of HIFU
• Oncological outcomes
• Complications of HIFU and quality of life considerations
• Focal HIFU
• HIFU in specific settings
• Management of HIFU failures
• HIFU: future research
• Conclusions
• Chapter 60: Focal Therapy for Prostate Cancer
• Abstract
• Introduction
• Goals of focal therapy
• Candidate selection
• Methods for disease mapping
• Modalities for focal treatment
• Follow-up
• Limitations of therapy
• Conclusions
• Chapter 61: Quality of Life: Impact of Prostate Cancer and its Treatment
• Abstract
• Introduction
• The trifecta, the pentafecta
• Instruments for QOL research
• Prostate cancer HRQOL studies
• HRQOL outcomes of prostate cancer treatment
• Spousal/partner assessment of quality of life (QOL)
• Impact of quality of life (QOL) changes on overall outcome of treatment
• Conclusions
• Chapter 62: Impact of Prostate Cancer Treatments on Sexual Health
• Abstract
• Erectile dysfunction
• Anejaculation
• Orgasm Changes
• Sexual incontinence
• Changes in sexual desire
• Penile length loss
• Part XI: Govermental Policies
• Chapter 63: Coding and Billing for Diagnosis and Treatment of Prostate Cancer
• Abstract
• Introduction
• Diagnoses
• Prostate cancer screening
• Office consultative services (urological consultations)
• Diagnostic procedure coding for carcinoma of the prostate
• Coding for surgical procedures for carcinoma of the prostate
• Coding for drug management of prostatic carcinoma
• Other drugs used in the treatment of prostatic carcinoma
• Coding for pathological services
• MRI-assisted transrectal ultrasound (for fusion-guided biopsy of the prostate gland)
• Chapter 64: Health Policy for Prostate Cancer: PSA Screening as Case Study
• Abstract
• PSA testing: an ongoing dialogue
• The statistics
• Policy concerns around PSA screening
• What considerations should drive prostate cancer policy?
• Variations in guidelines and recommendations
• The role of shared decision making (SDM)
• The way forward
• Chapter 65: Legal Implications of Prostate Cancer Screening
• Abstract
• Introduction
• Prostate cancer screening recommendations: a brief review
• Clinical practice guidelines: an introduction
• The legal implications of prostate cancer screening: clinical practice guidelines and medical malpractice law
• Conclusions
• Part XII: New Horizons for Prostate Cancer
• Chapter 66: New Markers for Prostate Cancer Detection and Prognosis
• Abstract
• Introduction
• Who should be biopsied?
• Who should be rebiopsied?
• Who should be treated vs monitored?
• Therapeutic response assessment
• Conclusions
• Chapter 67: Testosterone Therapy in Hypogonadal Men with Prostate Cancer
• Abstract
• Background
• Testosterone supplementation following definitive therapy for localized prostate cancer
• Can patients on active surveillance with symptomatic hypogonadism receive testosterone therapy?
• How is the new thinking being employed in practice?
• Subject Index