Imaging and management of Prostate cancer

Publication date: Available online 18 February 2020Source: Seminars in Ultrasound, CT and MRIAuthor(s): Devaki Shilpa Sudha Surasi, Brian Chapin, Chad Tang, Gregory Ravizzini, Tharakeswara Kumar BathalaAbstractProstate cancer (PCa) is the most common non-cutaneous malignancy in men and the second leading cause of cancer related death in the United States. Men with clinical suspicion of PCa undergo tissue sampling and based on features including the Gleason score, Prostate Specific antigen (PSA) levels and clinical tumor (T) stage, patients are risk stratified into 6 major groups based on National Comprehensive Cancer Network (NCCN) guidelines. This forms the basis for deciding imaging and management. Active surveillance is the preferred approach for less aggressive tumors. Surgery or radiation +/- androgen deprivation therapy continue to be the primary treatment options for localized disease. Imaging plays a critical role in the diagnosis, staging and management of PCa. Multiparametric MRI (mpMRI) is currently the imaging modality of choice for locoregional staging. Magnetic Resonance Imaging (MRI) and Computed tomography (CT) and bone scan remain the preferred modalities for evaluation of nodal, soft tissue and bone metastases respectively. Advanced Positron Emission Tomography (PET) imaging using novel radiotracers are being developed but are not yet integrated in the diagnostic guidelines for initial staging. In this review, we will discuss the imaging and treatment algori...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research

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Purpose: The availability of novel imaging modalities (NIM) in prostate cancer (PCa) has overtaken the evidence informing their use. The recent EORTC consensus statement on modern imaging recognises the need for large-scale clinical trials of novel imaging [1]. The UK environment is well placed to conduct such trials; the NCRI prostate cancer CSG wished to benchmark current UK imaging availability and practice to inform future national trials.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: The role of pelvic nodal irradiation in prostate cancer remains controversial. Nevertheless, many high-risk patients are treated with prostate and pelvis radiotherapy in addition to androgen deprivation therapy (ADT) [1]. A recent retrospective study [2] and data from the UK Stampede control arm [3] suggest that radiotherapy may be of benefit to node positive patients. The aim of our study was to document outcomes in patients with node positive prostate cancer treated with pelvic nodal radiotherapy in a UK cancer centre.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: Relapsed or progressive prostate cancer frequently manifests as consecutive PSA rises long before disease is clinically detectable. Imaging with novel radiotracers targeting prostate-specific membrane antigen (PSMA) has been shown to be more sensitive in identifying the site of disease at lower PSA levels compared with conventional imaging, which may provide increased opportunity for salvage therapy, more aggressive local management of oligometastatic disease or increased confidence in proceeding with systemic therapy [1].
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: To assess the benefits and risks of co-administering maintenance prednisolone with docetaxel and androgen-deprivation therapy (ADT) in hormone sensitive metastatic prostate cancer (HSMPC).
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: As doctors we are required to take consent for radiotherapy; we typically take written consent [1]. We must tell a patient if a treatment might result in a serious adverse outcome, even if the likelihood is very small [2]. As many cancer centres move towards tumour site-specific consent forms for prostate radiotherapy we wanted to ascertain if there was consensus.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
In this study, we describe our experience with both drugs at the Diana Princess of Wales Hospital (DPoW), Grimsby.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: The STAMPEDE trial has recently shown a benefit in overall survival by irradiating the prostate of patients with newly diagnosed metastatic prostate cancer [1]. This benefit was only shown in patients with low burden of metastatic disease, as per the CHAARTED criteria [2]. The current standard of care for these patients is androgen deprivation therapy ± docetaxel chemotherapy and radiotherapy to symptomatic areas of disease if required. The aim of this audit is to determine the potential number of men with low burden of metastatic disease who may require additional radiotherapy.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: Radiotherapy to the prostate in mHSPC improves overall survival and progression-free survival (PFS) for patients with low-volume disease [1]. Radium-223 in metastatic castration resistant prostate cancer improves overall survival [2]. We conducted a prospective phase I/II clinical trial in mHSPC, testing the combination of LHRHa with concurrent pelvic radiotherapy and radium-223.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
Purpose: Prostate cancer in Black men has traditionally been associated with poorer outcomes than in their White counterparts. However, this perception has been largely extrapolated from studies in the localised cancer to the advanced cancer setting, where there have been few studies. We aim to evaluate whether ethnicity influences outcome in the advanced prostate cancer setting based on real-world data.
Source: Clinical Oncology - Category: Radiology Authors: Source Type: research
ABSTRACT Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018. Materials and Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤ 2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were rec...
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
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