Role of genetic testing for inherited prostate cancer risk: Philadelphia prostate cancer consensus conference 2017

Purpose: Guidelines are limited for genetic testing for prostate cancer (PCA). The goal of this conference was to develop an expert consensus-dri

Hormonal therapy options for prostate-specific antigen-only recurrence of prostate cancer after previous local therapy

Prostate cancer recurrence that is detectable only by a rise in PSA level after successful local treatment for prostate cancer is a very common problem facing patients and their clinicians. Recent studies suggest that early hormonal therapy provides a survival benefit in patients with M0 disease and after RP in patients with pelvic lymph node metastases; however, the survival benefit for PSA-only recurrence has yet to be confirmed. As shown by the case histories presented here, unconventional hormonal therapy, e.g. antiandrogen monotherapy, appears to be a reasonable option. The potency-sparing potential of this approach is appealing, as is the reduced degree of other side-effects associated with traditional hormonal (castration) therapies, but the long-term efficacy in patients with early PSA-only progression is unknown. The possibility of breast symptoms during antiandrogen monotherapy may be reduced with the use of prophylactic low-dose breast irradiation. More clinical trials are needed to determine the best treatments, alone and in combination, for these patients.SCOPUS: sh.jFLWINinfo:eu-repo/semantics/publishe

Downsides of Robot-assisted Laparoscopic Radical Prostatectomy:Limitations and Complications

Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. Evidence synthesis: RALP has the following principal downsides: (1) device failure occurs in 0.2–0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Conclusions: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients

The Role of Magnetic Resonance Imaging in Focal Therapy for Prostate Cancer: Recommendations from a Consensus Panel

To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. Topics specifically not included staging of prostate cancer (PCa), but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to a) determine focality of prostate cancer (i.e. localizing small target lesions of 0.5 cm3 and greater), b) to monitor and assess the outcome of focal ablation therapies, and c) to indentify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy?Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors.Consensus was reached on most key aspects of the meeting, however on definition of the optimal requirements for mpMRI, there was 1 dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5 with endorectal coil) and judged by an experienced radiologist. Structured and standardized reporting of prostate MRI is paramount. State of the art mpMRI is capable to localize small tumors for focal therapy. State of the art mpMRI is the technique of choice for follow up of focal ablation.The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumor aggressiveness. Template guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available, however, suspicious lesion should always be confirmed by (targeted) biopsy