Prostate Cancer

Prostate Cancer – news and research

PSA screening reduces risk of prostate cancer death by 29% at 11 years follow up.

Urological society of Australia advocate PSA testing in the 55-69 age group.

Urological society of Australia advocate a PSA test in men between 40-50 years to stratify the future risk of prostate cancer.

Canadian urological society advocate PSA testing in all men above 50 years, and 40 years if positive family history.

Robotic radical prostatectomy for prostate cancer has similar or better outcomes than open surgery.

Radical prostatectomy surgery for early prostate cancer affords 6% reduction in prostate cancer specific mortality in men younger than 65.

The risk of prostate cancer death in men who fail surgery for prostate cancer is based on time to failure, PSA doubling time and Gleason grade.

Adjuvant radiotherapy given to men within 18 weeks of a diagnosis of T3 prostate cancer after radical prostatectomy benefit from increased survival, increased metastasis free survival, a 7 year delay to PSA failure and freedom from long term hormone thera.

Finasteride 5 mg daily given for 7 years results in a 25% reduction in the prevalence of prostate cancer based on prostate biopsy in men >55 and with a PSA >4ng/mL (PCPT).

Dutasteride 0.5 mg daily for 4 years in men 50-75 reduces the risk of detecting prostate cancer at biopsy and improves urinary symptoms related to a large prostate (Reduce trial).

Dutasteride 0.5 mg daily for 3 years in men 48-82 on active surveillance for low risk prostate cancer had less cancer progression on biopsy and less need for intervention (Redeem trial).

Salvage radiotherapy for biochemical failure after radical prostatectomy works best when the preradiotherapy PSA <0.6 ng/mL, long PSADT >10 months, positive margins, no seminal vesicle invasion and Gleason 4-7.

In men who develop PSA recurrence after surgery for prostate cancer the main determinants of clinical progression are PSADT < 10 months, time to recurrence <2 years and Gleason 8-10.

Immediate hormonal therapy or orchiectomy is beneficial in men with locally advanced or asymptomatic metastatic prostate cancer.

High risk prostate cancer requires multi-modality treatment however surgery can be offered with good results.

70 Gy radiotherapy to the prostate, seminal vesicles and whole pelvis when combined with 3 years of hormones improves overall and disease specific survival compared with radiotherapy on its own.

Men with Gleason 5-6 prostate cancer followed for 24 years and treated conservatively have a very low risk of dying from prostate cancer whereas men with Gleason 7-10 are likely to die from prostate cancer.

Active surveillance is a good strategy for men with clinically insignificant prostate cancer who want to preserve their erectile and urinary function until definitive treatment is needed.

Extended lymph node dissection should be performed as part of surgery for high and intermediate risk prostate cancer.

Abiraterone plus prednisone prolongs overall survival in metastatic hormone resistant prostate cancer in men who have already had docetaxel chemotherapy.

Docetaxel plus prednisone has superior overall survival, PSA response, pain and quality of life response versus mitoxantrone in metastatic hormone refractory prostate cancer.

Denosumab delays time to bone metastasis in patients with hormone refractory non-metastatic prostate cancer who are at high risk of bone metastasis.

Immediate hormones in men with positive lymph nodes after radical prostatectomy is associated with a progression free survival benefit of 14 years versus 2.4 years if just watched and better overall and prostate cancer specific survival at 12 years.

Zoledronic acid 4 mg infusion every 3 weeks in men with bone metastases in hormone resistant prostate cancer and normal kidney function have 11% fewer skeletal complications including fewer fractures, a longer time to any skeletal problem and less pain.

Benign prostatic hypertrophy (BPH)

Benign prostatic hypertrophy (BPH) – news and research

Combination medical therapy with alpha blocker plus finasteride reduces clinical progression of BPH more than either drug alone, and combination or finasteride alone reduces the risk of acute urinary retention or needing surgery (MTOPS).

Combination dutasteride plus tamsulosin significantly improves symptom scores in men with IPSS =12, PSA =1.5-10 ng/ml, prostate volume =30 ml, flow rate 5-15 ml/sec (combAT).

Men with PSA >1.4 ng/ml and/or larger prostate sizes (>30 ml) are most likely to benefit from finasteride 5mg daily in terms of symptom and flow rate improvement.

Photoselective vaporization of the prostate using 80-W or 120-W laser has equivalent functional outcomes but less bleeding, shorter catheterization times and shorter hospital stay than traditional TURP.

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