With nearly one in every seven men diagnosed during their lifetime, prostate cancer (PCa) is a common disease in the United States. Although widespread screening and aggressive treatment has led to an improved survival rates, “overtreatment” and treatment-related side effects have had a drastic impact on the quality of life of survivors. As a result, the diagnosis and management of PCa has come under considerable controversy over the last decade. The many medical specialities involved in the treatment of PCa—the primary care provider, the urologist, the radiation oncologist, the pathologist, the radiologist, and the medical oncologist—have been left with key questions to answer. Which patients should be screened? How do we best diagnose PCa? Can we minimize the detection of indolent PCa? Which men with PCa need treatment? For those that require treatment, what can we do to improve the unintended side effects of intervention? Finally, for the men we are unable to cure, how can we improve survival and quality of life?
Washington University School of Medicine has leaders in PCa research across multiple sub-specialties. For this review, we have gathered faculty members to highlight the “state of the art” for their field.
Robert Grubb, III, MD, discusses the key PCa screening trials, summarizes the current guidelines for the early detection of PCa, and discusses new tests designed to improve risk discrimination for clinically significant PCa prior to biopsy.
Joseph Ippolito, MD, and colleagues discuss the newest innovations in imaging for both localized and metastatic disease, specifically focusing on the growing role of multiparametric magnetic resonance imaging.
Eric Kim, MD, and Arnold Bullock, MD, discuss the role of surgery in the management of PCa, for both early and advanced disease, as well as the emerging role for focal therapy.
Hiram Gay, MD, and Jeff Michalski, MD, discuss the role of radiation therapy in the management of PCa, focusing on the improvements made to reduce the side effects of treatment.
Jennifer Sehn, MD, discusses the most recent updates in histopathologic grading of PCa, which have a tremendous impact on PCa care.
Theodore Thomas, MD, and Russell Pachynski, MDreview the role of hormone deprivation and chemotherapy for advanced PCa, discuss the newest FDA approved medications for metastatic castrate resistant PCa, and the ongoing investigation of immunotherapy in PCa.
We hope that this review provides all practitioners important insights into the contemporary diagnosis and management of PCa.
Biography
Gerald L. Andriole, MD, is the Robert K. Royce Distinguished Professor, Chief of Urologic Surgery, at Washington University School of Medicine, St. Louis, Missouri.
Contact: andrioleg@wustl.edu
