Prostate Cancer

In my experience, being treated for low-volume Gleason 6 tumors is the norm, not the exception, for men in the United States. Surveillance may be discussed as an option, but it is not taken seriously.

The concept of active surveillance is based on the observation that Gleason 6 (pattern 3) prostate cancer is an indolent condition that poses little or no threat to the patient’s life. Conservative management is thus appropriate for these patients.

A 46-year-old man sought consultation for an abnormal prostate-specific antigen (PSA) level of 9 ng/mL and one prior negative biopsy. Five months ago, while traveling, he had presented to an urgent care facility with a 24-hour history of fever, chills, nausea, and vomiting.

The majority of patients with systemic prostate cancer treated with androgen deprivation therapy (ADT) will develop castration-resistant prostate cancer (CRPC).

Our aims in this article are to describe the various imaging sequences that comprise the multiparametric MRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and to expound on the role of prostate MRI in clinical practice.
• The State of Prostate MRI in 2013: Into the Breach
• Multiparametric MRI: Standardizations Needed

Only the possibility of increasing survival with better tumor localization and staging is probable with multiparametric MRI—and improved survival with MR imaging in prostate cancer has not been shown in a clinical trial or meta-analysis to date.

In this review we focus on the recent evolution of the concept of focal therapy and the potential applications of this management approach within an array of options currently available for patients with localized prostate cancer.
• Focal Therapy: A New Active Surveillance Tool?
• Focal Therapy of Prostate Cancer—The Challenge

This review summarizes recent findings in clinical prostate cancer research reported at the 2012 Annual Scientific Meeting of the American Society of Clinical Oncology (ASCO) and addresses their relevance to clinical practice.
• Prostate Cancer 2012: Where Do We Stand and Where Are We Heading?

There is no question that the robot has leveled the playing field. It has allowed more surgeons to offer patients a minimally invasive approach. In terms of perioperative outcomes, there is clear evidence showing shorter hospital stays, less blood loss, lower complication rates, and shorter convalescence with robotic-assisted laparoscopic prostatectomy.
• Robotic-Assisted Radical Prostatectomy: Who Is Benefiting?
• Robotic Prostatectomy Improves Outcomes—After the Potentially Risky Adoption Phase

Over the last decade, robotic-assisted laparoscopic prostatectomy (RALP) has rapidly gained in popularity, primarily for three reasons: the enthusiasm of surgeons keen to try something new, medical marketing, and patients’ desire to avoid side effects from surgery.
• Hopes and Dreams for Quality Improvement in Radical Prostatectomy

A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?

An asymptomatic, 57-year-old man underwent a prostatic biopsy.

Core biopsy of prostate from an elderly male. Your diagnosis is: