RT Book, Section
A1 Dall’Era, Marc A.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1193162603
T1 Prostate Cancer
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193162603
RD 2024/04/18
AB Key  Clinical  Updates  in  Prostate  CancerMultiparametric  MRI  (mpMRI)  has  emerged  as  the  imaging  study  of  choice  for  localized  prostate  cancer  detection  and  characterization.  Suspicious  prostatic  lesions  may  then  be  sampled  via  MRI-guided  needle  biopsy  or  via  MR  Fusion  (in  which  prostate  MRI  images  are  fused  in  real-time  with  images  from  an  ultrasound-guided  needle  biopsy).  Such  an  approach  may  improve  discovery  of  potentially  life-threatening  disease  while  limiting  overdetection  of  indolent  prostate  cancer  or  unnecessary  prostate  biopsies.NCCN  guidelines  recommend  considering  germline  genetic  testing  in  men  presenting  with  localized  high-risk,  regionally  advanced,  or  metastatic  disease.  Commercially  available  cancer  tissue  RNA-based  assays  are  available  for  further  risk  assessment  after  prostate  cancer  diagnosis;  these  may  help  determine  the  need  for  and  timing  of  prostate  cancer  treatment  as  well  as  treatment  intensity.A  secondary  data  analysis  from  the  Prostate,  Lung,  Colorectal,  and  Ovarian  trial  demonstrated  that  baseline  PSA  for  younger  men  in  their  50s  can  predict  long-term  risk  of  prostate  cancer  and  can  be  used  to  tailor  PSA  screening  intervals.Active  surveillance  is  now  the  preferred  initial  treatment  recommendation  for  men  with  well-differentiated  prostate  cancer  and  low-risk  clinical  features.Results  from  the  PEACE-1  trial  demonstrate  that  a  three-drug  regimen,  with  androgen  deprivation  therapy,  docetaxel  and  abiraterone  acetate  used  together,  provides  the  best  survival  outcome  for  men  with  hormone-naïve  metastatic  cancer.  With  this  regimen,  the  median  survival  for  men  with  de  novo  metastatic  prostate  cancer  is  now  expected  to  be  5  years.Poly(ADP-ribose)  polymerase  (PARP)  inhibitors  represent  a  novel  class  of  anticancer  agents  with  some  activity  against  prostate  cancer  particularly  those  harboring  mutations  in  genes  important  for  homologous  recombination  such  as  BRCA1,  BRCA2,  and  ATM.  There  are  two  FDA-approved  PARP  inhibitors  available  for  men  with  metastatic  castrate-resistant  prostate  cancer  with  these  genetic  alterations.Kovac  E  et  al.  JAMA  Netw  Open.  [PMID:  31940039]