Radiotherapy in Prostate Cancer: Utilization of Adjuvant and Salvage Radiotherapy
Written by Rashid Sayyid, MD MSc, & Zachary Klaassen, MD MSc
March 21, 2023
While external beam radiotherapy is a standard treatment option as first-line therapy for men with localized prostate cancer, it is also an important component of care for patients following radical prostatectomy. For approximately two-thirds of patients undergoing radical prostatectomy for prostate cancer, surgery is curative, and patients remain disease-free (without biochemical or radiographic evidence of recurrence).1 However, patients with adverse pathologic findings (defined as seminal vesicle invasion, extraprostatic extension, and positive surgical margins (residual tumor at the surgical site) experience up to a 60% risk of recurrence at 10 years.2
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The Impact of Surgeon Experience and Volume on Patient Outcomes in Radical Prostatectomy Patients
Written by Rashid K. Sayyid, MD MSc and Zachary Klaassen, MD,MSc
March 27, 2023
Introduction
The last decade has seen an increased uptake of the robotic-assisted laparoscopic approach for radical prostatectomies. Despite the negative results of the only published phase III randomized clinical trial comparing robotic-assisted laparoscopic to open radical prostatectomy, which demonstrated no significant differences in short- and medium-term functional outcomes between the two approaches,
1 it is currently estimated that more than 70% of radical prostatectomy surgeries performed since 2012 in the United States have been with robotic assistance.
2 In 2018, it was estimated that 92.6% of all radical prostatectomies in England were performed using this minimally invasive technique.
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Artificial Intelligence and Prostate Cancer: Diagnosis and Grading, mpMRI, and Active Surveillance
Written by Zachary Klaassen, MD MSc & Rashid K. Sayyid, MD MSc
March 29, 2023
Across all aspects of daily life, artificial intelligence more than ever is harnessing the power of machine learning to automate and improve the efficiency of tasks. This is also true in medicine and, in particular, in the field of prostate cancer. The concept of artificial intelligence began in the 1950s with the prime objective of emulating the cognitive capabilities of human beings in machines. More specifically, artificial intelligence is the ability of a machine to independently replicate intellectual processes typical of human cognition. Machine learning comprises algorithms that parse data, learn from that data, and then apply what they have learned to make informed decisions. Deep learning is a form of machine learning that is inspired by the structure of the human brain and is particularly effective in feature detection:1
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The Importance of a Prostate Cancer Survivorship Program: A Multi-Disciplinary Approach
Written by Zachary Klaassen, MD, MSc & Sherita A. King, MD
January 9, 2023
Despite prostate cancer being the second most common cause of cancer mortality among American men,
1 there are over 3 million men in the United States living with prostate cancer. As such, there are many “prostate cancer survivors” that are either on active surveillance/watchful waiting or have undergone treatment for localized (ie. radiation therapy, radical prostatectomy, focal therapy, etc) or advanced disease (ie. androgen deprivation therapy, chemotherapy, novel hormonal therapy, immunotherapy, etc).
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Radiotherapy in Prostate Cancer: Concurrent Use of Systemic Therapy with Radiotherapy in Localized and Locally Advanced Disease
Written by Rashid Sayyid, MD MSc, & Zachary Klaassen, MD MSc
January 6, 2023
External beam radiotherapy, along with radical prostatectomy, has been a mainstay treatment option for prostate cancer for decades and is currently recommended by numerous guidelines for the treatment of intermediate- and high-risk disease.1-3 Unlike surgery which is often, at least initially, planned as a monotherapy, many patients who opt for external beam radiotherapy will receive concurrent therapy. This center of excellence article will review the evidence for concurrent systemic therapy with radiotherapy in men with localized and locally advanced disease.
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Radiotherapy in Prostate Cancer: Hypofractionation for Clinically Localized Disease
Written by Rashid Sayyid, MD MSc, & Zachary Klaassen, MD MSc
December 13, 2022
External beam radiotherapy, along with radical prostatectomy, has been a mainstay treatment option for prostate cancer and is currently recommended by numerous guidelines for the treatment of intermediate- and high-risk disease.1-3 While external beam radiotherapy has been foundational in prostate cancer treatment for decades, there have been significant changes in the delivery of radiotherapy, corresponding to technical advances.
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Active Surveillance in Prostate Cancer: The 2021 NCCN Controversy
Written by Christopher J.D. Wallis, MD, PhD & Zachary Klaassen, MD, MSc
December 8, 2021
Active Surveillance Background
Prostate cancer represents a public health dilemma: while prostate cancer is the second leading cause of death among men in the US
1 and third in Canada,
2 it is widely over-diagnosed and over-treated, leading to significant patient anxiety and morbidity.
3 Much of the over-diagnosis of prostate cancer relates to the use of serum prostate-specific antigen (PSA) testing for prostate cancer screening, beginning in 1987.
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The Fight Against Increased Rates of Prostate Cancer
Written by David Crawford, MD
December 8, 2021
Over the nearly two years of navigating the COVID pandemic, urology practices were forced to increase their efficiency by focusing on streamlining patient visits without sacrificing care quality. However, postponed checkups were unavoidable as the public was encouraged to stay home. According to the Centers for Disease Control and Prevention (CDC), 40% of Americans in 2020 delayed or avoided medical care due to pandemic-related concerns. Although necessary, we are now facing the severe consequences of delayed diagnosis and prostate cancer seems to be leading the way.
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Real-World Clinical Utility of Decipher Biopsy Testing in Localized Prostate Cancer
In prostate pre- and post-biopsy decision making, more precision is urgently needed. Whereas expert imaging and biomarker-based risk scores already enable the clinician in this respect, the dilemma remains for those patients that are diagnosed with apparent indolent cancer. Additional diagnostic tools that (de)select patients for active surveillance (AS) would provide a great benefit for the patient.
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Improving Prostate Cancer Early Detection with Biomarkers in Primary Care
Written by Neal D. Shore, MD, FACS, and Michael S. Cookson, MD, MMHC
October 12, 2020
The COVID-19 pandemic has resulted in numerous physical and psychological adjustments for clinicians, patients, and their families—wearing personal protective equipment, adopting telemedicine, adjusting clinic workflow, etc. The ensuing uncertainty and attendant anxiety from the fluidity of information and healthcare policy debate has augmented the need for enhanced communication
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Biomarker Strategies for Prostate Cancer Care During COVID-19
Written by Neal D. Shore, MD, FACS, and Michael S. Cookson, MD, MMHC
June 24, 2020
Despite the recent disruptions in health care delivery due to the COVID-19 pandemic, patients at risk for developing prostate cancer as well as those diagnosed with prostate cancer still deserve timely and optimal decision making.
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Prostate Cancer Early Detection During the COVID-19 Pandemic
Written by Zachary Klaassen, MD, MSc
April 20, 2020
Currently, there is a global pandemic surrounding the spread of betacoronavirus SARS-CoV-2 leading to Coronavirus Disease 2019 (COVID-19). The rapid spread to all corners of the globe has had tremendous health and economic implications, including the appropriate allocation of healthcare resources.
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Localized Prostate Cancer Management in the Time of COVID-19
Written by Zachary Klaassen, MD, MSc
April 17, 2020
The rapid spread of Coronavirus Disease 2019 (COVID-19) throughout the world, caused by the betacoronavirus SARS-CoV-2, has had dramatic effects on health care systems with impacts far beyond the patients actually infected with COVID-19. Patients who manifest severe forms of COVID-19 requiring respiratory support typically require this for prolonged durations, with a mean of 13 days of respiratory support reported by the China Medical Treatment Expert Group for Covid-19.
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The History of Imaging for Prostate Cancer
Written by Zachary Klaassen, MD, MSc
March 19, 2020
Radiographic imaging has played a key role in the diagnosis and staging of patients with prostate cancer for decades. Today, transrectal ultrasound and multiparametric magnetic resonance imaging are important in diagnosis and local staging of the primary tumor while axial imaging and molecularly targeted positron emission tomography
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Diagnosing and Staging of Prostate Cancer
Written by Zachary Klaassen, MD, MSc
April 16, 2019
Secondary to the introduction of prostate specific antigen (PSA) screening in the 1980’s/1990’s, symptomatic presentation of prostate cancer has become less frequent. Symptoms of locally advanced prostate cancer may include obstructive urinary symptoms, gross hematuria, and/or upper tract urinary obstruction leading to renal failure.
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Prostate Cancer and Utilization of Multi-Parametric MRI
Written by Zachary Klaassen, MD, MSc
April 16, 2019
Over the last decade, imaging for prostate cancer has improved immensely. Specifically, prostate multiparametric MRI (mpMRI) has improved primarily as a result of an increase in magnet strength from 1 to 3-tesla. mpMRI consists of anatomic and functional imaging techniques:
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