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Journal: Prostate Cancer and Prostatic Diseases

Prostate Cancer and Prostatic Diseases

The Association Between Androgen Deprivation Therapy and Autoimmune Diseases in Men with Prostate Cancer - Commentary

Many adverse events have been described in men receiving androgen deprivation therapy (ADT), ranging from loss of bone density, hot flushes, cardiovascular risk, metabolic syndrome, cognitive dysfunction, and even less common risks such as deep vein thrombosis and colorectal cancer development. In the January 2019 edition of PCAN, Liu and colleagues describe a novel potential decreased risk of autoimmune diseases with ADT. This is intriguing for several reasons:

Androgen Deprivation Therapy for Prostate Cancer and the Risk of Autoimmune Diseases - Full Text Article

Background - Androgen deprivation therapy (ADT) has been a mainstay of treatment for advanced prostate cancer (PCa), but limited studies have been performed to investigate the association between ADT and autoimmune diseases.

Performance of PCA3 and TMPRSS2: ERG Urinary Biomarkers in Prediction of Biopsy Outcome in the Canary Prostate Active Surveillance Study (PASS)

Background - For men on active surveillance for prostate cancer, biomarkers may improve the prediction of reclassification to a higher grade or volume cancer. This study examined the association of urinary Prostate Cancer Gene 3 (PCA3) and TMPRSS2:ERG (T2:ERG) with biopsy-based reclassification.

The Association of Urinary PCA3 and TMPRSS2:ERG with Biopsy-based Reclassification

The dilemma that resulted from the widespread use of serum prostate-specific androgen (PSA) testing was the identification of a significant number of men with indolent pure red cell aplasia (PrCa). After a significant period of overtreatment, the implementation of active surveillance (AS) has partly solved that issue. However, 25-50 % of AS patients will undergo an intervention. The follow up is rather invasive including serum PSA and repeat biopsies.

Models based on clinical parameters can be used to predict repeat biopsy outcome, yet improved methods to asses the risk to predict adverse pathology are needed. Candidate tools are improved imaging and biomarkers. In the past decade, molecular urine biomarkers were introduced in clinical practice (i.e.Prostate Cancer Gene 3 (PCA3) and TMPRSS2 erg).

The Use of 68Ga-PET/CT PSMA to Determine Patterns of Disease for Biochemically Recurrent Prostate Cancer Following Primary Radiotherapy

Background - 68Ga-PET/CT PSMA scan is being increasingly used for the staging of biochemically recurrent disease. Early identification of recurrent disease after radiotherapy is important in considering suitability for early salvage therapy to improve prognosis. The aim is to identify patterns of suspected prostate cancer recurrence in relation to post-radiotherapy PSA levels, especially below the accepted Phoenix definition of PSA failure (PSA nadir + 2).

Determining Patterns of Disease for Biochemically Recurrent Prostate Cancer by Using 68Ga-PET/CT PSMA - Editorial

This Australian study is the largest published experience of the use of Ga68 PSMA PET/CT imaging in the context of previous primary radiotherapy for prostate cancer. 

This study evaluated 276 men who had undergone a Ga68 PSMA PET/CT for which the majority had PSA biochemical failure (mean PSA 3.60 ng/mL, range 0.01–83 ng/mL). Overall, 86% (239/276) men had positive scans with morethan half having evidence of local disease recurrence. Clearly, there are some limitations given that in the relatively small number of 33 men who underwent a prostate biopsy, only 28 men (85%) were confirmed to histological recurrence. Lymph node metastases were identified in 122 men (44%) of which 49 men had positive lymph nodes that were located outside the template for an extended pelvic lymph node dissection. Bone metastases were documented in 50 men.
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