The prostate cancer dilemma selecting patients for active surveillance, focal ablation and definitive therapy ; [extras online

Stone Nelson N. (ed.) The Prostate Cancer Dilemma - Selecting Patients for Active Surveillance, Focal Ablation and Definitive Therapy 2016 [pdf 213sc 206c. 7.10mb]This text provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in early prostate cancer. The book reviews new data about genetic markers, transperineal mapping biopsy and mpMRI, how to apply each of these technologies in patients with elevated PSA, when a prior prostate biopsy performed by the standard TRUS method is negative and in cases where low risk disease is already diagnosed, how to differentiate those men who might harbor more aggressive disease from those who do not. Over 75% of newly diagnosed prostate cancer meets the criteria for low risk disease which has created a dilemma for both patients and clinicians. Active surveillance programs have been initiated and are reviewed. How the new technologies impact surveillance programs is addressed. Clinical stage designation is updated and a new intra-prostatic staging system is discussed. Prostate biopsy techniques utilizing transrectal ultrasound, transperineal mapping, elastography and mpMRI are compared. Finally, utilization of this new technology in the application of focal therapy is reviewed.The Prostate Cancer Dilemma will serve as a very useful resource for physicians and researchers dealing with, and interested in this challenging malignancy. Chapters are written by experts in their fields and include the most up to date scientific and clinical information as well as links to procedural video content. Preface 6 Contents 10 Contributors 12 Editor’s Biography 14 Part I : Diagnosis 16 Chapter 1: History of Prostate-Specific Antigen, from Detection to Overdiagnosis 17 The Pursuit and Discovery of PSA 18 The Golden Years of PSA Testing 20 The Trials and Tribulations of PSA Screening 21 The Effects of Screening with PSA and Overdiagnosis 25 The Evolution of Prostate Tumor Markers 26 References 26 Chapter 2: Pathology of Prostate Cancer: What Has Changed in the Last 30 Years 31 Introduction 31 Histopathology of Prostate Cancer and Evolving Concepts in Grading 32 Multifocality and Heterogeneity 37 The Role of Pathological Examination of the Prostate Biopsy in Management Decisions 38 Advances in Molecular Pathology: The New Frontier 41 Conclusion 42 References 42 Chapter 3: Clinical Risk Prediction Tools for Prostate Cancer: TNM to CAPRA—Should Risk Be Redefined? 46 Introduction: Rationale for Consistent Risk Stratification in Research and Clinical Practice 46 Principles of Instrument Evaluation 47 TNM Staging 49 Epstein Criteria 50 Risk Groupings 51 D’Amico 51 AUA and NCCN Risk Groupings 52 Nomograms 53 UCSF-CAPRA Score 54 CAPRA-S 57 J-CAPRA 58 Future Directions: Novel Biomarkers, Gene Expression Testing, Advanced Imaging 59 Conclusion 61 References 61 Chapter 4: TRUS Biopsy: Is There Still a Role? 66 Introduction 66 Principles of Evaluation 67 Rationale for Systematic Biopsy 67 Sampling Limitations of Systematic Biopsy 68 Procedure-Related Complications 69 Measures to Improve Biopsy 70 Rectal Swab Cultures 70 Refined Selection 71 Biomarkers for Biopsy Selection 71 Improved US Imaging Techniques 72 Power Doppler Ultrasound 72 Contrast-Enhanced Ultrasound 72 Elastography 72 Improving Negative Predictive Value 73 MR Fusion Biopsy Techniques 73 Future Directions 75 Conclusions 75 References 76 Chapter 5: Transperineal Biopsy Technique 81 Introduction 82 Transperineal Prostate Mapping Biopsy Technique 82 Rationale for TPMB 86 Validation of TPMB as a More Accurate Prostate Cancer Detection Technique 87 Comparison of TPMB to TRUS Biopsy 87 Morbidity Associated with TPMB 90 Conclusions 91 References 92 Chapter 6: 3D Biopsy: A New Method to Diagnose Prostate Cancer 95 Introduction 95 3D Mapping Software 96 Other Considerations 102 Conclusions 102 References 103 Chapter 7: Elastography: Can It Improve Prostate Biopsy Results? 104 Introduction 104 Transrectal Ultrasound and Elastography 106 Technique of Transperineal Biopsy and Elastography 110 Results of Transperineal Template-Guided Biopsy with Elastography 114 Conclusions 115 References 116 Chapter 8: Multiparametric MRI of the Prostate as a Tool for Prostate Cancer Detection, Localization, and Risk Assessment 118 Introduction 118 Limitations of Contemporary Systematic Biopsy Technique and Methods for Prostate Cancer Detection 118 Multiparametric MRI: Image Sequences 119 T2-Weighted Imaging 119 Diffusion-Weighted Imaging 120 Perfusion Imaging 121 Accuracy in Detection/Performance Characteristics 121 MRI Suspicion Score 122 Negative Predictive Value of MRI 122 Correlation of MRI with Surgical Pathology: Disease Localization 125 Outcomes of MRI-Targeted Biopsy in Clinical Practice 127 Among Men with No Previous Biopsy 129 Among Men with Previous Negative Biopsy 129 Among Men with Low-Risk Cancer 130 Limitations of MRI-Targeted Biopsy 130 Technique of MRI-Targeted Biopsy 131 Visual Estimation MR-Targeted TRUS Biopsy 131 Software Co-registered MRI-Targeted TRUS Biopsy 131 In Bore MRI-Guided Biopsy 132 Comparative Studies 133 Conclusions 133 References 134 Chapter 9: Genomic Markers 138 Introduction 138 Who Is Best Suited for an Initial Biopsy? 139 PSA 139 Prostate Health Index (Phi) 140 4KScore 141 Who Can Safely Avoid a Repeat Biopsy? 141 PCA3 141 ConfirmMDx 142 PCMT 142 PTEN 142 Who Should Undergo Interventional Therapy or Consider Active Surveillance? 143 Oncotype DX® 143 Prolaris® 143 Decipher® 144 ProMark 144 Markers to Assist Post-prostatectomy Evaluation 145 Clinical Utility and Value of Biomarkers 145 Conclusion 146 References 146 Part II : Treatment 149 Chapter 10: Current Status of Clinical Trials in Active Surveillance 150 Background 150 Metastatic Potential of Low-Risk Prostate Cancer 151 Active Surveillance Technique 155 Ongoing Clinical Trials 157 Conclusion 157 References 158 Chapter 11: Focused Targeted Therapy in Prostate Cancer 162 Introduction 162 Patient Selection 165 Technique 167 Follow-Up 169 Future Trends and Challenges 169 References 171 Chapter 12: Technologies and Methods in Primary Ablation with Focal Therapy 176 Introduction 176 General Issues for Optimizing Focal Therapy 177 Patient Population for Focal Therapy 177 Patient Staging for Focal Therapy 179 The Immune Response Associated with Tumor Ablation 182 Technical Considerations for Optimizing Focal Therapy Using Cryoablation 183 The Technologies of Tumor Ablation for Focal Therapy 184 Cryoablation 184 Irreversible Electroporation (IRE) 186 Laser Ablation 188 Focal Radiation Therapy 189 Photodynamic Therapy 190 High Intensity Focused US-HIFU 190 Conclusion 192 References 192 Chapter 13: Multiparametric MRI (mpMRI): Guided Focal Therapy 195 Introduction 195 Cryotherapy 198 High-Intensity Focal Ultrasound 200 Laser Interstitial Therapy 201 Future Directions 204 Conclusion 204 References 205 Conclusions 209 Index 210 This comprehensive text provides a complete description of the newest technologies to diagnose and manage the most common prostate cancer diagnosed today: low risk disease. The book reviews new data about genetic markers, transperineal mapping biopsy and mpMRI, how to apply each of these technologies in patients with elevated PSA, when a prior prostate biopsy performed by the standard TRUS method is negative, and, in cases where low risk disease is already diagnosed, how to differentiate those men who might harbor more aggressive disease from those who do not. Over 75% of newly diagnosed prostate cancer meets the criteria for low risk disease which has created a dilemma for both patients and clinicians℗lbecause of the inaccuracy of the standard TRUS biopsy method. Active surveillance programs have been initiated and are reviewed. How the new technologies impact surveillance programs℗lare℗laddressed. Clinical stage designation is updated and a new intra-prostatic staging system is discussed. Prostate biopsy techniques utilizing transrectal ultrasound, transperineal mapping, elastography and mpMRI are compared. Finally, utilization of these℗lnew technologies℗lin the application of focal therapy is reviewed.℗l℗l℗l℗l℗l℗l The Prostate Cancer Dilemma℗lwill serve as a valuable resource for clinicians, surgeons and researchers with an interest in early prostate cancer.℗lChapters are written by experts in their fields and include the most up-to-date scientific and clinical information as well as links to procedural video content This comprehensive text provides a complete description of the newest technologies to diagnose and manage the most common prostate cancer diagnosed today: low risk disease. The book reviews new data about genetic markers, transperineal mapping biopsy and mpMRI, how to apply each of these technologies in patients with elevated PSA, when a prior prostate biopsy performed by the standard TRUS method is negative, and, in cases where low risk disease is already diagnosed, how to differentiate those men who might harbor more aggressive disease from those who do not. Over 75% of newly diagnosed prostate cancer meets the criteria for low risk disease which has created a dilemma for both patients and clinicians because of the inaccuracy of the standard TRUS biopsy method. Active surveillance programs have been initiated and are reviewed. How the new technologies impact surveillance programs are addressed. Clinical stage designation is updated and a new intra-prostatic staging system is discussed. Prostate biopsy techniques utilizing transrectal ultrasound, transperineal mapping, elastography and mpMRI are compared. Finally, utilization of these new technologies in the application of focal therapy is reviewed. The Prostate Cancer Dilemma will serve as a valuable resource for clinicians, surgeons and researchers with an interest in early prostate cancer. Chapters are written by experts in their fields and include the most up-to-date scientific and clinical information as well as links to procedural video content This text provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in early prostate cancer. The book reviews new data about genetic markers, transperineal mapping biopsy and mpMRI, how to apply each of these technologies in patients with elevated PSA, when a prior prostate biopsy performed by the standard TRUS method is negative and in cases where low risk disease is already diagnosed, how to differentiate those men who might harbor more aggressive disease from those who do not. Over 75% of newly diagnosed prostate cancer meets the criteria for low risk disease which has created a dilemma for both patients and clinicians. Active surveillance programs have been initiated and are reviewed. How the new technologies impact surveillance programs is addressed. Clinical stage designation is updated and a new intra-prostatic staging system is discussed. Prostate biopsy techniques utilizing transrectal ultrasound, transperineal mapping, elastography and mpMRI are compared. Finally, utilization of this new technology in the application of focal therapy is reviewed. __The Prostate Cancer Dilemma__ will serve as a very useful resource for physicians and researchers dealing with, and interested in this challenging malignancy. Chapters are written by experts in their fields and include the most up to date scientific and clinical information as well as links to procedural video content. Front Matter....Pages i-xiv Front Matter....Pages 1-1 History of Prostate-Specific Antigen, from Detection to Overdiagnosis....Pages 3-16 Pathology of Prostate Cancer: What Has Changed in the Last 30 Years....Pages 17-31 Clinical Risk Prediction Tools for Prostate Cancer: TNM to CAPRA—Should Risk Be Redefined?....Pages 33-52 TRUS Biopsy: Is There Still a Role?....Pages 53-67 Transperineal Biopsy Technique....Pages 69-82 3D Biopsy: A New Method to Diagnose Prostate Cancer....Pages 83-91 Elastography: Can It Improve Prostate Biopsy Results?....Pages 93-106 Multiparametric MRI of the Prostate as a Tool for Prostate Cancer Detection, Localization, and Risk Assessment....Pages 107-126 Genomic Markers....Pages 127-137 Front Matter....Pages 139-139 Current Status of Clinical Trials in Active Surveillance....Pages 141-152 Focused Targeted Therapy in Prostate Cancer....Pages 153-166 Technologies and Methods in Primary Ablation with Focal Therapy....Pages 167-185 Multiparametric MRI (mpMRI): Guided Focal Therapy....Pages 187-200 Back Matter....Pages 201-206