Current opinion in urology
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The recent Food and Drug Administration approval of sipuleucel-T for metastatic castration-resistant prostate cancer and of the anticytotoxic T-lymphocyte antigen 4 antibody (Ipilimumab) for metastatic melanoma has led to a renewed interest in immunotherapy for prostate and other cancers. Ipilimumab has entered phase III testing for prostate cancer, as has a viral-based anti-prostate-specific antigen vaccine (ProstVac-VF). Complementing these phase III studies are a number of innovative phase II studies, aimed at bringing immunotherapy forward in the setting of less advanced disease, as well as a number of interesting trials combining immunotherapy with conventional therapy for prostate cancer. ⋯ Immunotherapy for prostate cancer represents an attractive treatment approach, with the currently available agent sipuleucel-T providing a significant survival benefit without appreciable toxicity. Novel approaches to improve the efficacy of this and other immune-active agents are currently under evaluation.
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Active surveillance has evolved to become a standard of care for favorable-risk prostate cancer. This article is a summary of the rationale, method, and results of active surveillance beginning in 1995 with the first prospective trial of this approach. ⋯ We observed a very low rate of prostate cancer mortality in an intermediate time frame. Among the one-third of patients who were reclassified as higher risk and retreated, PSA failure was relatively common. However, other cause mortality accounted for almost all of the deaths. Further studies are warranted to improve the identification of patients who harbor more aggressive disease in spite of favorable clinical parameters at diagnosis.
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Overdiagnosis has become a major problem in medicine in general and cancer in particular. This is a summary of this problem. ⋯ Reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.
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In this review, we summarize the recent advances in modern imaging, particularly multiparametric (mp) MRI and its role in the selection and monitoring of patients on active surveillance. ⋯ Upon confirmation of these results, MRI may be used to better select patients for active surveillance inclusion. Incorporation of mp-MRI into active surveillance selection criterias for patients with low-risk prostate cancer can reduce the number of patients reclassified at subsequent biopsies because of better initial prognosis evaluation. In addition to additional cost, MRI requires a highly skilled team to obtain information adequate to drive clinical decisions.
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To define the link between metabolic syndrome (MetS) and sexual dysfunction. The global epidemic of obesity and diabetes has led to a striking increase in the number of people afflicted with the MetS. The MetS consists of a myriad of abnormalities, including central obesity, glucose intolerance, dyslipidemia, and hypertension. ⋯ Few randomized studies exist to guide treatment of sexual dysfunction related to MetS; rather, most studies have been observational in nature. Medical therapy has formed the mainstay of treatment.