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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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.