Current opinion in urology
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To inform readers on the ongoing activities of the Prostate cancer Research International: Active Surveillance (PRIAS) study in the light of current findings and research problems on active surveillance worldwide. ⋯ The PRIAS study is a rapidly growing registry for active surveillance of low-risk prostate cancer. The study is conducted worldwide, facilitated by an electronic Web-based decision tool with password-restricted access for physicians. Inclusion and monitoring is performed according to protocol. Over 2000 men have been included from over 100 participating centres in 17 countries in four continents. The study was initiated in December 2006. Risk reclassification on repeat biopsy during follow-up has occurred in 27% of biopsied men, although a switch towards active therapy has been performed in 22% of the total cohort.
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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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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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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.