Prostate cancer is heterogeneous disease and the most commonly diagnosed non-cutaneous malignancy in men. Advanced-stage prostate cancer is often treated with androgen-deprivation therapy, which is associated with decreased bone mineral density and an increased risk of osteoporotic fragility fractures. In the past 5 year many new targeted agents in the metastatic setting have been approved, and the remit of bone-targeted agents for the management of advanced-stage prostate cancer has gathered momentum. This collection will critically discuss the role of surgery, radiotherapy, and hormonal therapy in men with high-risk disease based on the available trial data. In patients with low-risk disease, the role of active surveillance and focal therapy is covered together with the challenges of over diagnosis and under diagnosis in men with small-volume unpredictable disease. Other topics include multiparametric MRI for detection, staging and treatment planning, as well as the challenges of managing elderly men with prostate cancer.
EDITORIAL
Closing the controversies gap in prostate cancer?
Lisa Hutchinson
doi:10.1038/nrclinonc.2014.87
Nature Reviews Clinical Oncology 11, 299 (2014)
NEWS & VIEWS
Prostate cancer: A new look at prostate cancer treatment complications
Matthew R. Cooperberg
doi:10.1038/nrclinonc.2014.58
Nature Reviews Clinical Oncology 11, 304-305 (2014)
Prostate cancer: Muddying the waters by overlooking treatment modality
Ronald D. Ennis & S. Aidan Quinn
doi:10.1038/nrclinonc.2014.52
Nature Reviews Clinical Oncology 11, 305-307 (2014)
REVIEWS
High-risk prostate cancer—classification and therapy
Albert J. Chang, Karen A. Autio, Mack Roach III & Howard I. Scher
doi:10.1038/nrclinonc.2014.68
Nature Reviews Clinical Oncology 11, 308-323 (2014)
High-risk prostate cancer includes a heterogeneous group of patients with a range of prognoses, with some that can be fatal. The optimal management of this patient subgroup is evolving. We critically evaluate the existing literature focused on defining the high-risk population, the management of patients with high-risk prostate cancer, and future directions to optimize care.
Management of low risk prostate cancer—active surveillance and focal therapy
Laurence Klotz & Mark Emberton
doi:10.1038/nrclinonc.2014.73
Nature Reviews Clinical Oncology 11, 324-334 (2014)
Low-risk prostate cancer is diagnosed in nearly half of men undergoing screening. About a third of these men harbour high-grade cancer that is not detected by conventional systematic biopsy. Should we treat men with low-risk prostate on the basis that it might be of higher grade that it seems? Should we treat it to prevent future progression to a more aggressive form of cancer? What are the nonivasive treatment options for these men? In this Review, Mark Emberton and Laurence Klotz discuss the two current choices to manage low-risk prostate cancer: active surveillance and focal therapy.
Managing bone metastases and reducing skeletal related events in prostate cancer
Benjamin A. Gartrell & Fred Saad
doi:10.1038/nrclinonc.2014.70
Nature Reviews Clinical Oncology 11, 335-345 (2014)
Metastatic prostate cancer and its treatment are associated with skeletal complications, which cause some of the most distressing symptoms as well as being associated with poor survival. This Review addresses the therapeutic options that exist to treat the morbidity associated with skeletal-related events.
Multiparametric MRI in prostate cancer management
Linda M. Johnson, Baris Turkbey, William D. Figg & Peter L. Choyke
doi:10.1038/nrclinonc.2014.69
Nature Reviews Clinical Oncology 11, 346-353 (2014)
The combination of conventional anatomical MRI and functional magnet resonance sequences–known as multiparametric MRI (mp-MRI) is emerging as an accurate tool for identifying clinically relevant tumours. This Review discusses the role of mp-MRI in the detection, staging, and treatment planning of prostate cancer.
Challenges of managing elderly men with prostate cancer
Gautam G. Jha, Vidhu Anand, Ayman Soubra & Badrinath R. Konety
doi:10.1038/nrclinonc.2014.71
Nature Reviews Clinical Oncology 11, 354-364 (2014)
Men who are elderly constitute a unique patient group who are often denied effective treatments for fear of toxicity or diminished efficacy or are unduly subjected to intense therapies despite multiple comorbidities and indolent disease. This Review highlights the importance of individualizing therapy based on the comorbidities, functional status, nutritional status and aggressiveness of disease rather than age alone.
Evolution of androgen receptor targeted therapy for advanced prostate cancer
Yien Ning Sophia Wong, Roberta Ferraldeschi, Gerhardt Attard & Johann de Bono
doi:10.1038/nrclinonc.2014.72
Nature Reviews Clinical Oncology 11, 365-376 (2014)
Over 70 years ago, Huggins and Hodges discovered that prostate cancer depends on androgens. Since then, targeting the androgen receptor signaling pathway has remained the backbone of prostate cancer treatment. This Review discusses the past, present and future of androgen receptor targeting therapeutics.
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