Volume 11 Issue 6, June 2014

A recent population-based analysis from Nam and coauthors found high complication rates occurring within 5 years of prostatectomy or radiation therapy interventions for prostate cancer. These findings emphasize that treatments should be reserved for men at significant risk of disease progression, and perhaps further concentrated into higher-volume centres of excellence.

Although large, population-based studies are a powerful tool for elucidating real-world outcomes and uncommon events, confounding factors must be tightly controlled. A recent report from Nam and coauthors has neglected such a confounding factor and, therefore, stands in need of further study to clarify the findings.

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.

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 than 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.

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.

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.

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.

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.

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-Vol. 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.