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The presence of lymph node metastases is one of the most important prognostic factors after radical prostatectomy. However, not all patients with node-positive prostate cancer have the same risk of cancer-specific death and stratification can help identify those patients with few lymph node metastases who could expect a better prognosis.
Serum PSA testing remains controversial as the data regarding its utility are conflicting. However, a recent study adds to the growing body of evidence supporting its usefulness in middle-aged men, especially in the determination of the long-term risk of metastasis and death from prostate cancer.
Radiotherapy is not a well-established option for men with intermediate-risk prostate cancer and further substratification of these patients could help to guide treatment decisions. Researchers have developed a new risk-classification system for intermediate-risk patients undergoing dose-escalated external-beam radiation therapy, but how effective is this system?
A cancer in its entirety might be thought of as an organ comprising many parts. Thus, potential therapeutic targets for prostate cancer exist in the nonepithelial components of the tumour. In this Review, Sluka and Davis discuss the targets and pathways of the microenvironment that could be targeted for treatment of prostate cancer.
Here, Sridhar and co-authors describe the applications of robotic technology in combination with image guidance in the surgical, including organ preserving, management of prostate cancer. Although several of these platforms have been developed in the diagnostic setting, their use in surgical and nonexcisional interventions is increasing.
Fertility preservation is an essential consideration of cancer management. Katz et al. outline the issues related to infertility for both prepubertal and postpubertal male patients with cancer and review the currently available approaches of fertility preservation. Experimental strategies that are under investigation for fertility preservation both before and after cancer treatment are also discussed.
In this Review, Van der Kwast and Roobol consider the risk of overdiagnosis of PSA-detected prostate cancers and reassess the pathological definition of insignificant prostate cancer based on an extensive literature review.
In this Perspectives article, Centenera et al. chronicle the development of ex vivoculture models that utilize tumour material from men with prostate cancer and discuss the advantages, limitations, and potential applications of these systems to expedite the evaluation of novel drugs for the treatment of prostate cancer.
