Bone and prostate cancer cell interactions in metastatic prostate cancer

The interplay in prostate cancer bone metastases between the 'seed' (the prostate cancer cells) and the 'soil' (the bone microenvironment) has been increasingly recognized as integral to the remarkable tropism for bone shown by prostate cancer. Increasing research into this area is elucidating the mechanisms involved in this complex 'cross-talk'. Recent developments, including the use of bisphosphonates in metastatic disease, highlight the important role of bone cells in the development and progression of metastatic prostate cancer. We review the current reports emphasising these possible mechanisms and indicating possible factors for future treatment directions.     

Advanced prostate cancer

Both the definition and therapy of advanced prostate cancer is challenging. The advanced prostate cancer session at "The 8th International Prostate Cancer Update" had discussions which tried to answer the questions of management of these patients who either present with advanced disease or fail any form of therapy for clinically confined prostate cancer. This article provides an overview of therapeutic options: monotherapy and minimal androgen blockade options versus maximal androgen blockade, adjuvant therapy, intermittent therapy and timing of therapy as well as chemotherapy when all these measures fail. The impact of these therapies on progression as well as quality of life is reviewed.     

Local-regional prostate cancer

Historically, locally advanced prostate cancer was defined clinically with the digital rectal exam (DRE). With the introduction of screening prostate specific antigen (PSA), further pretreatment stratification of locally advanced prostate cancer was possible. Tables and nomograms have been developed to predict pathologic staging prior to therapy. By combining DRE, PSA, Gleason score, and clinical staging, a patient's probability of treatment failure is estimated, thereby stratifying the risk of locally advanced disease. Pretreatment PSA velocity (PSAV) and PSA doubling time (PSADT) will likely continue to play a role in defining locally advanced prostate cancer. Imaging studies, especially high-field strength pelvic MRI, may provide additional information regarding the presence of locally advanced prostate cancer. In the future, molecular or genetic testing may permit further stratification of patients with locally advanced disease, who are at variable risk for recurrence and death after treatment. Future trials will need to assess the utility of multimodality treatments for patients in the diverse classification of locally advanced prostate cancer.     

Metastatic prostate cancer

Summary For decades the palliation of prostate cancer has centered around hormonal manipulation using orchiectomy or estrogen administration. Newer modalities, such as LHRH agonists and nonsteroidal antiandrogens, are now available. Patients receiving combination therapy enjoy superior progression-free and median survival rates.     

Hormone-refractory prostate cancer

Hormone-refractory prostate cancer is an advanced stage of the metastatic disease; it has a poor prognosis and a short median survival, about 9 to 18 months. The current article is based on a literature review regarding the prognostic factors and medical treatments, with a focus on recent advances in chemotherapy. With the use of docetaxel that increases the median survival of this disease and improves the symptoms, new clinical protocols have been developed, with promising results; these protocols propose a combination with calcitriol or antiangiogenic agents. Supportive care is also an important part of the treatment due to the high level of bone involvement and its consequences. Such recent advances constitute a real progress in the management of prostate cancer, namely the pharmacological combinations with a promising efficacy and little toxicity.     

Defining prostate cancer risk before prostate biopsy

Prostate cancer is the most commonly diagnosed cancer in men. At present, patients are selected for prostate biopsy on the basis of age, serum prostate specific antigen (PSA), and prostatic digital rectal examination (DRE) findings. However, due to limitations in the use of PSA and DRE, many patients undergo unnecessary prostate biopsy. A further problem arises as many patients are diagnosed and treated for indolent disease. This review of the literature highlights the strengths and weaknesses of existing methods of prebiopsy risk stratification and evaluates promising serum, urine, and radiologic prostate cancer biomarkers, which may improve risk stratification for prostate biopsy in the future.     

Echograms of prostate cancer: inside echo patterns of localized prostate cancer

Transrectal ultrasonography has been considered useful for the diagnosis of prostate cancer. There have been few reports on localized cancer in the prostate diagnosed by echogram. In this paper, we discuss echograms of the prostate in cases of localized cancer, advanced cancer and well-controlled cancer. Hypoechoic lesions seem to suggest prostate cancer.     

Immunotherapy for prostate cancer

Whereas androgen deprivation and chemotherapy have become the cornerstone of therapy for advanced prostate cancer, novel therapies are being developed that may expand upon currently available treatments. The identification of antigens expressed by prostate tissue and/or prostate cancer that are recognized by T cells or antibodies creates opportunities to develop novel immunotherapeutic approaches including tumor vaccines. Proteins expressed in prostate cancer including prostate-specific antigen, prostatic acid phosphatase, and prostate membrane antigen have been used as immunologic targets for immunotherapy. Moreover, innovations in cancer genomics and proteomics also will aid in the identification of immunologic targets. Emerging trials have demonstrated that immunotherapy may not only generate immune responses in patients, but also clinical responses. Future studies will be directed at capitalizing on these findings.     

前列腺癌的放射治疗

在前列腺癌的治疗中,放疗具有重要的作用。早期前列腺癌放疗可达到根治目的,疗效与前列腺癌根治术相近。局部晚期前列腺癌的治疗则以放疗为主,已远处转移的前列腺癌放疗也可取得减轻症状,改善生存质量的目的。放疗具有疗效好,适应证广,并发症相对少和治疗后患者生存质量高等优点。放疗的外照射一、常规外照射前列腺的放疗因20世纪50年代引入兆伏射线治疗技术后,已成为前列腺癌治疗的主要方法之一。Kuban等报告652例前列腺癌体外照射的疗效,10年无病生存率T1b66%,T2a57%,T3b、T3c48%,T3-429%;生化无病生存率(biochemical dis-ease-free su…     

Modeling prostate cancer distributions

Objectives. To use computer-assisted three-dimensional (3D) reconstruction to study cancer distribution in the prostate. The distributions have been determined using data from 81 prostates surgically removed because of cancer.Methods. The pattern of distribution was determined by reshaping (morphing) all prostates in the same size category (small, medium, large) into the same shape and by overlayering the 3D distribution of all cancers into a “unit prostate.” Also, the pattern of 3D distribution was defined for small, medium, and large volume cancers.Results. The study yielded a clear, visual “scatter diagram” representation of the statistics of prostate cancer distribution. It confirmed previous general knowledge: small cancers are mainly found in the lower one third and principally in the dorsolateral part of the gland.Conclusions. This report is part of the investigations preliminary to establishing an optimal protocol for needle biopsy of prostate cancer.     

Proteomics in prostate cancer

PURPOSE OF REVIEW: State-of-the-art proteomics technologies are currently being assessed for utility in the study of prostatic malignancy. This review aims to provide background information on the current proteomics techniques employed in prostate cancer research, recent reports showing the potential application of proteomics in urological practice, and the future direction of proteomics in prostate cancer research and management. RECENT FINDINGS: Proteomic profiling of serum as a diagnostic tool and a platform for biomarker discovery in prostate cancer continues to draw favorable attention as well as close scrutiny as technological enhancements and multi-center study results are reported. In-vitro studies on prostate cell lines provide positive proof-of-principle results. The application of proteomics to query prostate tissue specimens yields novel prostate cancer biomarkers requiring further validation. The integration of proteomics with immunology also yields promising findings that may translate into clinically relevant biological assays. SUMMARY: The study of proteomics is an emerging research field, and current studies continue to display potential future usage in prostate cancer management. Succeeding scientific investigations will probably yield new diagnostic and prognostic tools for prostate cancer, provide insights into its underlying biology, and contribute to the development of novel treatment strategies.