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Management of Prostate Cancer: Advances and Controversies

2004 Edition, October 27, 2004

Complete Document

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Active, Most Current

Additional Comments:
ISBN: 978-0-8247-5441-9
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Product Details:

  • Revision: 2004 Edition, October 27, 2004
  • Published Date: October 27, 2004
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 422
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Prostate-Specific Antigen (PSA) testing to detect patients at risk for disease has resulted in increased prostate cancer detection, as well as significant stage migration, with a significant increase in the new cases detected representing patients with localized disease. Additionally, PSA has permitted monitoring of disease progression in treated patients, permitting a greater clarity in efficacy of specific therapeutic interventions.

Associated with the therapeutic advances of the past decade is controversy. The subjects about which uncertainty remain include the best treatment for localized disease and include the comparative efficacy of radical prostatectomy—anatomic radical retropubic prostatectomy (ARRP), radical perineal prostatectomy (RP), laparoscopic radical prostatectomy (LRP), or robot-assisted laparoscopic radical prostatectomy (RARP)—and definitive radiation (three-dimensional conformal radiation, brachytherapy combined modality radiation, or intensity modulated radiation therapy) or Cyroablation. Further, the benefits of postprostatectomy radiation in high-risk, localized disease and its timing (adjuvent or salvage) is not defined. Despite the observation that androgen deprivation (AD) was demonstrated to be of significant clinical benefit for men with advanced prostate cancer over sixty years ago, the timing of AD for PSA progression as the first indication of failure of local treatment remains a major controversy.

The role of ‘‘novel therapies'' for patients with PSA progression in the absence of imageable metastatic disease may represent an opportunity for experimental therapeutics and ‘‘drug discovery.'' In a disease in which systemic metastasis leads to death from disease, and where no curative therapy has been defined, it is appropriate to examine future perspectives.

Many of the issues of clinical management are contentious and likely are consequent to our inability or unwillingness to subject some of the important clinical questions to well-designed, adequately powered, randomized, and controlled clinical trials.

In the attempt to provide clarity for clinicians, acknowledged leaders in their field and advocates for their therapeutic approach have provided a careful review of their patient selection criteria, staging procedures, therapy, and outcomes. To provide understanding and definition in areas of controversy, a ‘‘point–counterpoint'' approach has been taken for each presentation with thoughtful critical reflection by acknowledged experts in the field. It is hoped that this volume will be timely, edifying, and of value in aiding clinicians to select an individualized treatment option for the patients for whom they bear ‘‘the responsibility of care.''