Rethinking the Prostate Cancer Paradigm in the Urology Community

Raoul S. Concepcion, MD, FACS
Published: Saturday, Aug 04, 2018
Raoul S. Concepcion, MD, FACS

Raoul S. Concepcion, MD, FACS

As we are all keenly aware, there is not a day that passes when our email inbox doesn’t include news of a genetic discovery that contributes to the ever-expanding body of knowledge in the prostate cancer world. The practicing urologist has to decipher this maelstrom of data, somehow gain a basic understanding of its significance, and determine its clinical utility. Clearly, the world of prostate cancer management has taken on degrees of complexity that none of us ever imagined. We are well past the days of bilateral orchiectomy.

These scenarios highlight the need for clinicians to rethink and challenge their traditional ways of practice and educational needs. In particular, it is imperative that we gain a better understanding of the molecular drivers that result in progression of disease. We will continue to have a cascade of discovery and new information from the many scientists working in this field. To better serve our patients and avoid clinging to tradition, we, as clinical scientists, need to continue to evolve our thinking and approach to patient care.

References

  1. Yu EY, Miller K, Nelson J, et al. Detection of previously unidentified metastatic disease as a leading cause of screening failure in a phase III trial of zibotentan versus placebo in patients with nonmetastatic, castration resistant prostate cancer. J Urol. 2012;188(1):103-109. doi: 10.1016/j.juro.2012.03.008.
  2. Kantoff PW, Higano CS, Shore ND, et al; IMPACT Study Investigators. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med. 2010;363(5):411- 422. doi: 10.1056/NEJMoa1001294.
  3. Sartor O, Coleman R, Nilsson S, et al. Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial. Lancet Oncol. 2014;15(7):736-746. doi: 10.1016/S1470-2045(14)70183-4.
  4. Hussain M, Fizazi K, Saad F, et al. PROSPER: a phase 3, randomized, double-blind, placebo (PBO)-controlled study of enzalutamide (ENZA) in men with nonmetastatic castration-resistant prostate cancer (M0 CRPC). J Clin Oncol. 2018;36(suppl 6S; abstr 3). ascopubs.org/doi/abs/10.1200/JCO.2018.36.6_suppl.3.
  5. Smith MR, Saad F, Chowdhury S, Oudard S, et al; SPARTAN Investigators. Apalutamide treatment and metastasis-free survival in prostate cancer. N Engl J Med. 2018;378(15):1408-1418. doi: 10.1056/NEJMoa1715546.

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