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Prostate Cancer Screening and Surveillance Continue to Evolve

Gina Columbus @ginacolumbusonc
Published: Thursday, Mar 29, 2018

William K. Kelly, DO
William K. Kelly, DO
Developments in screening and localized treatment for prostate cancer are two components that have been part of the prostate cancer field’s transformation, explains William K. Kelly, DO, adding that treatment of these patients must involve a multidisciplinary approach. “Prostate cancer is not 1 disease; it is [made up of] multiple diseases and it takes multiple people to treat a patient,” Kelly said.

on Prostate Cancer, Kelly, professor, director, Division of Solid Tumor Oncology, Thomas Jefferson University Hospital, discussed the evolving imaging techniques and emerging therapeutic approaches in prostate cancer.

OncLive: What are some notable advancements in prostate cancer?

Kelly: It starts off with localized disease; we are really starting to rethink what we can do with [that setting]. In the meeting, Dr Edouard Trabulsi introduced the fact that, even in patients with locally advanced disease, there is a role for local control of tumor. We forgot that before because, in all of the other tumor types, we have maximized local control of the tumor.

Years ago, we swung away from that. Anybody who had a locally advanced prostate cancer we shied away from [doing] local disease control on them. There is a swing backwards—even in those patients who had micrometastatic disease. We are now doing surgery in those patients because it does give optimal local control. However, it also brings up the multimodality approach that is approaching with prostate cancer.

Looking at localized prostate cancer, what are your thoughts on the use of active surveillance, and especially how the USPSTF took a step back and then a step forward with its recommendations?

When you see a task force go back and forth, that means there are limited data to guide them; there are not black-and-white data, it’s really gray. There are a lot of things that go into a decision about active surveillance—not only about the tumor type, but it is based on anywhere from the pathology to the genomics to other characteristics. We have to also include the patient preferences because they actually drive [the decision]. We need to understand patient preferences and their comorbidities. 

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