This handbook is written to provide a "bedside" reference for the practicing oncologist, as well as a compendium of prostate cancer information useful to urologists, clinical researchers and educators, medical students and nurses. The book is written in outline format to provide the reader with quick and easy access to information on the major trials, landmark articles, and reviews in prostate cancer. The results of important clinical trials are summarised in 5-10 lines, with key data including : whether or not randomised, number of subjects, study periods, median follow-up, dosages, results, limitations and conclusions. In addition, there is a comprehensive index so that specific information can be found quickly.

Dedication ii
Acknowledgements v
How to use this book ix
Commonly used abbreviations xi
History of prostate cancer 1
Epidemiology of prostate cancer 9
Worldwide 9
North America 10
Africa 12
The UK and Europe 13
Asia 14
Risk factors 15
Factors that increase risk 15
Hereditary prostate cancer 18
Estimating risk factors 24
Genetic testing 25
Current recommendations for high-risk patients 25
Potential risk factors 28
Factors that decrease risk 30
Chemoprevention 33
5[alpha]-Reductase inhibitors 33
Selenium 36
Vitamin E ([alpha]-tocopherol) 37
Selective estrogen receptor modulators 40
Soy 40
Lycopene 41
Major ongoing trials 41
Prostate-specific antigen and digital rectal examination screening for prostate cancer 43
Introduction 43
Digital rectal examination 43
Transrectal ultrasonography of the prostate 45
Prostate-specific antigen 46
New serum markers and novel techniques 52
Prostate cancer: imaging features 53
Ultrasound: transrectal ultrasonography 53
Computerized tomography 54
Magnectic resonance imaging and magnetic resonance spectroscopy 56
Nuclear medicine studies 60
Evaluation of abnormal digital rectal examination or elevated prostate-specific antigen 63
Digital rectal examination 63
Prostate-specific antigen 64
Prostate biopsy 66
Prostate pathology 70
Prostatic intraepithelial neoplasia 70
Prostatic carcinoma 71
Adenocarcinoma of peripheral ducts and acini 73
Immunohistochemistry 80
Other prostate carcinomas 81
Sarcoma, lymphoma, and other malignancies 86
Staging 91
Clinical 91
Pathologic 91
TNM classification 92
Histologic grade (G) 93
Radiological evaluation 94
Prognostic factors and predictive factors in prostate cancer 96
Serum prostate-specific antigen 97
Digital rectal examination 98
Gleason score 98
Surgical margin status 99
Tumor ploidy and nuclear morphometry 101
Histologic subtypes of cancer 101
Number of biopsies of the prostate 101
Molecular prognostic markers 102
bcl-2 102
p53 102
pp32 103
Microvessel density 103
Vascular endothelial growth factor 103
Perineural invasion 103
Transforming growth factor-[beta]1 106
Bone morphogenetic proteins 106
Insulin-like growth factors 106
Her-2/neu 107
Interleukin-6 107
Bone sialoprotein 107
E-Cadherin 108
CD44 108
Genetic factors 108
Predictors of pathological stage before radical retropubic prostectomy 108
Bone metabolic markers in advanced disease 109
High-grade prostatic intraepithelial neoplasia 110
HGPIN demonstrated during a sextant biopsy scheme should be repeated 111
HGPIN demonstrated during an extended biopsy scheme does not warrant immediate repeat biopsy 111
HGPIN and extended repeat biopsy at 3 years 113
Relationship of HGPIN to prostate-specific antigen 113
Testosterone replacement in men with HGPIN 114
External beam radiation therapy 115
Radiation therapy techniques 115
Radiation therapy dose-response 121
Pelvic node radiation in prostate cancer 125
Introduction and background: how commonly are lymph nodes involved? 125
Patients who are pathologically node negative 128
Can imaging improve the detection of lymph node metastasis? 129
Treatment of patients with pelvic lymph nodes: a role for radiotherapy? 130
Conclusions 132
Selected papers on the incidence of pelvic lymph node involvement (2006) 132
Prostate brachytherapy 136
Low dose rate brachytherapy 136
Isotopes 137
Low dose rate brachytherapy as monotherapy 138
Low dose rate brachytherapy in combination with external beam radiation therapy 140
High dose rate brachytherapy 141
High dose rate brachytherapy in combination with external beam radiation therapy 143
High dose rate brachytherapy as monotherapy 150
Radical prostatectomy 153
Indications 153
History 155
The University of Miami radical prostatectomy 155
Outcome measures for radical prostatectomy 164
Complications 168
Changes in quality of life measures 174
Summary 178
Post-prostatectomy radiation therapy 179
Adjuvant post-prostatectomy radiation therapy 179
Salvage post-prostatectomy radiation therapy after relapse 181
Choice of postoperative versus salvage radiation 182
Radiation therapy techniques 182
Morbidity of postoperative radiation 183
Role of hormone therapy with postoperative radiation 183
Cryotherapy for prostate cancer 185
History 185
Cryobiology 186
Patient selection for primary treatment of prostate cancer 187
Cancer-related outcomes after cryosurgical ablation of the prostate 188
Cryosurgical ablation as salvage therapy after radiation treatment 190
Complications following cryosurgical ablation of the prostate 192
Adjuvant androgen suppression for locally advanced prostate cancer 194
Adjuvant androgen deprivation 194
Neoadjuvant androgen deprivation for locally advanced prostate cancer 196
Neoadjuvant versus adjuvant androgen deprivation 198
Clinically localized prostate cancer 200
Current phase III trials 203
Prostate cancer recurrence 205
Biochemical recurrence 205
Treatment of biochemical recurrence 208
Local recurrence 210
Treatment modalities for local recurrence after radiation therapy 213
Treatment modalities for local recurrence after surgery 216
Metastatic prostate cancer 220
Management of bone metastases 220
Spinal cord compression 227
Soft tissue metastases 229
Endocrine therapy for metastatic prostate cancer 231
Androgen-deprivation therapy 231
Orchiectomy 232
Leuteinizing hormone releasing hormone agonists 232
Leuteinizing hormone releasing hormone antagonists 233
Androgen antagonists (anti-androgens) 233
Complete androgen blockade 234
Complete androgen blockade versus monotherapy 234
Early versus deferred androgen-deprivation therapy 236
Intermittent androgen suppression 236
Androgen antagonist addition 237
Androgen antagonist subtraction (androgen withdrawal) 237
Other endocrine therapy used in prostate cancer 237
Bone mineralization management 238
Chemotherapy in hormone-refractory prostate cancer 240
Prognostic factors in hormone-refractory prostate cancer 241
Historical overview of chemotherapy in hormone-refractory prostate cancer 241
Single-agent docetaxel 242
Randomized trials of docetaxel 243
Toxicity of docetaxel 245
Estramustine 246
Docetaxel-refractory patients 247
Ongoing clinical trials in hormone-refractory prostate cancer 247
Investigational agents 251
New cytotoxic agents 251
Calcitriol (DN-101) 252
Growth factor receptor antagonists 253
Anti-angiogenetic agents 254
Proapoptotic agents 255
Other novel targeted agents 256
Immunotherapeutic agents 256
Complications of radical prostatectomy 259
Hemorrhage 260
Rectal injury 262
Oliguria/anuria 263
Lymphocele 264
Nerve injury 264
Cardiovascular effects 265
Infection 266
Foley catheter loss 266
Perineal pain syndrome 267
Bladder neck contracture 268
Incontinence 268
Impotence 269
Side-effects of treatment 272
Prostatectomy 272
External beam radiation 274
Low dose rate brachytherapy 278
High dose rate brachytherapy as monotherapy 281
Cryotherapy 283
Androgen-suppression therapy 285
Chemotherapy 288
Follow-up of patients after treatment of localized prostate cancer 293
Recurrence after primary therapy 293
Follow-up protocol following primary therapy 294
Biochemical recurrence 294
Predictors of recurrence 295
Distinguishing local from systemic recurrence 296
Treatment following recurrence 298
Index 303