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It is very exciting to open this special issue describing the latest advances in prostate cancer treatment options. This project has been organized to continue my third monothematic workshop on prostate cancer, focused on therapy. Prostate cancer is the second most frequently diagnosed malignancy and the fifth leading cause of cancer morbidity in men worldwide. It is characterized by being usually indolent, but it can be aggressive or result in incurable disease if it progresses to its advanced stages, showing special features, including the androgen receptor splicing variant 7 (AR-V7). This special issue, titled “Recent Advances in Prostate Cancer Treatment,” contains interesting articles discussing various aspects of this cancer.
The papers deal with the different therapeutic strategies usually used for prostate cancer. There is an article dealing with the new precision medicine to treat patients with novel computational methodologies, including artificial intelligence or machine learning. This paper is entitled “Prostate Cancer: Trends towards Personalized Medicine.” Therapies to treat patients with this malignancy, trying to achieve cancer control, the main objective of urologic oncology, are usually divided into local and systemic treatments. In the article “New Local Therapy with Focal Treatment Approaches in Prostate Cancer,” three novel treatment approaches in radiotherapy, prostatectomy, or cryotherapy for patients with localized prostate cancer are described. The most systemic treatment for this cancer is androgen deprivation therapy. A second article on the treatment of advanced prostate cancer is “Novel Drugs for the Treatment of Resistance of Metastatic Castration-Resistant Prostate Cancer.” Prostate cancer patients treated with these toxic antitumor drugs frequently need supportive care. In other articles, novel approaches are described for mitigating drug resistance, imaging treatments for the disease, or ethical and legal aspects of clinical trials, including prostate cancer management.
Prostate cancer is a condition wherein tumors emerge and progress from the prostatic epithelium. Although the exact etiology of prostate cancer continues to be a topic of discussion, many pundits believe that contributions toward genitourinary need to be considered when assessing patients exposed to certain drug(s). Currently, prostate cancer is considered the second most common genitourinary cancer in all men worldwide and is rapidly becoming the most common form of cancer in older men.
The prostate itself is part of the male genitourinary system and is responsible for producing seminal fluid. Additionally, the prostate surrounds the male urethra as it exits the bladder, a situation that has implications following surgical prostatectomies. Presently, the two primary modalities for treating prostate cancer surgery and radiation, which can have a lasting genitourinary sequelae such as urinary incontinence and erectile dysfunction. Androgen deprivation therapy continues to be an effective treatment for patients with advanced prostate cancer, however, these patients will all experience tumor recurrence (hormone-refractory). Finally, many treatments for prostate cancer are age/extent driven and require vigilant pathologic stratification.
The age of onset for this class of cancer is 65 years and older, which can cause mortality in approximately 25% of individuals within 5-10 years. Additionally, the cancer will often be locally advanced or metastatic once detected. Tumorigenesis can be partially attributed to androgen sensitivity, specifically in the nuclei of prostate epithelial cells. Although slow-growing, the utilized therapies have toxic side effects that debilitate the overall quality of life of patients. Some of the methods employed to confirm the presence of prostate cancer include assessing the plasma level of protein antigens prostate-specific antigen (PSA). In general, symptoms for prostate cancer include bone pain and weight loss, the site of metastasis for patients. In conclusion, early detection and continued treatment make prostate cancer one of the most survivable in men.
Treatment for prostate cancer always begins with one fundamental question: What is the precise nature of the disease causing problems in the patient? This means identifying how much, if any, of the disease has spread beyond the prostate. It is also important to understand patient-specific factors such as additional diseases like diabetes or heart disease, kidney functions, bone health, bladder control, frequency and severity of symptoms, and patient preferences. Some patients may choose not to treat at all. Determining if and how aggressively the disease needs to be treated is aided by several blood and imaging tests. These can vary from patient to patient. A few well-known lab tests include: a Prostate Specific Antigen (PSA) test measures a protein (PSA) in the blood produced by prostate cells and is commonly used as one way to screen for the presence of PCa; a digital rectal exam (DRE) identifies physical changes in the prostate such as lumps, hard spots, or swelling; a Urine PCA3 test that measures a higher amount of the currar RNA in urine in men with PCa compared to those without the disease and is used in patients with slightly elevated PSAs to support a biopsy decision.
Surgical interventions include prostatectomy, which is the surgical removal of the entire prostate gland, and afterloading, a type of surgery performed with a radiation source placed directly inside or alongside the cancer. Radiation therapy is a potential primary treatment for localized prostate cancer (with curative intent). The main forms of radiation therapy for prostate cancer are external beam radiotherapy (EBRT) and brachytherapy. Hormone or Androgen Deprivation Therapy (ADT) is pharmaceutical treatment that removes androgens (male hormones) from the body, specifically testosterone and dihydrotestosterone (DHT). Other standard treatments include the chemotherapeutic treatment of men with castrate-resistant and non-metastatic PCa should be offered one of the following treatments or participation in a clinical trial. Retrospective analyses and small, prospective ones suggest that patients continue to benefit from hormonal therapy after they are discovered to have a rising PSA level, suggesting the disease is becoming hormone resistant. Some sub-populations in randomized trials seem to benefit from addition of daily Tarabcury, the active compound in Casodex for the long term; these patients are those with higher volumes of disease or increased risk for cancer in the bones based on scans.
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The role of radical prostatectomy is still an unresolved issue as a possible therapeutic option in preventing PCa. The biopsy holds no predictive value for optimal therapy in grade, staging, or predicting biological aggressiveness of the disease. Currently available prostate cancer surgery recovery data suggest a significant improvement in the surgical technique, which corresponds to an increase in biochemical control. Ostaloven surgical treatment has been experienced mainly by early detection of the disease. From this point of view, therefore, positron emission tomography, except for axial images, is important in the clinical staging of the disease and in the treatment of patients with altered axial images. A clear benefit of limiting complications to the basic ear has been demonstrated.
The same is true of minor sequelae that conflict with the patient’s quality of life, in particular the contact. The current use of laparoscopic radical prostatectomy with 4 ports has made the small surgeon use a really high-power optic system to carry out a playful operation that is sometimes interchangeable with laparotomies. A key role within our team is the role of permit, which is the maintenance and service of all components necessary for surgery. This organization is now a key to the success of the intervention and also the reduction of surgical time. The only barrier to penetrating this technique is the need to always carry out treatments and lead the operator to a selection of candidates for prostate knowledge.
Some of the major latest advances in traditional treatment approaches that have been discussed in the previous section included active surveillance or observation (AS/watchful waiting), radical prostatectomy, robotic-assisted radical prostatectomy, and open radical prostatectomy. The in-depth study in the last section suggested radiation therapy as another potential option for the management of patients with localized prostate cancer. The therapeutic effect of radiation is the result of the tissue’s reaction to controlled injury. The goal of radiotherapy is to delimit the adverse effects of radiation on the normal tissues surrounding the tumor, to facilitate healing of the damaged tumor, or both.
Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA. The treatment is delivered through different modes of radiation exposure, where each kind of radiation therapy approach has varied mechanisms through which they treat with different implications in clinical practice. The different treatment delivery options include EBRT, brachytherapy, stereotactic body radiation therapy, proton therapy, etc. Stereotactic high precision of the robotic arm with the aid of real-time imaging enables radiation to be delivered more accurately with minimum radiation dose and hence with fewer prostate cancer treatment side effects. SBRT treatments are performed within a few days and at times as a single procedure for convenient time for patients. Both EBRT and brachytherapy can be used together, as it improves cancer control rates and decreases side effects. SBRT can be used alone or in combination with EBRT. Longer follow-up times are needed in order to confirm complete effectiveness of SBRT in cancer control.
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Immunotherapy has emerged as a potential intervention to overcome the hardships associated with trying to treat advanced prostate cancer. Rather than trying to use radiation or surgery to target the cancer within the prostate, researchers have shifted their focus to trying to prime the body’s immune system to attack the prostate cancer as if it was any other infection or threat to the body. Of course, the challenge here is that the body’s immune system corresponds to the dysfunction of normal cells. Therefore, developing immunotherapy to treat prostate cancer entails attempting to train the body to recognize prostate cancer in the face of the dysfunction of the tissue of the prostate itself.
Immunotherapies are being studied for the treatment of different stages of prostate cancer, including the following therapeutic approaches:
– Immune checkpoint plus radiation therapy.
– CyberKnife stereotactic radiosurgery (SBRT) as a neo-adjuvant to pembrolizumab in M0 hormone-sensitive prostate cancer.
– Radiotherapy with 177Lu-PSMA 617 plus durvalumab for metastatic castrate-resistant disease.
The design and execution of clinical trials to address the use of the immune therapies require very careful selection and development of the tools to decide if a therapy is promising or not and how to choose which of the many approaches going forward to test if one has shown promise. Strategies for immune therapy assessment in many disease areas, including prostate cancer, using the following approaches:
The programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), lymphocyte activation gene 3 (LAG-3), and CD4 checkpoint pathways have been evaluated as potential immunotherapy targets. These are involved in downregulating T-cell effector functions and proliferation in the tumor microenvironment. Two drugs targeting the PD-1 pathway, pembrolizumab and nivolumab, have been FDA approved and used in other cancer types, including advanced renal cell carcinoma, a common differential diagnosis for clear cell CRPC due to its similar histology. FDA halted the trial assessing the efficacy of the PD-1 inhibitor pembrolizumab in combination with low-dose of docetaxel in second-line settings after the agent failed to significantly increase overall survival as compared with standard chemotherapy. The checkpoint inhibitors seem to have a 17% frequency of adverse events leading to dose reduction.
Nivolumab was studied in a multi-institutional phase Ib dose-escalation trial for patients with mCRPC who had histologically confirmed prostate adenocarcinoma, radiographic progression and/or rising prostate-specific antigen (PSA) despite standard of care including or not docetaxel therapy and who had no history of autoimmune disease. This early trial demonstrated a higher proportion of urinary toxicity, with about 10% of grade ≥3 pneumonitis in the mCRPC population. Other advanced immunotherapy options have latterly been evaluated in checkpoint studies. The PD-1 checkpoint inhibitor immune agent is under investigation in multiple prostate cancer settings using combination strategies. Most combinatorial studies have been performed primarily in castrate-sensitive prostate cancer (CSPC), but multiple other clinical trial strategies are underway in metastatic CRPC (mCRPC) setting.
Prostate cancer remains the most prevalent malignant tumor in male patients and a substantial burden on global healthcare systems. Translational and clinical research focusing on prostate cancer is rapidly expanding, and new diagnostic, prognostic, and predictive biomarkers are being proposed according to a potential granular sub-classification of prostate cancer in terms of relative molecular and clinical heterogeneity. The principles of precision medicine apply to the treatment of prostate cancer patients, offering the possibility to choose the best treatment option in relation to the underlying biology responsible for prostate cancer management and to patient individual clinical aspirations. Steadily integrating imaging and tissue-based genomic and epigenomic technologies into routine clinical practice in order to direct early, definitive, curative, or palliative treatments.
Indeed, several ongoing prospective clinical trials offer intra-patient comparison between combinatorial treatments outside the framework of genetic biomarkers due to the polygenic nature that many outcomes can have. Some of these trials are also incorporating the use of adaptive co-designed randomization to ensure the most effective therapeutic dose combinations in the experimental arms and optimal control arm to be compared across both, in every possible biomarker-defined subpopulation. The promise of true precision medicine when managing prostate cancer is that treatments can be tailored to meet the needs of each different patient. In the future, this really could be 100 unique treatments. This can capture each person’s unique requirements in partnership with the multi-modal imaging that makes advances such as PSMA imaging possible.
Genomic testing comes under the “precision medicine” umbrella and is still under strong investigation, with varying data supporting its role. Many questions await evidence. The papers under this subsection can point out the key utility related to prostate cancer. They can generally guide towards “pharmacodynamics” drugs (new class and mechanism of action of antiandrogen, such as enzalutamide and abiraterone) rather than isolated biological functions or potentially harmful variants. Additionally, the above papers are useful tools for clinicians to select patients for clinical trials by identifying targetable subset populations. Cabozantinib from the COSMIC-021 trial will soon be placed under FDA accelerated approval based on the same principle.
As conventional prostate cancer treatment options like surgery, radiation, and chemotherapy are not conflict-friendly, researchers conduct studies to decipher the potential efficiencies of diverse novel agents beyond immunotherapy and hormonal treatment. The following are some of the promising new agents currently explored in clinical trials:
The potential targets mentioned above fall into several cellular stage activities such as DNA transcription, DNA damage repair, DNA translation, neurotransmitter function, PI3K cell-growth pathway, histone pathway, radiation resistance, and steroid receptor pathway. Importantly, there are no new invasive imaging technologies that can detect them nor any FDA/EMA approved medications to treat these domains.
The conceptual framework to attack AR signaling remains pivotal in the treatment of prostate cancer at all phases of the disease. The currently approved androgen receptor (AR)-targeted therapies improve overall survival in patients. Currently, a variety of novel drugs is being developed that lead to an even newer molecule of the AR pathway. A total of 8 drugs in three classes—2 ARNIs, 4 PROTAC PSMA-TTCs—have been tested in clinical trials involving 160,225 men, the majority have been heavily pretreated (median received previous lines = 2.5) with metastatic castration-resistant prostate cancer (mCRPC). These early-phase trials demonstrated a good safety profile and mild-to-modest clinical activity even in very advanced patients. Animal models have provided some preliminary evidence of efficacy in combination with other drugs. Although follow-up was limited, some signs of antitumor activity have been observed in at least one study in the phase II development. Putative predictive molecules have gained interest.
Molecular characterization of circulating tumor cells and cfDNA from the patients and a preliminary “targeted” trial are planned. The androgen receptors are essential for prostate cancer. Previous standard treatment included androgen deprivation (ADT), but eventually, disease adaptation happens, leading to metastatic castration-resistant prostate cancer (mCRPC). It is now generally recognized that successful approaches can significantly alter the lives of patients with prostate cancer if any stage of the disease affects AR function. The older line of drugs focuses on decreasing the creation of androgens and suppressing and blocking AR translocation, for instance, the use of newer and more powerful inhibitors of CYP17A1 enzymes and the anti-androgens Enzalutamide and Abiraterone are much more desirable than Bicalutamide with its remaining partial androgens. The molecule can act similarly to a wide, newer nonsteroidal lipophilic anti-androgen known to prevent the AR/CBF-ß protein interaction segment.
Modern multifocal prostate cancer treatment is focused on combining various treatment tools in order to add them together in different modalities, working in a synergistic or complementary way. Different combinations are being used in contemporary practice. In cryotherapy, it is combined with androgen deprivation therapy (ADT), radiation and high-intensity focused ultrasound (HIFU), and CCH. Radiotherapy is used with ADT, hyperthermia, immunotherapy, chemotherapy, targeted therapy, and radiopharmaceuticals. Currently, dual-reshapeable computer-aided technologies are being investigated, using different permutations of additional therapies, but the results of many investigations are still awaited.
Other nontargeted and targeted local therapy combinations combine radical prostatectomy with cryotherapy and radiotherapy. Similarly, the minimally invasive surgical treatments combine RT with ADT, hyperthermia, peptide receptor radioligand therapy, external radiation, and other cancer treatment modalities. An important change is the use of imaging-guided biopsies for various areas, both inside and outside the prostate, looking at the appropriate targeted therapy for imaging footprints. Placing biopsies before and at the time of multimodal therapy will also restrict, develop, and control therapies. In the current context, only one clinical trial has shown that supplementation prevented metastases. In a modern multimodal approach, many local therapies are suitable for supplementation. Decreased complementation has also been recorded due to circumferential tissue toxicity, which will not prevent endemic disease. The addition of local supportive therapy to systemic therapy is stated to kill cancer cells, while those who die due to systemic care. In this regard, trial data are required in order to distinguish one therapy from that resulting from systemic therapy.
In an effort to create additional treatment synergies, current research also focuses on the combination of locoregional approaches and systemic treatment options. A prerequisite for all treatment intensifications is accurate local and systematic staging because they are also of great importance for therapy planning. Multimodal strategies, such as surgery combined with external beam radiation therapy and/or androgen deprivation therapy (ADT), have shown benefits, particularly for patients with locally advanced diseases. Although prospective evidence of the superiority of this therapeutic approach over monomodal treatment is still limited, conducted a meta-analysis in which the study authors evaluated the evidence of multimodal therapy compared with monomodal treatment in locally advanced prostate cancer patients, including surgical intervention.
The researchers found that the superiority of multimodal treatment over monomodal therapy, reaching statistical significance, was described by one multi-institutional study and two hospitals’ cohort studies, all of which included data on unfavorable intermediate-risk patients, and one study included the data of all locally advanced patients. In the multi-institutional trial, a statistically significant improvement in the cancer-specific survival (hazard ratio (HR) of 0.74, p = 0.003) and in the distant metastases-free survival (HR of 0.66, p < 0.001) was found for men receiving multimodal treatment. Consequently, the national comprehensive cancer center alliance developed the consensus statement that this approach is “the most rational treatment in node-positive disease.”
Treating patients with prostate cancer – especially those bearing very low, low, and intermediate-risk disease – mostly follows a strategy of surveillance. As a consequence of this, advances have been made in diagnosis and monitoring revolutionary cells in the imaging world that were long founded in neuropsycho-Ilinal Probate (PSMA) PET/CT, using Ga68 presumed-3-amino tumarem-celikinc-iramide (PS-iramicic), has been-3-amino-L-f-APA) and positron emission monitoring has a significant impact on the management of prostate cancer, where authorities and recommendations support its usage in multiple clinical settings, such as biochemical restaging and, finally, selection of patients that are more likely to benefit from the novel together against the nuclear therapy.
Diagnostic: 1. (PSMA)-PET/CT has shown promising results for the detection of primary prostate cancer. For the most desirable Gleason Pattern, the sensitivity is 89 percent and specificity is 78 percent, and sensitivity and specificity are 73 and 98 percent, respectively, on image result or MR quote 4 or 5. For M0 GRPCR non-metastatic CRPC patients, PET/CT with the use of Flucucvistidine may be used for GRPavi-avid spread. Formal dynamic comprehensive wincomesInd with accurate staging and the path of the prolatermine enabling the applicants to carry out the basilisation, tube, or cellulose. Grace is considered combincible for all timen and helpdocost (if) therapy. It is done before the initiation of radiotherapy and peeluradical shutter that mediates the prostate from the blood supply, interfering endotheliun and protection from damage during ischemia. Iprostateluxicrosecondstudies-in-outcome randomi.
One of the most direct forms of qualitative images that are sought after in imaging today is PSMA PET imaging. This shows whether or not a tumor or cancerous cell expresses PSMA, in addition to localizing the lesion and in some cases identifying a pattern of viable cancer involvement or aggression. One of the most common patterns of use for PSMA PET imaging is for NEOADT informed radiation therapy and or the prophylactic or therapeutic casting of stereotactic body radiation therapy to other viable lesions. One of the caveats currently faced by some regional and national providers is the absence of PSMA diagnostic PET imaging in some locales. One question that was addressed by one of the speakers was whether or not in the absence of disease having PSMA PET imaging one should make therapeutic decisions based on a negative choline PET imaging study? The answer was an equivocal “probably not”, but further discussion is nuanced and no clear overarching set of guidelines having been discussed by the panel during the meeting.
The use of PSMA PET imaging over conventional molecular imaging has also allowed for PSMA-specific therapies such as 177 lutetium PSMA or PSMA-617 radiolabeled therapies. This has allowed more focused PSMA agents to be delivered selectively to PSMA expressing tumors responsibly regionally with minimal BPAD conversations regarding “off target” side recipes. This target is in principal aberrantly over expressed on prostate cancer metastases in up to 90% of cases at the time of therapy avoiding mull functional wastes of treatment.
As prostate cancer provides opportunities to address the holistic needs of men, it also presents a stage to consider supportive care, typically delivered by multidisciplinary teams, but extending to patients’ lived experience, including their narratives of survivorship, as a reciprocal connection between ‘milieus’ of care and lived experiences of illness. This integrated combination of curative research and palliative care is how the situation is often perceived by those who receive care. One consequence of the cancer field’s early dominance by engineering and curative science approaches to medicine, the term has the implication of ‘second rate’ and, thus, quickly gave way to ‘palliative care’.
In part, supportive care involves overcoming the inherent inequity of the term ‘palliative care’, which is in essence the provision of physical, emotional and spiritual support, and helping symptom management to patients during any time of their cancer journey, not just and including the ‘terminal’ phase of progressive disease when some determinants of treatment response have become exhausted. A focus on supportive care further aligns with, and promotes, acknowledgement of the very many other demands and perspectives on care that patients and families bring to both cancer clinics and the wider community. This section seeks to illuminate some of the real needs as expressed directly or indirectly by prostate cancer surgery patients and families and symbolized by their talk and other presentations in various healthcare settings beyond the hospital system where we do our ‘work’.
Palliative care should be considered from the time of diagnosis through all phases of care until the completion of life. The Clinical Practice Guidelines provide an overview of supportive care in prostate cancer together with a presentation on palliative care as part of supportive care in these revised guidelines. The concepts are clear and provide a foundation for the following chapters.
The development and management of this chapter need to be entirely dedicated to comprehensively presenting palliative radiotherapy as a pillar of prostate cancer management (and not just crisis management) when the cancer is causing symptoms and quality-of-life-related issues. It is expected that palliative care is based on principles and validated by science. External radiation therapy and symmetric approaches must be included, although systemic drugs can also be added when indicated. The palliative targets will differ closely according to the radio-protocol chosen: in a single fraction or spread in years; for example, gradually with the addition of bone health agents such as bisphosphonates, RANKL, etc. Palliative medical options will be less aggressive in their added capabilities and in their toxicity.
Few oncological diseases have among their symptoms pain and significant impact on the chronological and functional quality of life as one of their main symptoms. Both palliative care and control according to the principles of this bio-psycho-social care designed for the patient, from when the cancer affects will offer a greater view of what is advisable to avoid in the palliative approach. With the aim of achieving the best possible QoL for the patient and offering better conditions to reduce the anxiety and depression of the affected families, most patients in prostate cancer patients are diagnosed with advanced and metastatic metastases and they need palliative care. Management of this section is dedicated to presenting external radiation therapy for the management of prostate cancer, when the metastatic cancer is causing clinical and subclinical symptoms. Management of these patients remains, for the most part, reserved to radiation therapy.
The launch of new and innovative therapies to treat advanced prostate cancer, together with increased media attention, has heightened the expectations of men living with this disease. As a result, men with advanced prostate cancer are now seeking information on how to access these therapies if they become available in the future. Active participation in clinical trials remains the best hope for accessing novel therapies. Despite the availability of active treatments for men with advanced prostate cancer, clinical trials are the focus for many men.
A recent review in this journal identified a large number of potential future developments in the treatment landscape of advanced prostate cancer, including the increased use of systemic therapy earlier in the disease trajectory and potential combinations of androgen deprivation therapy with systemic agents. The review also highlighted the importance of identifying and demonstrating the benefits of active agents in the earlier stages of disease when mortality is a long-term and infrequent event, and of identifying and implementing surrogate endpoints. This review aims to further assist men in making informed decisions about clinical trial participation by providing up-to-date data on clinical trials for the treatment of advanced prostate cancer and discussing the potential implications for clinical practice. In summary, research in the area of advanced prostate cancer is fast-paced. There are currently several clinical trials studying new and emerging treatment opportunities. This provides hope to men diagnosed with advanced prostate cancer.
The development of several novel agents that target processes crucial to treatment resistance during the past several years requires a fresh evaluation of promising investigational therapies. Some are in, and others are awaiting concluding, a clinical testing phase, although all have demonstrably significant efficacy in advanced prostate cancer, arguably one of the biggest unmet requirements in advanced prostate cancer therapy.
Prostate-specific membrane antigen (PSMA) is the most promising therapeutic goal in patients with metastatic castration-resistant prostate cancer (mCRPC) or men. Both radiolabeled small molecules and radiolabeled antibodies targeting PSMA include PSMA-targeted radiotherapeutics. These radiopharmaceuticals can associate with B-cell signaling inhibitors and other forms of therapy such as PARP inhibitors or taxanes to increase medical reactions to the tumor, though they have a nuclear aspect to themselves. Prospective studies to evaluate their potential use in a mix with immune checkpoint inhibitors and typical mCRPC systemic treatment are appropriate. Furthermore, ongoing clinical growth of 177Lu-PSMA-617 and 213Bi-PSMA-617 demonstrates that beta, as well as alpha radioactive isotopes, may be administered to prostate cancer cells and have the consequences of increased PSMA antigen amounts on these cells and their surroundings. PSMA-targeted alpha radioimmunotherapy may be a therapeutic approach for PSMA-positive diseases if it is safe and clinically satisfactory.
When it comes to considering the latest treatment options for men with advanced prostate cancer, a patient-centered approach is widely recognized as a high priority. This concept reflects the fact that not only is cancer care now more individualized based on molecular tumor assessments and other factors, but also that many different treatments may be equally valid. Honor existing preferences and priorities, shared decision making, and effective patient education on treatment options are critical aspects of this approach.
Similarly, a section on novel treatments must dedicate significant space to the prevention and/or management of the prostate cancer treatment side effects, as the lowest likelihood of side effects has been shown to be one lever to sway men’s treatment preferences when efficacy is similar between treatments.
Each man has his own characteristics and may have strong feelings about side effects, the frequency and mode of treatment administration, and expected underlying burden of a disease process. Making treatment decisions will be more informed and care will be tailored to each patient if we have solid clinical trial evidence around patients’ expected melanoma progression, toxicity, and overall performance to help make these tough decisions.
There is not a consensus about Up Front Treatment with Bipolar melting or HIV-positive (UMsch) for intermediate risk hormone-sensitive prostate cancer. The Phase III CheckMate-7OB trial is a currently enrolling study that will compare the best shared decision-making arm (SOC/ ipi/nivo) vs. the best upfront treatment arm (SOC/ ipi/nivo)/(SOC + nonmelanoma T-site radiation) actuavir.
Advanced prostate cancer (PCa) is a deadly disease and, despite the agreed importance of patient-centered care, it remains a source of distress given the profound impact of side effects. Services offer multiple treatments to address the balance between over- and under-treatment, yet very little is known about the impact or effectiveness of these choices on outcomes. This first paper is about the process of shared decision making and decisional regret in PCa. Initial evidence on decisional regret is variable, with no consistency across measures or time points, and scarce evidence on shared decision making in UK PCa settings. A prevailing need was reported for healthcare professionals to individualize information to the patient, to create a space for collaborative decisions to be made, aligned with the patient’s ideals, and to provide ongoing psychosocial support.
Shared decision making between patients and healthcare professionals is a process through which they work collaboratively to make decisions that align with what matters to the patient, including the burden of treatment choice and prostate cancer treatment side effects. This is increasingly being seen as a useful patient-centered intervention that can help to prepare patients for treatment-related adverse effects and align selected treatments with what matters to the patient. The extent of patient involvement in decision making is determined by factors such as the severity of the decision, the patient’s state of information, and the patient’s psychological constitution. Given the alignment of treatment choice with what matters to the patient, shared decision making processes also have a beneficial association with clinical outcomes. Withdrawals of treatment said that needed in counseling – what do they tend to believe create the most distress to patients?
As our knowledge on prostate cancer continues to expand, we have transitioned from relatively one-size-fits-all approaches to modes of patient-centered individualized care. This can be challenging, with the need to balance benefit, risk, patient preference, and cost for both high- and low-risk tumors when choosing treatment. Ultimately, the goal is to reduce financial toxicity, as prostate cancer treatment costs are associated with adverse changes in quality of life. Fortunately, some treatment modalities, particularly those used in the high-risk setting, are more cost-effective than others, although the upfront financial burden to the patient can be challenging. While chemotherapy, immunotherapy, radium-223, HIFU, and even surgery will have larger price tags, the vast majority of patients can safely be observed with or without an androgen deprivation pellet. Further, unlike other cancers, harm from missed treatment for localized prostate cancer is not typically permanent.
Cost considerations in cancer, including specifically for prostate cancer, has been an active field of research for several years. From the Urology perspective, treatment strategies which would emphasize cost-effective treatment modalities and transition to lower intensity and complexity until disease progression occurred would ultimately save more money while focusing on observation unless treatment is met where indicated. As genitourinary oncologists we are tirelessly treating patients who have not only undergone cancer-related treatments but also have sequelae related to treatment and survivorship of their malignancies. Outlining the financial and high-burden treatments for these patients is an important aspect of cancer care. For these reasons, thoughtful conversations regarding each patient include both clinical and sociocultural constructs.
Ethical and legal issues are critical aspects of advanced patient care for patients with prostate cancer. Given the uncertain potential magnitude, timing, and distribution of benefits and toxicities, patients need to be informed about what uncertainty entails in healthcare decision making. Presenting uncertainties to patients is a valuable challenge, and communication of different facets of the uncertainty can be very difficult. Several comorbidities affect life expectancy and the risk of dying of some of these. Studies have consistently shown that debates surrounding prostate cancer evaluation and treatment are not clearly understood by many providers and patients. Shared decision-making is extremely important in contemporary healthcare, but patients might be unable to make a truly autonomous choice given the current context.
Patients with advanced prostate cancer sometimes do not receive a good quality of end-of-life care. Capacity to make choices can be influenced not just by the prostate cancer or its use of drugs, but also by comorbidities, disabilities, cognitive impairment, or even a significant change in risk profile. Patients with untreated, localized prostate cancer, given their life expectancy relative to other comorbidities, have a risk of dying of disease. Decision making is simplified by a broad prognostic profile of life expectancy much lower than anticipated adverse effects from other illnesses. Decisional subtlety arises between these two givens. The cognitive and competency part of the decision must be established before a decision will be truly autonomous. Hostility in studies because of a deviation from the updated presentation tool for this illness of interest has also caused problems.
We have reviewed recent advances in prostate cancer treatment. Androgen receptor pathway inhibitors (ARPIs) and sipuleucel-T have become the standard treatment for metastatic hormone-sensitive or castration-resistant prostate cancer. Furthermore, capivasertib, olaparib, rucaparib, and talazoparib have been approved for treatment-refractory prostate cancer with genetic alterations. Therefore, in addition to the number of approved treatments, systemic treatment will continue to evolve, with numerous combination studies on hormonal therapy, immune checkpoint inhibitors, targeted therapy, and radionuclides ongoing. On the other hand, the total prescription volume was decreased by 20% according to the NABG. Because of this, there are several challenges facing urologists.
Clinical studies have become progressively complex, with a significant rise in the number of drugs and lines of therapy. The cost of hormonal therapy-based regimens, particularly combination therapies, has increased considerably. As a result, the effects on the standard of living and overall survival may be small. Furthermore, patients’ perspectives must be addressed, not only in terms of ADT combinations but also in terms of their usage. There are numerous extra said and expected mechanisms as identified above which should prompt more research attention. Nonetheless, it is fair to assume that, in conjunction with the improvements described herein, alternative options will be studied and optimized in the near future.
In conclusion, numerous new pharmacologic agents, in addition to traditional chemotherapy, have been approved for the treatment of refractory prostate cancer. A couple ignore the androgen receptor signaling cascade and the tumor infiltrating T cells overall. Nonetheless, we may expect a significant number of highly relevant reportable results from the majority of the 105 clinical trials in the pipeline.
Prostate cancer treatment costs vary 6000-7500 USD in Turkey. Turkey has become one of the most important centers in the world in Prostate Cancer Treatment. Barış Nuhoğlu, an expert in this field, has many successful operations.
An increasing number of studies indicate the significant impact of diet and physical activity on the risk of developing prostate cancer, its progression, stabilization, and improvement of well-being, symptoms, and psychophysical condition.
Food and physical activity have become a permanent feature of the global perspective of prostate cancer management. And these very activities help in the treatment process and in reducing the risk of neoplastic disease occurrence. They also become an essential part of comprehensive cancer care. Diet can influence the processes accompanying many diseases and very often changes in eating habits are recommended as an essential mechanism supporting general medicine treatment. It was confirmed that a diet rich in plant ingredients, especially of natural origin, reduces the risk of prostate cancer incidence and progression, and the omega-3 fats in fish have a protective effect. Conversely, other fats, especially of animal origin, may promote cancer development. It was therefore concluded that diets rich in vegetables, fruits, whole grains, lean protein (legumes, fish), and dairy products can improve general well-being and minimally affect the course of cancer treatments. Behavioral and dietary interventions have a positive effect on general health, reduce and prevent complications after treatment, and improve overall well-being.
Prostate cancer is a genetically complex disease. Family history is often used as a marker of predisposition or predisposing genes and may increase the risk of prostate cancer, particularly when combined with other associated factors. The risks of developing prostate cancer and aggressive prostate cancer (higher disease volume and Gleason scores) are elevated two- to sixfold in close relatives of individuals diagnosed with prostate cancer. Genetic variation, particularly in genes associated with older age, such as DNA-repair genes like BRCA2 or hormonal signaling genes like androgen receptor, is also associated with an increased risk of prostate cancer, particularly for high-risk disease. Rare high-risk mutations predict early-onset and aggressive disease, while more common variants tend to predict prostate cancer in older men.
On the basis of strong family and clinical histories, men at high genetic risk of developing prostate cancer can be identified. Men carrying some mutations have a lifetime risk of up to 50%, and this risk might increase further in the presence of additional genetic or environmental risk factors. Genetic testing is also possible and can be used to help inform patient decisions regarding prevention through regular screening, or treatment, through the identification of aggressive or incurable disease requiring active surveillance, and the identification of treatments tailored to an individual’s genetic risk.
Prostate cancer can cause urinary symptoms, including the need for frequent urination, bladder pain, or pain while urinating (dysuria). It can sometimes cause prostate obstruction, leading to symptoms such as weak, intermittent, or inability to urinate, which can indicate that the cancer has advanced. Other symptoms of advanced prostate cancer may include bone pain and painful urination. Prostate cancer is not associated with irritation or hyperplasia of the prostate. The cancer is considered a serious invasive tumor. Other characteristics include hypochromatic cancer and new tumor blood supply.
Treatment options depend on the severity of the cancer, the patient’s age, and health, after all aspects are considered by an expert panel of oncologists. If the cancer has not been controlled and has not completely infiltrated the prostate, the most scientific way is prostate cancer surgery recovery alone to remove as much tumor mass as possible, and then patients are advised to look for hospitals with the best prostate cancer radiation facilities. If the murkiness has spread widely around the prostate, the most advanced assessments recommend that radiation and hormone therapy be given at the same time as aggressive disease. Hormone therapy can lower testosterone levels to the lowest point. Another option is drug therapy that will kill cancer cells when given periodically for years every few months. No chemotherapy is harmful when done under the guidance of an expert. Targeted therapy is currently performed for certain cancers only. However, chemotherapy can be given as one alternative treatment, currently in addition with the development of new and most advanced drugs that can be used to treat this disease. Early detection is important to treat and prolong life. Hope this information is helpful.
Prostate cancer is frequently categorized as low- or high-aggressive. Other prostate cancer-related classifications are the following:
– Locally Invasive Prostate Cancer: Localized cancer may not cause any symptoms due to the initial stage of the disease, so invasive diagnosis is required. Referred to as the growth of prostate cells to the nearby tissue or organs such as seminal vesicles or lymph nodes.
– Hormone-Refractory Prostate Cancer: Prostate cancer that does not respond to hormone treatment or after this treatment, enabling it to stop dramatically growing.
– Castrate-Prostate Cancer: Precastration level substances contribute to the growth of prostate cancer.
– Androgen Independent Prostatic Carcinoma: Prostate cancer progressing without control negatively following hormone therapy stopping.
– Advanced Prostate Cancer: It is advanced prostate cancer, also called stage 4. The affected areas can be different in every person; people can show one or more symptoms, including lower body aches, urine difficulties, less control of urine, erectile dysfunction, and lower quantity of semen. Biologically, prostate cancer can be of different cell origin, not cancerous tumor. Tumors may be derived from benign tissue including lymph nodes, bones, skin, liver, and lungs. Some tumor cells display originated from an abnormal site. Invasive inherited prostate cancer geographically distributes frequently with the leptin receptor and interleukin-6 gene in the metastasis. A unique combination of prostate cancer may be histological or clinical, but the latest results show potential different therapeutic targets.
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