Management of Biochemically Recurrent Prostate Cancer: Ensuring the Right Treatment of the Right Patient at the Right Time

2018 ◽  
pp. 355-362 ◽  
Author(s):  
Daniel E. Spratt ◽  
Deaglan J. McHugh ◽  
Michael J. Morris ◽  
Alicia K. Morgans
Keyword(s):  
Prostate Cancer ◽  
New Technologies ◽  
Postoperative Radiotherapy ◽  
The United States ◽  
Common Disease ◽  
Recurrent Prostate Cancer ◽  
Systemic Treatments ◽  
Effect Of Therapy ◽  
New Gene ◽  
The Right

Biochemically recurrent prostate cancer is an increasingly common disease state, with more than 25,000 cases occurring annually in the United States. Fortunately, progress continues to be made to more effectively identify metastatic disease, optimize existing therapies, and develop new technologies and therapeutic strategies for the timing and delivery of systemic treatments to improve outcomes. This review covers three topics related to the diagnosis and treatment of men with biochemical recurrence (BCR). First, we provide an update on the state of the rapidly evolving field of molecular imaging and its place in practice. Second, we describe validated clinicopathologic methods to risk stratify patients with biochemically recurrent disease, including new gene expression classifiers, to personalize postoperative radiotherapy (RT) timing. Last, we define our approach to optimal management with systemic therapy, including identifying the patients who may benefit most and balancing the duration and timing of treatment with consideration of the effect of therapy on quality of life (QOL) and medical complications associated with treatment.

scholarly journals Cutaneous Metastasis of Prostate Adenocarcinoma: A Rare Presentation of a Common Disease

2021 ◽  
Vol 9 ◽  
pp. 232470962199076
Author(s):  
Alexander Dills ◽  
Okechukwu Obi ◽  
Kevin Bustos ◽  
Jesse Jiang ◽  
Shweta Gupta
Keyword(s):  
Prostate Cancer ◽  
Serine Proteases ◽  
Cancer Genetics ◽  
Performance Status ◽  
Distant Metastases ◽  
The United States ◽  
Cutaneous Metastasis ◽  
Common Disease ◽  
Cutaneous Metastases ◽  
Rare Presentation

Prostate cancer is the most common cancer affecting men in the United States and the second greatest cause of cancer-related death. Metastases usually occur to bone followed by distant lymph nodes and then viscera. Cutaneous metastases are extremely rare. Their presence indicates advanced disease and a poor prognosis. As they are highly variable in appearance and may mimic a more benign process, biopsy is essential for identification. Serine proteases, particularly human tissue kallikreins, may play an important role in promoting metastasis and facilitate infiltration of the skin. Individual cancer genetics may predispose to more aggressive cancer and thus earlier and more distant metastases. In this article, we report our case of a 67-year-old man with a 4-year history of castrate-resistant prostate cancer with cutaneous metastases confirmed by histology. Despite multiple lines of systemic therapy, the patient suffered progressive disease with worsening performance status and was enrolled in hospice.

scholarly journals Rare Paravertebral and Skull Base Metastases in Prostate Cancer

2016 ◽  
Vol 9 (3) ◽  
pp. 738-746 ◽  
Author(s):  
Gbeminiyi Samuel ◽  
Amir Isbell ◽  
Onyekachi Ogbonna ◽  
Hasan Iftikhar ◽  
Susmita Sakruti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Metastatic Prostate Cancer ◽  
Clinical Presentation ◽  
The United States ◽  
Unique Case ◽  
Skull Base Metastases ◽  
The Right ◽  
Upper Mediastinum ◽  
Paravertebral Mass

Prostate cancer is the most commonly diagnosed visceral cancer in the United States. A majority of cases exhibit an insidious course and nonaggressive tumor behavior. Prostate cancer can manifest as lesions which remain localized, regionally invading or metastasize to lymph nodes, bones, and lungs. Here, we report a unique case of metastatic prostate cancer to the right upper mediastinum, presenting as a paravertebral mass within 2 years of initial tissue diagnosis. Paravertebral spread has not been described for prostate cancer, and herein, we discuss the clinical presentation, diagnostic workup, and possible therapeutic options available in light of the literature.

scholarly journals PROJECT CRESCENT: A PROPOSAL TO BUILD A SUSTAINABLE MOONBASE

2021 ◽  
Author(s):  
Noor Basanta Das ◽  
Malaya Kumar Biswal M
Keyword(s):  
New Technologies ◽  
Space Station ◽  
Federal Budget ◽  
The United States ◽  
The Moon ◽  
International Space ◽  
The Earth ◽  
The Right ◽  
Do So

Be it harsh snowy mountains or dry hostile deserts, wherever there is space to expand into humans have done so boldly. With Earth mostly discovered and inhabited it is hardly surprising that many countries, organizations and space agencies are already making preparations to build permanent settlements and bases throughout the solar system starting with the Moon and Mars. The Moon our only satellite and the closest celestial body to the Earth is the next logical step in the ladder to becoming an interplanetary civilization. We have the technology to do so and NASA’s current estimates say it could be possible with a budget of 20 to 40 billion Dollars spread over the time of a decade. This budget is comparable to that of the International Space Station or a mere 1% of the United States Federal Budget in 2019. A small investment with an immeasurable payoff if done right. This is a step in the right direction towards becoming a type 2 civilization on the Kardashev scale, develop new technologies and discover new sources of energy.

scholarly journals Internal Sources of Labour Productivity Growth in Russia

2020 ◽  
Vol 14 (2) ◽  
pp. 32-43
Author(s):  
E. V. Balatsky ◽  
N. A. Ekimova
Keyword(s):  
New Technologies ◽  
Labour Productivity ◽  
The United States ◽  
Economic Losses ◽  
Russian Regions ◽  
New Production ◽  
High Productivity ◽  
Labour Productivity Growth ◽  
Ability To Act ◽  
The Right

In this article, the authors analysed the readiness of Russian regions for the integration of technological innovations. In this context, managerial dichotomy “borrowing/creation of innovations” is of fundamental importance. The right choice of the way to increase productivity in the regions of the country represents a nontrivial task since the wrong solution would lead to significant economic losses. The authors proposed to use the concept of technological boundary to increase objectivity managerial decisions making. “Technological boundary” means the relative productivity of the region corresponding to the average productivity in the United States, the excess of which allows the region to develop new production technologies. The use of the concept of technological frontier and comparison of labour productivity in the Russian regions showed that only two regions in the country could act as drivers for the development of their own new technologies. At the same time, the available data and calculations show that in many regions there are leading companies of different industries with extremely high productivity and ability to act as innovative local drivers within the regions. This circumstance made it possible to formulate a multi-step strategy to accelerate the technological diffusion for Russia.

scholarly journals A Physician’s Commentary on Electronic Health Records in the United States Medical Practice

2021 ◽  
Vol 6 (1) ◽  
pp. 9-11
Author(s):  
Irina V. Angel ◽  
Keyword(s):  
United States ◽  
Electronic Health Records ◽  
New Technologies ◽  
Healthcare Providers ◽  
The United States ◽  
Point Of View ◽  
Health Records ◽  
Electronic Health ◽  
Healthcare Innovation ◽  
The Right

This commentary presents a point of view on how the arrival of electronic health records (EHR) in the United States (U.S.) has changed physicians’ practice. EHR implementation has pros and cons. EHR systems have been a great asset during the pandemic and help with efficiency, safety, and cost reduction. Despite their benefits, healthcare providers and organizations still face challenges, including usability and interoperability across systems, contributing to physicians’ burnout. Can physicians adopt new technologies and adapt to current challenges? Is it the right time for physicians to stop being observers and become active participants in the process of healthcare innovation and implementation?

scholarly journals Androgen deprivation and immunotherapy for the treatment of prostate cancer

2017 ◽  
Vol 24 (12) ◽  
pp. T297-T310 ◽  
Author(s):  
Melissa Gamat ◽  
Douglas G McNeel
Keyword(s):  
Prostate Cancer ◽  
Immune System ◽  
Metastatic Prostate Cancer ◽  
The United States ◽  
Primary Treatment ◽  
Androgen Deprivation ◽  
Newly Diagnosed ◽  
Recurrent Prostate Cancer ◽  
System A ◽  
Different Types

Prostate cancer is the most common newly diagnosed malignancy in men, and the second most common cause of cancer-related death in the United States. The primary treatment for recurrent prostate cancer is androgen deprivation, and this therapy is typically continued lifelong for patients with metastatic prostate cancer. Androgens and androgen deprivation have profound effects on the immune system, a finding that has become more appreciated in an era where immune-based treatments for cancer are being increasingly explored. Preclinical studies suggest that androgen deprivation could potentially positively or negatively affect the use of approved immunotherapies, or those that are being developed for the treatment of prostate cancer. In this review, we provide a brief overview of the different types of androgen deprivation treatments used in the management of prostate cancer, discuss their effects on prostate tumors and the immune system and how they are being explored in combination with immunotherapy. Finally, we address some of the critical questions in the field that must be answered to identify the best approaches to combine androgen deprivation with immunotherapy for the treatment of prostate cancer.

scholarly journals Inherited genetic variant predisposes to aggressive but not indolent prostate cancer

2010 ◽  
Vol 107 (5) ◽  
pp. 2136-2140 ◽  
Author(s):  
Jianfeng Xu ◽  
Siqun Lilly Zheng ◽  
Sarah D. Isaacs ◽  
Kathleen E. Wiley ◽  
Fredrik Wiklund ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
The United States ◽  
Recessive Model ◽  
Independent Study ◽  
Common Disease ◽  
Low Grade ◽  
Significance Level ◽  
Aggressive Disease ◽  
Aging Men

Autopsy studies suggest that most aging men will develop lesions that, if detected clinically, would be diagnosed as prostate cancer (PCa). Most of these cancers are indolent and remain localized; however, a subset of PCa is aggressive and accounts for more than 27,000 deaths in the United States annually. Identification of factors specifically associated with risk for more aggressive PCa is urgently needed to reduce overdiagnosis and overtreatment of this common disease. To search for such factors, we compared the frequencies of SNPs among PCa patients who were defined as having either more aggressive or less aggressive disease in four populations examined in the Genetic Markers of Susceptibility (CGEMS) study performed by the National Cancer Institute. SNPs showing possible associations with disease severity were further evaluated in an additional three independent study populations from the United States and Sweden. In total, we studied 4,829 and 12,205 patients with more and less aggressive disease, respectively. We found that the frequency of the TT genotype of SNP rs4054823 at 17p12 was consistently higher among patients with more aggressive compared with less aggressive disease in each of the seven populations studied, with an overall P value of 2.1 × 10−8 under a recessive model, exceeding the conservative genome-wide significance level. The difference in frequency was largest between patients with high-grade, non–organ-confined disease compared with those with low-grade, organ-confined disease. This study demonstrates that inherited variants predisposing to aggressive but not indolent PCa exist in the genome, and suggests that the clinical potential of such variants as potential early markers for risk of aggressive PCa should be evaluated.

scholarly journals Foreign aggairs of the customs organization and operation activities on the example United States of America

2020 ◽  
pp. 112-116
Author(s):  
V.O. Khoma ◽  
V.P. Zhdanov
Keyword(s):  
United States ◽  
United States Of America ◽  
New Technologies ◽  
Developed Countries ◽  
The United States ◽  
Court Order ◽  
Federal Bureau Of Investigation ◽  
Government Body ◽  
Search Warrant ◽  
The Right

In modern developed countries it is important to protect national economic interests, and therefore there is a need to improve cooperation between customs authorities to combat smuggling and the illegal movement of goods across the customs border of the countries. This article focuses on the study of foreign experience of functioning of the bodies authorised to apply measures of operational-search activities in the system of combating smuggling and illegal movement of goods across the customs border by the example of the United States of America. Every year the customs border of America cross goods valued at a trillion dollars as the total imports, and therefore the customs authorities of the United States of America require the improvement of existing technologies for the protection of the state border. New technologies play a crucial role in the customs of the United States of America. Today in America, the custom is the only governmental Agency in which its officials have the authority for the inspection of people, goods and vehicles crossing the border without a search warrant. It should be noted that the customs service of the United States of America has also partnered with the police departments, the Federal Bureau of investigation in providing customs information that would allow them to detect, and in some cases to predict organized crime, i.e. the police investigate. In addition, the customs service of the United States of America, as the main government body that has the right to apprehend criminals at the border, faced with a complex, multifaceted threat to the smuggling of goods, narcotic drugs and so on. But because the customs service is working on these tasks with the use of modern achievements of science and practice through a variety of approaches, directions: intelligence, operational, experienced, which bring a positive result. In case of detection by customs officers of the United States of America violations of the customs legislation, they have the right to conduct an investigation on this fact, as well as having the right to seize the goods which are subject to export outside the country. In addition, the customs authorities of the United States of America have the right to confiscate without a court order any goods that you intended to illegally vivactis from the country, and vehicle that was to be used for these purposes.

scholarly journals Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer

2016 ◽  
Vol 6 ◽  
pp. 18 ◽  
Author(s):  
Daniel Corey Oppenheimer ◽  
Eric P Weinberg ◽  
Gary M Hollenberg ◽  
Steven P Meyers
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Treatment Options ◽  
Specific Antigen ◽  
Focal Therapy ◽  
External Beam Radiation ◽  
Common Disease ◽  
Recurrent Prostate Cancer ◽  
Beam Radiation ◽  
Contrast Enhanced

Multiparametric magnetic resonance (MR) imaging of the prostate combines both morphological and functional MR techniques by utilizing small field of view T1-weighted, T2-weighted, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy to accurately detect, localize, and stage primary and recurrent prostate cancer. Localizing the site of recurrence in patients with rising prostate-specific antigen following treatment affects decision making regarding treatment and can be accomplished with multiparametric prostate MR. Several different treatment options are available for prostate cancer including radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, or a number of focal therapy techniques. The findings of recurrent prostate cancer can be different depending on the treatment the patient has received, and the radiologist must be able to recognize the variety of imaging findings seen with this common disease. This review article will detail the findings of recurrent prostate cancer on multiparametric MR and describe common posttreatment changes which may create challenges to accurate interpretation.

scholarly journals Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?

2020 ◽  
Vol 15 (4) ◽  
Author(s):  
Shiva Madhwan Nair ◽  
Andrew Warner ◽  
Arnon Lavi ◽  
George Rodrigues ◽  
Joseph Chin
Keyword(s):  
Prostate Cancer ◽  
Propensity Score ◽  
Local Treatment ◽  
Prostate Cancer Risk ◽  
High Intensity Focused Ultrasound ◽  
Recurrent Prostate Cancer ◽  
Cancer Specific Survival ◽  
Ablation Therapy ◽  
Systemic Treatments ◽  
The Impact

Introduction: Some men who experience prostate cancer recurrence post-radiotherapy may be candidates for local salvage therapy, avoiding and delaying systemic treatments. Our aim was to assess the impact of clinical outcomes of adding salvage local treatment in prostate cancer patients who have failed radiation therapy. Methods: Following radiation biochemical failure, salvage transperineal cryotherapy (sCT, n=186), transrectal high intensity focused ultrasound ablation (sHIFU, n=113) or no salvage treatment (NST, identified from the pan-Canadian Prostate Cancer Risk Stratification [ProCaRS] database [n=982]) were compared with propensity-score matching. Primary endpoints were cancer-specific survival (CSS) and overall survival (OS). Results: Median followup was 11.6, 25.1, and 14.3 years following NST, sCT, and sHIFU, respectively. Two propensity-score matched analyses were performed: 1) 196 NST vs. 98 sCT; and 2) 177 NST vs. 59 sHIFU. In the first comparison, there were 78 deaths and 49 prostate cancer deaths for NST vs. 80 deaths and 24 prostate cancer deaths for sCT. There were significant benefits in CSS (p<0.001) and OS (p<0.001) favoring sCT. In the second comparison, there were 52 deaths (31 from prostate cancer) for NST vs. 18 deaths (nine from prostate cancer) for sHIFU. There were no significant differences in CSS or OS possibility attributed to reduced sample size and shorter followup of sHIFU cohort. Conclusions: In select men with recurrent prostate cancer post-radiation, further local treatment may lead to benefits in CSS. These hypothesis-generating findings should ideally be validated in a prospective clinical trial setting.

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