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Prostate Cancer Update
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Barrett, T., et al. (2024). "Update on Optimization of Prostate MR Imaging Technique and Image Quality." Radiologic Clinics 62(1): 1-15: https://doi.org/10.1016/j.rcl.2023.06.00 URL
High-quality prostate MR imaging is a pre-requisite for accurately identifying lesions, with lower image quality is associated with increased uncertainty in MRI decision-making
Compliance with Prostate Imaging-Reporting and Data System (PI-RADS) technical parameters helps improve image quality but does not guarantee this
Patient-related degradations independently influence quality and potentially only allow for partial mitigation via rectal preparation, spasmolytics, novel diffusion techniques,
Bergengren, O., et al. (2023). "2022 Update on Prostate Cancer Epidemiology and Risk Factors—A Systematic Review." European Urology 84(2): 191-206: https://www.sciencedirect.com/science/article/pii/S0302283823027860
Context Prostate cancer (PCa) is one of the most common cancers worldwide. Understanding the epidemiology and risk factors of the disease is paramount to improve primary and secondary prevention strategies. Objective To systematically review and summarize the current evidence on the descriptive epidemiology, large screening studies, diagnostic techniques, and risk factors of PCa. Evidence acquisition PCa incidence and mortality rates for 2020 were obtained from the GLOBOCAN database of the International Agency for Research on Cancer. A systematic search was performed in July 2022 using PubMed/MEDLINE and EMBASE biomedical databases. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42022359728). Evidence synthesis Globally, PCa is the second most common cancer, with the highest incidence in North and South America, Europe, Australia, and the Caribbean. Risk factors include age, family history, and genetic predisposition. Additional factors may include smoking, diet, physical activity, specific medications, and occupational factors. As PCa screening has become more accepted, newer approaches such as magnetic resonance imaging (MRI) and biomarkers have been implemented to identify patients who are likely to harbor significant tumors. Limitations of this review include the evidence being derived from meta-analyses of mostly retrospective studies. Conclusions PCa remains the second most common cancer among men worldwide. PCa screening is gaining acceptance and will likely reduce PCa mortality at the cost of overdiagnosis and overtreatment. Increasing use of MRI and biomarkers for the detection of PCa may mitigate some of the negative consequences of screening. Patient summary Prostate cancer (PCa) remains the second most common cancer among men, and screening for PCa is likely to increase in the future. Improved diagnostic techniques can help reduce the number of men who need to be diagnosed and treated to save one life. Avoidable risk factors for PCa may include factors such as smoking, diet, physical activity, specific medications, and certain occupations.
Hadfield, M. J., et al. (2023). "Updates in the Treatment of Non-Metastatic Castrate-Resistant Prostate Cancer: The Benefit of Second-Generation Androgen Receptor Antagonists." Annals of Pharmacotherapy 57(11): 1302-1311: https://journals.sagepub.com/doi/abs/10.1177/10600280231155441
Objective:To review pharmacology, efficacy, safety, and considerations for use, of second-generation androgen receptor (AR) antagonists in treatment of nonmetastatic castrate-resistant prostate cancer (M0CRPC).Data Sources:Conducted search in PubMed and Google scholar (January, 1, 2002—December 31, 2022), using relevant terms.Study Selection and Data Extraction:Relevant English-language studies, conducted in humans evaluating second-generation AR antagonists for M0CRPC, and additional articles and package inserts were considered.Data Synthesis:Apalutamide, darolutamide, and enzalutamide are effective in delaying the time to development of metastatic prostate cancer in men with M0CRPC with a rapid prostate-specific antigen (PSA) doubling time (<10 months). No head-to-head, randomized, clinical trials have been conducted. The most common adverse effects include fatigue and hypertension, and quality of life is maintained in most patients. Cost is similar among the agents (~$15,000/month). Drug-drug interactions vary among these agents and should be considered, when selecting therapy as well as likely adherence. Darolutamide is administered twice daily with the others once daily.Relevance to Patient Care and Clinical Practice:Second-generation AR antagonists are effective in reducing time to development of metastatic disease and prolonging overall survival in patients with M0CRPC and a PSA doubling time of <10 months. Recent imaging advances may alter how we evaluate outcomes.Conclusions:Second-generation AR antagonists improve disease control and overall survival. Generally, they are well tolerated and QOL is maintained. Selection of the best agent is based on the adverse effect profile, potential for drug- and disease-interactions, administration, cost, and patient preference.
Moses, K. A., et al. (2023). "NCCN Guidelines® Insights: Prostate Cancer Early Detection, Version 1.2023: Featured Updates to the NCCN Guidelines." Journal of the National Comprehensive Cancer Network 21(3): 236-246: https://jnccn.org/view/journals/jnccn/21/3/article-p236.xml
Virgo, K. S., et al. (2023). "Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update." Journal of Clinical Oncology 41(20): 3652-3656: https://ascopubs.org/doi/abs/10.1200/JCO.23.00155
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