Prostate Cancer: A Comprehensive Perspective Ash Tewari, MD Ronald P. Lynch Professor of Urologic-Oncology Director Weill Cornell Medical College and New York Presbyterian Hospital Center for Prostate Cancer Research and Clinical Care (CPCR&CC) Director Lefrak Center of Robotic Surgery, NYPH Ashutosh Tewari Editor Prostate Cancer: A Comprehensive Perspective Editor Ashutosh Tewari New York Presbyterian Hospital Brady Urologic Health Center Weill Cornell Medical Center New York New York USA ISBN 978-1-4471-2863-2 ISBN 978-1-4471-2864-9 (eBook) DOI 10.1007/978-1-4471-2864-9 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2013931841 © Springer-Verlag London 2013 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Prostate cancer has become a worldwide problem, not only in the developed world but in developing countries as well. As the population ages worldwide and other diseases become less frequent causes of premature death, prostate cancer, which rapidly increases in frequency with age, will present a growing public health problem. Prostate cancer is a complex and het- erogeneous disease. The ratio of deaths to new cases is one of the lowest of any of the major internal organ solid tumors. It is well known that most men die with, rather than of, prostate cancer, a paradox that has long stymied widespread understanding and the easy development of consensus about the management of this disease. Fortunately, clinical and basic research in the past 20 years have provided important tools that have enormously facilitated our understanding of prostate cancer, the ability to predict the course of the disease and the outcomes of various treatments. Today we can add to the standard clinical factors (stage, grade, PSA and biopsy results) the burgeoning technology of medical imaging (especially magnetic resonance imaging) and the more recent molecular characteriza- tions that could greatly enhance our ability to identify the threat posed by the cancer in any given patient. Further characterization of prostate cancer seems highly likely over the next decade with the expanding use of genomic analysis. The worldwide effort to characterize the prostate cancer genome will prove enormously fruitful and markedly increase our ability to discriminate between potentially lethal and indolent prostate cancers. The biomarker prostate speci fi c antigen (PSA) has revolutionized our understanding and ability to manage this disease. While PSA testing has proved the source of enormous debate over the last decade, it is clear that PSA is the best biomarker available in oncology. Recent studies have shown that a man’s PSA levels in his 40s, 50s, and 60s strongly predict the likeli- hood that he will ever develop advanced prostate cancer or die of the disease. Nevertheless, controversy swirls around the optimum protocol for PSA testing, the age of onset of testing, and the cost bene fi t of screening for prostate cancer. Epidemiological data show that in coun- tries where screening has been widely used, mortality from prostate cancer has been declining steadily and rapidly. Today, in the United States, the age-speci fi c mortality rate from prostate cancer has fallen by nearly 50 % over the last 15 years. The treatment of prostate cancer is also undergoing revolutionary changes. Technology has expanded the surgical options for radical prostatectomy, which now include robotic and free- hand laparoscopic as well as open retropubic and perineal techniques. Radiation therapy has also bene fi ted from a technological advance. Intensity-modulated radiation has allowed us to safely deliver doses as high as 86 Gy to the prostate, and image guidance promises to target the prostate more accurately, improving cancer control. Many centers have developed combina- tions of interstitial radiation (brachytherapy) with external beam radiation to deliver higher doses. Proponents of proton beam therapy argue that it offers an even greater therapeutic index, although there is little clinical data to support the contention. For those with metastatic prostate cancer, this is indeed an exciting era. There are over 100 new drugs in the pipeline for commercial development in the United States alone. Phase III clinical trials have shown substantially increased survival with new drugs that target the andro- gen receptor, such as abiraterone and Medivation 3100. The fi rst immunotherapy approved for use in human cancer was sipuleucel-T, approved for prostate cancer. Other exciting approaches v vi Foreword include immunomodulation with anti-CTLA4 antibodies and with monoclonal antibodies tar- geting B7x and other immunoinhibitory targets. These and many other exciting developments in prostate cancer are addressed in detail in this remarkable new book edited by Ashutosh Tewari and an international team of associate editors. Every possible aspect of prostate cancer is covered by a recognized authority in the fi eld. For those deeply interested in understanding this disease, especially clinical and labora- tory investigators, and for physicians and surgeons who devote their careers to treating men with prostate cancer, this book is a major new addition to the fi eld. Peter T. Scardino Contributors Associate Editors Anthony J. Costello, M.D., FRACS Professor, Royal Melbourne Hospital, Department of Urology, 32 Erin Street, Richmond, Victoria 3121, Australia; 61-3-9429-9555; [email protected] vii viii Contributors Mahesh Desai, M.S., FRCS (Eng), FRCS (Edin) Medical Director, Muljibhai Patel Urological Hospital, Department of Urology, Dr. V.V. Desai Road, Nadiad, Gujarat 387 001, India; +91 268 2520323; fax +91 268 2520248; [email protected] James A. Eastham, M.D. Chief, Urology Service, Memorial Sloan-Kettering Cancer Center, Department of Surgery, 1275 York Avenue, New York, NY 10065, USA; 646-422-4390; fax 212-988-0806; [email protected] Contributors ix John M. Fitzpatrick, MCh, FRCSI, FC Urol (SA), FRCSGlas, FRCS Head of Research, Irish Cancer Society, 43/45 Northumberland Road, Dublin 4, Ireland; Professor of Surgery, Consultant Urologist, Mater Misericordiac Hospital, University College, Dublin, Ireland; +353 1 231 0564; fax +353 1 231 0555; j fi [email protected] Martin Gleave, M.D., FRCSC, FACS British Columbia Leadership Chair; Distinguished University Scholar; Professor, Department of Urological Sciences, UBC; Director, The Vancouver Prostate Centre; Vancouver General Hospital, Vancouver Prostate Centre, DHCC, 6th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; 604-875-5006; fax 604-875-5024; [email protected] x Contributors David Neal, FMedSci, M.S., FRCS Professor of Surgical Oncology, University of Cambridge/Addenbrooke’s Hospital, Department of Oncology/Department of Urology, Box 279(S4), Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; 01223 331940; fax 01223 769007; [email protected] Contributors xi Francisco J. B. Sampaio, M.D., Ph.D. Full Professor and Chairman, Urogenital Research Unit, State University of Rio de Janeiro; University Hospital, State University of Rio de Janeiro, Department of Surgery, Rua Siqueira Campos, 30-1101, Copacabana, Rio de Janeiro 22031-070, Brazil; +55 21 9974-8168; +55 21 2548-0636; [email protected] xii Contributors Prasanna Sooriakumaran, BMedSci (Hons), BMBS (Hons), MRCS, Ph.D., PGCMedLaw, FRCS (Urol), ADC (ClinInv) New York Presbyterian Hospital/Weill Cornell Medical College, James Buchanan Brady Foundation Department of Urology, 525 East 68th Street, New York, NY 10065, USA; [email protected] Contributors xiii E. Darracott Vaughan, Jr., M.D. Professor Emeritus, Weill Cornell Medical College, New York Presbyterian Hospital, Department of Urology, 525 East 68th Street, New York, NY 10065, USA; [email protected]