Wednesday’s prostate cancer update: November 12, 2008

In today’s reports, we include items on:

  • The diagnosis and management of post-RP stress incontinence
  • Another review of MRI in diagnosis of prostate cancer
  • More on the potential of the PCA3 test in diagnosis of prostate cancer
  • Results of early data on salvage LRP by a highly skilled team

Bauer et al. have reviewed current data on the diagnosis and management of post-surgical stress incontinence in patients treated with radical prostatectomy for prostate cancer. Their summary notes that the European Association of Urology recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. They further note that treatment with duloxetine (Cymbalta) is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter is still the gold standard. They conclude that several minimal invasive treatment options have been introduced with different rates of success in recent years, but they have not yet surpassed the results of the artificial sphincter.

Another group of authors (Cornud et al., in France) has reviewed the current data on the role of magnetic resonance imaging (MRI) in the diagnosis of prostate cancer.

Schmitz-Dräger et al. have added to appreciation of the potential value of the PCA3 test in the diagnosis of prostate cancer in men with an elevated PSA level, a negative DRE, and a negative initial biopsy, with or without a finasteride challenge.

One highly skilled and experienced surgical team (see Liatsikos et al.) has reported excellent results with salvage laparoscopic radical prostatectomy in a small number of patients following failure of treatment with first-line brachytherapy, external beam radiation, or high intensity focused ultrasound (HIFU). However, it should be noted that these results probably reflect the considerable skill and experience of this sugical team. We doubt if the average urology group could replicate these results at this time. The data emphasize the importance of surgical skill in carrying out any form of salvage surgical procedure as a second line treatment.

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