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Radionuclide-based Diagnosis and Therapy of Prostate Cancer
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Sven-Erik Strand, Mohamed Altai, Joanna Strand, David Ulmert
Localized PCa is treated with surgery and/or EBRT. For those patients having advanced androgen sensitive disease, the standard treatment is usually different forms of androgen deprivation therapy. If the disease progresses to castration-resistant PCa (CRPC), the prognosis becomes poor, with an expected survival of less than 19 months for patients with metastases. Commonly, CRPC is treated with the continuation of androgen deprivation, chemotherapy, and EBRT. When the tumour progresses to a lethal form, there are no effective long-term treatments.
Urology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Management is palliative with the hope of long-term control of the cancer/symptoms. Androgen deprivation therapy, usually with an LHRH agonist (e.g. goserelin [Zoladex], see box) or antagonist (e.g. degarelix). Bilateral orchidectomy is a surgical optionPatients who are fit enough can have chemotherapy (e.g. docetaxel) or abiraterone (which blocks tumour production of testosterone) along with androgen deprivation therapy
Prostate Cancer
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
The plasma testosterone initially rises (the tumour flare), so an anti-androgen, such as bicalutamide, is given for 3 days before and 3 weeks after starting an LHRH agonist. The remainder all are recorded side effects for androgen deprivation therapy, anti-androgens have similar side effects but with better preservation of potency and libido.
Clinically feasible and prospective immunotherapeutic interventions in multidirectional comprehensive treatment of cancer
Published in Expert Opinion on Biological Therapy, 2021
Victor I. Seledtsov, Alexei von Delwig
Anti-hormonal strategies with a profound impact on cancer in clinical settings are based on using drugs that suppress hormonal proliferative signals, such as anti-androgen anti-estrogen therapies for prostate and breast cancer, respectively. Androgen-deprivation therapy is a current standard of care, which aims to remove circulating androgens that drive prostate cancer growth. Indeed, androgens possess immunosuppressive properties, thus laying a foundation for an anti-androgen therapy-mediated stimulation of anti-tumor immune reactivity. Consistent with this notion, combinations of anti-androgen therapy with checkpoint molecule inhibition have shown moderate success in prostate cancer treatment. When combined with anti-androgen therapy, vaccine-based approaches also exhibited detectable immunological and clinical efficiency [142]. Anti-estrogen therapy combined with cytotoxic anti-human epidermal growth factor receptor 2 (HER2) Abs (a common breast cancer treatment) was shown to stimulate anti-tumor immune responses and improved pathologic response rates in patients with HER2pos/ERpos early breast cancer [44]. An addition of anti-estrogen therapy to anti-HER2 dendritic cell vaccination improved regional nodal immune responses and pathologic complete response rates in patients with HER2pos breast cancer [143]. Different immune-based interventions in combination with anti-hormone therapy are currently investigated in clinical studies.
Evidence-based medicine, the number ‘three’ and its multiples in urological clinical rules
Published in Scandinavian Journal of Urology, 2021
Georges Mjaess, Fouad Aoun, Simone Albisinni, Michel Vanhaeverbeek, Thierry Roumeguère
Speaking about prostate cancer, the number of prostatic biopsy cores follows also the rule of three. At first, sextant systematic biopsy was proposed, and then, it increased to 12 cores, a maximal number demonstrated to be sufficient. However, nomograms determining the number of core biopsies based on the patient age and prostate volume have been published and reported that this number can range from 6 to 12 [8]. Moreover, concerning duration of androgen deprivation therapy when combined with radiotherapy for prostate cancer, Bolla et al. [9] have shown that a duration of ‘6 months’ is inferior to ‘3 years’ without a clear explanation to the choice of duration; then, a duration of ‘18 months’ was shown to be non-inferior to ‘36 months’ [10]. We can also mention the ‘trifecta’ of prostate cancer survival combining cancer control, continence and maintenance of sexual potency.
Downregulating testosterone levels enhance immunotherapy efficiency
Published in OncoImmunology, 2021
Luoyang Wang, Guoqiang Jiang, Nan Jing, Xuerun Liu, Huiren Zhuang, Wenfeng Zeng, Wei Liang, Zheng Liu
Disruption of gut microbiota with antibiotics, especially the broad-spectrum antibiotics has been associated with poor outcomes of tumor immunotherapy.24,45,46 In the present study, a detrimental effect of the narrow spectrum antibiotic colistin also appeared in female mice (Figure 5e). However, the antitumor efficiency of anti-PD-L1 was significantly enhanced by colistin in male mice through downregulating the sex hormone levels (Figure 5f). Although the precise mechanisms remain to be investigated in the future, colistin can notably impact the sex hormone levels of male mice without severe destruction of gut microbial diversity (Figure S1A). The gut microbiota plays a vital role in the intestinal androgen reabsorption through deglucuronidation of testosterone and dihydrotestosterone,47 thus serving as a new possible target for androgen regulation during tumor immunotherapy. Traditional androgen deprivation therapy can cause adverse effects including bone loss, metabolic changes, gynecomastia, increased cardiovascular events,48 and suppress the efficiency of antitumor immunotherapy.19 Thus, downregulation of testosterone levels through regulation of gut microbiota with certain antibiotics may present a novel way to enhance the efficiency of antitumor immunotherapy.