Abiraterone acetate for early stage metastatic prostate cancer: patient selection and special considerations.

In recent years, therapeutic advances, together with new medication sequences and combinations, have improved outcomes for prostate cancer. For a long time, androgen deprivation therapy (ADT) has been the standard of care for newly diagnosed, metastatic prostate cancer, first as a standalone therapy and then in combination with taxane-based regimens. More recently, the addition of abiraterone acetate to ADT to achieve complete androgen blockade has proven beneficial for the treatment of metastatic hormone-resistant prostate cancer and metastatic hormone-sensitive prostate cancer (mHSPC). In this review, we summarize recent findings on the early use of abiraterone in mHSPC and discuss survival benefits as reported in clinical trials. On the basis of existing data, abiraterone in combination with ADT could be considered a new standard of care for patients affected by mHSPC.

Diagnostic accuracy of biparametric vs multiparametric MRI in clinically significant prostate cancer: Comparison between readers with different experience.

BACKGROUND: MRI plays a crucial role to identify men with a high likelihood of clinically significant prostate cancer who require immediate biopsy. The added value of DCE MRI in combination with T2-weighted imaging and DWI is controversial (risks related to gadolinium administration, duration of MR exam, financial burden, effects on diagnostic performance). A comparison of a biparametric and a standard multiparametric MR imaging protocol, taking into account the different experience of the readers, may help to choose the best MR approach regarding diagnostic performance. PURPOSE: To determine the added value of dynamic contrasted-enhanced imaging (DCE) over T2-weighted imaging (T2-WI) and diffusion weighted imaging (DWI) for the detection of clinically significant prostate cancer, and to evaluate how it affects the diagnostic performance of three readers with different grade of experience in prostate imaging. MATERIALS AND METHODS: Eighty-five patients underwent prostate MR examination at 1.5 T MR scanner performed because of elevated prostate-specific antigen level and/or suspicion of prostate cancer at digital rectal examination. Two MR images sets (Set 1 = biparametric, Set 2 = multiparametric) were retrospectively and independently scored by three radiologists with 7, 3 and 1 years of experience in prostate MR imaging respectively, according to PI-RADS v2. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated by dichotomizing reader scores. Receiver operating characteristic (ROC) analysis was performed and areas under the curve (AUCs) were calculated for each reader and image set. A comparison of ROC curves was performed to test the difference between the areas under the ROC curves among the three readers. RESULTS: There was no significant difference regarding the detection of clinically significant tumor among the three readers between the two image sets. The AUC for the bi-parametric and multi-parametric MR imaging protocol was respectively 0.68-0.72 (Reader 1), 0.72-0.70 (Reader 2) and 0.60-0.54 (Reader 3). ROC curve comparison revealed no statistically significant differences for each protocol among the most experienced (Reader 1) and the other readers (Readers 2-3). CONCLUSION: The diagnostic accuracy of a bi-parametric MR imaging protocol consisting of T2-weighted imaging and DWI is comparable with that of a standard multi-parametric imaging protocol for the detection of clinically significant prostate cancer. The experience of the reader does not significantly modify the diagnostic performance of both MR protocols.

A multidisciplinary group for prostate cancer management: A single institution experience.

Increased knowledge regarding the heterogeneity of Prostate Cancer (PC) and its variable outcomes has generated controversy over the best clinical approach. Nowadays, it is well-known that patient outcomes and clinical management may be improved by an efficient organization of the national health care system. The Interdisciplinary Group for Oncological Care (GICO) for PC patients was created by our healthcare management company in September 2010. Since then, a multidisciplinary internal report was applied to PC patients. This report highlights our methodology and experience of planning a GICO, and illustrates the results obtained for the management of PC patients before and after the adopted GICO criteria in a single institution, the SS Annunziata Hospital (Chieti, Italy).