The role of enzalutamide in the treatment of castration-resistant prostate cancer.

Prostate cancer is the most common solid organ cancer affecting the male population. Men with metastatic prostate cancer treated with androgen ablation therapy often respond rapidly, with improvement in bone pain and decreases in serum prostate-specific antigen. However, almost all patients progress to the castration-resistant state and abiraterone acetate was the last treatment available with proven survival benefit. Enzalutamide (formerly MDV3100) is an androgen receptor signaling inhibitor that has been shown to improve survival in men with metastatic castration-resistant prostate cancer previously treated with chemotherapy. In this article we discuss the characteristics of enzalutamide and provide a review of its clinical development.

Prostatic length predicts functional outcomes after iodine-125 prostate brachytherapy.

PURPOSE: To determine the value of prostatic length as a predictor of urinary morbidity after brachytherapy for prostate cancer. METHODS AND MATERIALS: Between May 2002 and September 2008, 214 consecutive patients received brachytherapy for localized prostate cancer at our institution. A prospective analysis of factors predicting urinary toxicity was carried out for these patients. To evaluate urinary morbidity, the posttreatment International Prostate Symptom Score (IPSS) at 3, 9, and 18 months together with rates of urinary retention was recorded. RESULTS: The mean patient age was 62 years, and the mean followup period was 24.4 months. The median IPSS before treatment was 5 (range, 0-20). This increased to 15 (0-33) at 3 months, before subsequently falling to 8 (0-31) and 6 (0-35) at 9 and 18 months, respectively. Twenty-six of 214 (12%) patients experienced urinary retention. Both prostatic length (p-value=0.001, <0.001) and volume (p-value=0.002, <0.001) correlated with a higher posttreatment IPSS at 3 and 9 months. In addition, prostate length and volume predicted those patients developing urinary retention requiring catheterization (p-value <0.001, <0.001). Pretreatment IPSS predicted IPSS at 3, 9, and 18 months (p-value <0.001, <0.001, and 0.011) but did not significantly correlate with retention rates. Other factors predicting IPSS at 3 months included radiation dose (D(90)) (p-value=0.01) and number of needles used (p-value=0.01). CONCLUSION: Prostatic length is a useful tool for determining urinary toxicity after brachytherapy for prostate cancer and should be included in the pretreatment assessment.

Brachytherapy for prostate cancer: is the pretreatment prostate volume important?

OBJECTIVE: To prospectively determine the effect of prostate volume on lower urinary tract symptoms (LUTS) in terms of changes in the International Prostate Symptom Score (IPSS), and to determine whether prostate volume affects the retention rate after brachytherapy, as there is concern that patients with larger prostates might develop more troublesome LUTS after brachytherapy. PATIENTS AND METHODS: We prospectively identified 100 consecutive patients who had brachytherapy for prostate cancer, using a real-time three-dimensional seed implantation technique, at one institution. At each follow-up review the IPSS was recorded. To determine the effect of prostate volume on the IPSS after treatment the patients were divided into two groups according to prostate volume at brachytherapy (<50 and >or=50 mL). RESULTS: The median patient age was 62 years, the overall median prostate volume was 42 mL and the median intraoperative D90 was 190 Gy. The pretreatment IPSS was 4 and 8 for the <50 and >or=50 mL groups, respectively, and at 3 months after brachytherapy the median IPSS increased to 18 and 20 for the two groups, respectively. Eleven patients went into acute retention of urine after brachytherapy (six in the >or=50 mL group). CONCLUSIONS: This study shows that patients with prostates of >or=50 mL have an IPSS comparable with those who have prostates of <50 mL. Large prostates should not be considered an exclusion criterion when an intraoperative planning technique is used for brachytherapy.