Indications and practice with androgen deprivation therapy

ProCanBio: A Database of Manually Curated Biomarkers for Prostate Cancer

Prostate cancer (PCa) is the second lethal malignancy in men worldwide. In the past, numerous research groups investigated the omics profiles of patients and scrutinized biomarkers for the diagnosis and prognosis of PCa. However, information related to the biomarkers is widely scattered across numerous resources in complex textual format, which poses hindrance to understand the tumorigenesis of this malignancy and scrutinization of robust signature. To create a comprehensive resource, we collected all the relevant literature on PCa biomarkers from the PubMed. We scrutinize the extensive information about each biomarker from a total of 412 unique research articles. Each entry of the database incorporates PubMed ID, biomarker name, biomarker type, biomolecule, source, subjects, validation status, and performance measures such as sensitivity, specificity, and hazard ratio (HR). In this study, we present ProCanBio, a manually curated database that maintains detailed data on 2053 entries of potential PCa biomarkers obtained from 412 publications in user-friendly tabular format. Among them are 766 protein-based, 507 RNA-based, 157 genomic mutations, 260 miRNA-based, and 122 metabolites-based biomarkers. To explore the information in the resource, a web-based interactive platform was developed with searching and browsing facilities. To the best of the authors' knowledge, there is no resource that can consolidate the information contained in all the published literature. Besides this, ProCanBio is freely available and is compatible with most web browsers and devices. Eventually, we anticipate this resource will be highly useful for the research community involved in the area of prostate malignancy.

Hormone naïve prostate cancer: predicting and maximizing response intervals

Hormone naïve advanced prostate cancer is subdivided into two disease states: biochemical recurrence and traditional M1 (metastatic) prostate cancer and characterized by no prior hormonal therapy or androgen deprivation therapy (ADT). In biochemical recurrence/prostate-specific antigen (PSA) recurrence, men should be risk-stratified based on their PSA doubling time, the Gleason score and the timing of the recurrence. In general, only men who are at high risk should be considered for early/immediate ADT although this is best done using shared decision with the patient. The type of ADT to be used in biochemical recurrence ranging from oral-only peripheral blockade (peripheral androgen deprivation) to complete hormonal therapy (combined androgen blockade [CAB]) remains in debate owing to lack of randomized controlled trials (RCT). However, there is good RCT support for use of intermittent hormonal therapy (IHT). There is also limited research on biomarker response (PSA and testosterone decline) to predict prognosis. On the other hand, in the setting of M1 hormone naïve prostate cancer, there are many more RCT's to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps provide a slight efficacy advantage while IHT may be slightly inferior with minimal M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic tool for M1 patients. There is growing recognition that serum testosterone (T) control while on ADT is linked to the development of castrate-resistant prostate cancer. Especially for a M1 patient, maintaining a serum T below 20–30 ng dl⁻¹ prolongs the response to ADT. Novel oral agents (abiraterone and enzalutamide) may soon find use in hormone naïve disease and may alter the treatment landscape. Despite over 75 years of experience with ADT, many questions remain, and the field continues to evolve.

Divorcing diagnosis from treatment: contemporary management of low-risk prostate cancer

Today, the majority of men with newly diagnosed prostate cancer will present with low-risk features of the disease. Because prostate cancer often takes an insidious course, it is debated whether the majority of these men require radical treatment and the accompanying derangement of quality of life domains imposed by surgery, radiation, and hormonal therapy. Investigators have identified various selection criteria for "insignificant disease," or that which can be monitored for disease progression while safely delaying radical treatment. In addition to the ideal definition of low risk, a lack of randomized trials comparing the various options for treatment in this group of men poses a great challenge for urologists. Early outcomes from active surveillance cohorts support its use in carefully selected men with low-risk disease features, but frequent monitoring is required. Patient selection and disease monitoring methods will require refinement that will likely be accomplished through the increased use of biomarkers and specialized imaging techniques.