Cancer Forum Forum

Multidisciplinary progress in research and treatment of genitourinary cancers

Ian D Davis and Martin R Stockler

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Advances in radiation therapy for prostate cancer

Nitya Patanjali and Scott Williams

Abstract

The last decade has seen several new treatment technologies being incorporated into the radiation treatment of localised prostate cancer. More established treatment modalities, such as external beam radiation therapy, are being constantly refined by improvements in imaging, planning software and delivery systems. Newer modalities, such as brachytherapy and proton radiation therapy, are emerging as alternatives to conventional external beam radiation therapy, and will no doubt play a larger part in the treatment of localised prostate cancer in the near future.

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Major advances in surgical technique for the treatment of genitourinary cancers

Manish I Patel and Mark Frydenberg

Abstract

There have been numerous recent advances in surgical techniques for the treatment of genitourinary cancer. The advent of robotic-assisted laparoscopic radical prostatectomy is certainly a major technical development, however its superiority over the open technique has not yet been proven. Clinical trials of focal prostate therapy have begun, utilising the latest generation of ablative technologies such as cryotherapy and high intensity focused ultrasound. Small renal masses are now managed by active surveillance, nephron sparing surgery and ablative techniques with good success. Finally, extended lymphadenectomy for bladder cancer and high risk prostate cancer not only allows better pathological staging but also improved survival.

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Management of testicular cancer

Peter S Grimison and Guy C Toner

Abstract

The management of testicular cancer has changed dramatically over the last 30 years. Almost all patients with early stage disease and over 80% of patients with advanced disease can now be cured with optimal treatment in experienced cancer centres. Strategies for stage I seminoma are surveillance, adjuvant radiotherapy or adjuvant chemotherapy with carboplatin. Strategies for stage I non-seminoma are surveillance or two cycles of adjuvant combination chemotherapy. First-line treatment for advanced disease is combination chemotherapy. Salvage treatment for early relapse of advanced disease is standard or high-dose chemotherapy. Current controversies for stage I disease include the appropriate selection of patients with stage I disease for surveillance or adjuvant therapy, the optimal surveillance program and the nature and intensity of adjuvant therapy. Current controversies for advanced disease include the role and timing of high-dose chemotherapy. Priorities for future research are identified.

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Quality of life research in prostate and testicular cancer

Tim Luckett, Madeleine T King and Martin R Stockler

Abstract

Health related quality of life research is contributing substantially to the management of prostate and testicular cancer, but in different ways. Both diseases have good prognoses, but their trajectories and affected age groups differ greatly. In early stage prostate cancer, there are many different treatment options to choose between and their relative benefits and harms are unclear. Here, health related quality of life research is providing comparative information about functioning, symptoms, wellbeing and preferences to help inform choice. In advanced prostate cancer, the big questions are about whether and when to have various treatments, rather than about the choices between them. Here, health related quality of life research is focused on determining net effects of treatment by measuring benefits in cancer related symptoms, harms from treatment toxicity and allowing these to be considered alongside modest effects on survival. In testicular cancer, the effects of treatment on survival are substantial and options are fewer. Here, health related quality of life research is focused on minimising the effects of disease and treatment on short and long-term health related quality of life by screening, improving supportive care and modifying treatments.

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Supportive care intervention in prostate cancer: recent advances and future challenges

Suzanne K Chambers, Peter Baade and Carole Pinnock

Abstract

Prostate cancer is highly heterogeneous in its nature, effects, pattern of progression and outcomes. Survival, treatment approaches and mortality, differ substantially by socio-economic and geographic factors, and psychosocial outcomes are also likely to be affected by these factors and other personal characteristics. While a number of therapeutic approaches to supportive care have been found to have efficacy, unless these are responsive to patient preferences and can be integrated into routine clinical services or existing community services infrastructure, these are unlikely to translate broadly in the field. Accordingly, a framework to underpin the development of supportive care interventions is suggested that has application in not only genitourinary cancer, but cancer more generally.

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