Genitourinary Cancers: Update on Detection, Treatment, and Research
This issue of Cancer Control highlights several exciting new developments in
genitourinary cancers. There are controversies in screening and early detection, treatment
options are being expanded, patient outcomes are becoming better defined, and research of
these diseases is ongoing. Prostate cancer, currently the most common cancer and the
second most common cause of cancer mortality in men, poses innumerable challenges in
diagnosis and treatment. The controversy surrounding screening for prostate cancer will
continue until sound evidence shows that early detection will result in a decrease in
mortality from the disease. There is concern that potentially harmful and unnecessary
interventions will expose those patients with indolent cancers to the risks and
complications of treatment with impairment of their quality and quantity of life. We need
to be able to better identify and define those patients with very indolent disease from
those who will benefit from interventions.
The optimal management choice for localized prostate cancer is controversial, even
though the presence of cancer beyond the confines of the prostate is considered to be an
incurable situation. Hormone therapy may affect this situation. Drs Ravat Panvichian and
Kenneth Pienta review the principles and effects of hormonal manipulation and discuss the
recent advances of combining it with chemotherapy for prostate cancer.
Outcomes of patients with invasive and metastatic bladder cancer were expected to
improve with the advent of effective platinumbased combination chemotherapy in the 1980s.
However, data accumulated over 15 years on the M-VAC regimen (methotrexate, vinblastine,
doxorubicin, and cisplatin) have shown that this combination does not improve long term
survival. Drs Milind Javle and Derek Raghavan put into perspective the issues regarding
systemic chemotherapy for metastatic bladder cancer and the use of these agents in both
neoadjuvant and adjuvant settings. They conclude with a plea for designing and conducting
well structured, randomized clinical trials incorporating the best systemic chemotherapy
into multimodality treatment programs.
Our group reports on the surgical management of the urinary tract after radical
cystectomy for bladder cancer. Continuing advances in surgical technique have decreased
morbidity and mortality and have improved the quality of life for patients with this
disease who need cystectomy.
Testicular cancer is medical oncology's success story. With the availability of highly
effective chemotherapeutic agents, current research efforts are aimed at refining the
chemotherapy treatment schemes and redefining the role of surgery in this disease. Dr
Randall G. Rowland describes the evolution of retroperitoneal lymph node dissection in
staging and salvage therapy, as well as the improvements in surgical techniques that have
caused significant decrease in the morbidity and mortality previously associated with the
procedure.
Clinical practice guidelines have been developed at our center to address the
challenges in the diagnosis, staging, and treatment of prostate cancer. Clinical practice
guidelines are not viewed as "cookbook" medicine -- rather, they reflect the
effort to define the current state of knowledge for a particular clinical problem. These
guidelines combine the best available evidence in the literature with multidisciplinary
group consensus opinion to improve the quality and consistency of care, to decrease costs,
and to identify and prioritize questions for future basic and clinical research.
Extensive research is currently focusing on biologic response modifiers for carcinoma
of the kidney. Drs Gabriel P. Haas and Gilda G. Hillman present the state of the art in
immunotherapy for the management of this difficult disease. With a better understanding of
immunotherapy and other investigational interventions, it may be possible in the future to
combine this approach with chemotherapy, radiation therapy, surgery, and gene therapy to
improve the outcomes from treatment of kidney cancer.
Rounding out the scientific articles in the "Pathology Update" feature, Dr
Jose Diaz describes the pathobiology of preinvasive urothelial neoplasia -- a rather
poorly understood entity.
An update on urologic oncology is incomplete without recognizing the importance of
support groups. Patients are empowering themselves in national, regional, and local groups
to increase their knowledge about their disease and the available treatment options. These
groups not only provide strong support among themselves, but also are forging a leadership
role in developing important new funding sources for research and care. In our particular
region, Bob Samuels, a man with prostate cancer, provides a "face" to this
disease and has been instrumental in developing a highly active and effective organization
with these ends in mind. We congratulate him and many others who are taking on these new
challenges and responsibilities.
Julio Pow-Sang, MD
Program Leader, Genitourinary
H. Lee Moffitt Cancer Center &
Research Institute
Back to Cancer Control Journal Volume 3 Number 6