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Grand Rounds in Urology, Volume 6, Issue 2 |
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From the Editorial Board
Nicholas J. Vogelzang, MD
Among the most difficult issues that the urology profession faces in dealing with patients with genitourinary cancers are treatment resistance and the recurrence of the disease. In this issue of Grand Rounds in Urology we try to take a hard look at the reasons for recurrence of prostate cancer and the identification and application of novel therapeutic approaches to treating renal cell carcinoma (RCC), among the most treatment-resistant malignancies. In the first article, Dr. Zinelabidine Abouelfadel gives readers a thorough review of prostate cancer recurrence, and he offers insight into answering the question, “Who Is Most Likely to Suffer Treatment Failure?” He provides a comprehensive overview of the patient-related factors, including age, race and obesity, and disease-related factors, such as PSA and derivatives and biopsy specimen data.
Abouelfadel summarizes the results of studies on the association of therapy modality to treatment outcome, focusing on radical prostatectomy, radiation therapy, and adjuvant therapy. In association with this review of the literature, readers will find insights into other biological factors influencing treatment outcomes. Further commentary includes how genes, oncogenes, and cell-cycle regulators play a role, and predictive tables and scoring should be utilized when dealing with prostate cancer recurrence. This is a classic treatise and will serve as an up-to-date reference article for years to come.
In the second article, colleagues Jonathan Rosenberg and Eric Small, from UC, San Francisco, focus on the biology and clinical development of vascular endothelial growth factor (VEGF)-directed therapy for kidney cancer, According to the American Cancer Society, every year 13,000 patients die of advanced kidney cancer. Until recently, the treatment options have been limited to cytotoxic chemotherapy and immunotherapy (highdose interleukin-2, low-dose interferon, and other agents). Both modalities were relatively ineffective and associated with negative side effect profiles. The authors describe how these shortcomings have spurred research into the development of VEGF pathway-directed angiogenesis inhibitors and mTOR inhibitors. Of the newer therapeutic options discussed, sorafenib and sunitinib have recently been FDA-approved and added to the treatment arsenal. Not far behind, bevcizumab is being evaluated among the VEGF inhibitors, while temsirolimus and RAD001 are the mTOR inhibitors that have caused the most interest among health care providers and patients alike. Rosenberg and Small conclude that while data generated in clinical trials have established antiangiogenic therapy as frontline treatment for patients with advanced kidney cancer, the care of patients requires a multidisciplinary approach to treatment between urologists and medical oncologists.
While more data will be required to validate the recent findings, patients with genitourinary cancers, particularly prostate cancer and kidney cancer, will have a better future considering the promising research activity and focus being given to improving patient outcomes by preventing recurrence and treatment-resistance. I hope this issue of Grand Rounds in Urology will assist you in improving patient care.
Sincerely,
Nicholas J. Vogelzang, MD
Editorial Board Member
Grand Rounds in Urology
CONTENTS
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Continuing Medical Education
• Prostate Cancer Recurrence: Who Is Most Likely to Suffer Treatment Failure?
Zinelabidine Abouelfadel, MD
E. David Crawford, MD
• Biology and Clinical Development of VEGF-Directed Therapy in Kidney Cancer
Jonathan Rosenberg, MD
Eric J. Small, MD
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Post-Test
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Application for CME Credit
 Download a PDF of the full issue
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Perspectives in Urology website