Advances in Diagnosis and Management of Prostate Cancer, Second Edition

Dear Colleagues,

Prostate cancer (PCa) is the second most commonly diagnosed cancer in men worldwide. The aggressiveness of tumors can vary, ranging from non-aggressive tumors, which can be safely monitored, to tumors with a poor prognosis, which are only suited to palliative treatment.

Currently, screening for PCa remains one of the most controversial topics in the urological literature. It is recommended that early PSA testing is offered to well-informed men at elevated risk of PCa (men from 50 years of age; men from 45 years of age and a family history of PCa; men of African descent from 45 years of age if of African descent; and men from 40 years of age if carrying BRCA2 mutations). However, an individualized risk-adapted strategy for early detection may still be associated with a substantial risk of over-diagnosis. It is therefore essential to further “tune-up” criteria for opportunistic or systematic screening programs.

Many knowledge gaps are still present in the current literature in the setting of early detection. For example, it remains unclear when germline genetic testing should be considered and how this may impact disease management. Similarly, limited data are available on urine, serum, as well as tissue-based biomarkers.

Imaging in prostate cancer offers many research opportunities. For example, new sonographic modalities (such as micro-Doppler detection, sono-elastography contrast-enhanced US, or high-resolution micro-US) have provided promising preliminary findings and are gaining increasing interest. Moreover, despite its clear role in BCR and in the initial staging of patients with high-risk and ultra-high-risk diseases, studies are needed to assess the role of PSMA PET/CT as an alternative to ePLND for nodal staging and for the initial staging of intermediate-risk patients.

Finally, in the context of prostate cancer diagnosis, the role of machine learning and artificial intelligence (AI) in the identification of suspicious areas in a prostate MRI, and in assigning a Gleason score at pathology, is still under debate.

In the context of treatment, we have many unanswered questions.

Radical prostatectomy and external beam radiotherapy represent first-line treatment options for patients with localized PCa. However, promising results have been reported with new investigational therapies. Focal therapies, for example, can be used to ablate tumors selectively while limiting toxicity by sparing the neurovascular bundles, sphincter, and urethra.

Further, several newer forms of hormonal therapy have been developed in recent years and have been proven to be effective in high-risk cases or when PCa has become resistant to standard forms of hormonal therapy. Finally, PARP inhibitors, checkpoint inhibitors, vaccines, and targeted therapies represent novel promising treatment options for advanced PCa.

The aim of this Special Issue of Diagnostics is to provide new insights into the diagnosis and management of prostate cancer.

Dr. Francesco Chierigo
Guest Editor

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• prostate cancer
• screening
• biomarkers
• genetic testing
• imaging
• PSMA
• artificial intelligence
• radical prostatectomy
• radiotherapy
• hormonal therapies