Prostatic Neoplasms: Carroll PR

Kawachi MH, Bahnson RR, Barry M, Carroll PR, Carter HB, Catalona WJ, Epstein JI, Etzioni RB, Hemstreet GP, Howe RJ, Kopin JD, Lange PH, Lilja H, Mohler J, Moul J, Nadler RB, Patterson S, Pollack A, Presti JC, Stroup AM, Urban DA, Wake R, Wei JT, Anonymous00333. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17692177 No free full text.

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Dall'Era M, Carroll PR. · No affiliation provided · J Urol. · Pubmed #17437768 No free full text.

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Carroll PR. · No affiliation provided · J Urol. · Pubmed #15758699 No free full text.

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Carroll PR. · No affiliation provided · Urology. · Pubmed #11306354 No free full text.

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Carroll PR. · No affiliation provided · J Clin Oncol. · Pubmed #10715283 No free full text.

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Michalski JM, Roach M, Merrick G, Anscher MS, Beyer DC, Lawton CA, Lee WR, Pollack A, Rosenthal SA, Vijayakumar S, Carroll PR. · Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110-1032, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #19386445 No free full text.

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Dall'Era MA, Carroll PR. · Department of Urology, University of California, Davis, CA, USA. · Curr Opin Urol. · Pubmed #19295434 No free full text.

Abstract: PURPOSE OF REVIEW: Prostate cancer is now the most commonly diagnosed solid tumor in American men. Autopsy studies show the uniquely high prevalence rates of small, indolent tumors in men dying of other causes. These findings have led to an increased interest in managing men with prostate cancer and low risk features expectantly, with close observation for early signs of progression. This approach allows one to limit prostate cancer treatment and any risk of related morbidity to the men who will benefit the most from active intervention. RECENT FINDINGS: Several centers have published their results with active surveillance and delayed selective therapy for men with low grade, early prostate cancer. Although median follow up from these studies is relatively short, the outcomes appear favorable. About one third of men will receive treatment after 3-5 years of surveillance and quality of life remains high. SUMMARY: Data from these reports provide patients and clinicians with the early experiences and expectations with active surveillance for prostate cancer. They also provide a framework for selecting men for this approach and for following them over time. Prospective, randomized trials comparing active surveillance with standard interventions are underway.

Dall'Era MA, Cooperberg MR, Chan JM, Davies BJ, Albertsen PC, Klotz LH, Warlick CA, Holmberg L, Bailey DE, Wallace ME, Kantoff PW, Carroll PR. · Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California 94143-1695, USA. · Cancer. · Pubmed #18306379 links to  free full text

Abstract: The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed.

Eggener SE, Scardino PT, Carroll PR, Zelefsky MJ, Sartor O, Hricak H, Wheeler TM, Fine SW, Trachtenberg J, Rubin MA, Ohori M, Kuroiwa K, Rossignol M, Abenhaim L, Anonymous00105. · No affiliation provided · J Urol. · Pubmed #17936815 No free full text.

Abstract: PURPOSE: Based on contemporary epidemiological and pathological characteristics of prostate cancer we explain the rationale for and concerns about focal therapy for low risk prostate cancer, review potential methods of delivery and propose study design parameters. MATERIALS AND METHODS: Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of localized prostate cancer were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of cancer. A consensus summary was constructed by a multidisciplinary international task force of prostate cancer experts, forming the basis of the current review. RESULTS: In regions with a high prevalence of prostate specific antigen screening the over detection and subsequent overtreatment of prostate cancer is common. The incidence of unifocal cancers in radical prostatectomy specimens is 13% to 38%. In many others there is an index lesion with secondary foci containing pathological features similar to those found incidentally at autopsy. Because biopsy strategies and imaging techniques can provide more precise tumor localization and characterization, there is growing interest in focal therapy targeting unifocal or biologically unifocal tumors. The major arguments against focal therapy are multifocality, limited accuracy of staging, the unpredictable aggressiveness of secondary foci and the lack of established technology for focal ablation. Emerging technologies with the potential for focal therapy include high intensity focused ultrasound, cryotherapy, radio frequency ablation and photodynamic therapy. CONCLUSIONS: Early detection of prostate cancer has led to concerns that while many cancers now diagnosed pose too little a threat for radical therapy, many men are reluctant to accept watchful waiting or active surveillance. Several emerging technologies seem capable of focal destruction of prostate tissue with minimal morbidity. We encourage the investigation of focal therapy in select men with low risk prostate cancer in prospective clinical trials that carefully document safety, functional outcomes and cancer control.

Cooperberg MR, Moul JW, Carroll PR. · Department of Urology, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA 94115-1711, USA. · J Clin Oncol. · Pubmed #16278465 No free full text.

Abstract: Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumor among men. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumors may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both the United States and Europe. A significant proportion of men with prostate cancer may be overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which overdiagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, patients are less likely now than a decade ago to undergo a trial of active surveillance. Rates of brachytherapy and hormonal therapy use, in particular, have risen markedly. Important progress has been made in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the coming years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward increasingly tailored treatment.

Li LC, Carroll PR, Dahiya R. · Department of Urology, Veterans Affairs Medical Center, and University of California San Francisco, 94121, USA. · J Natl Cancer Inst. · Pubmed #15657340 links to  free full text

Abstract: Prostate cancer is the most common noncutaneous malignancy and the second leading cause of cancer death among men in the United States. DNA methylation and histone modifications are important epigenetic mechanisms of gene regulation and play essential roles both independently and cooperatively in tumor initiation and progression. Aberrant epigenetic events such as DNA hypo- and hypermethylation and altered histone acetylation have both been observed in prostate cancer, in which they affect a large number of genes. Although the list of aberrantly epigenetically regulated genes continues to grow, only a few genes have, so far, given promising results as potential tumor biomarkers for early diagnosis and risk assessment of prostate cancer. Thus, large-scale screening of aberrant epigenetic events such as DNA hypermethylation is needed to identify prostate cancer-specific epigenetic fingerprints. The reversibility of epigenetic aberrations has made them attractive targets for cancer treatment with modulators that demethylate DNA and inhibit histone deacetylases, leading to reactivation of silenced genes. More studies into the mechanism and consequence of demethylation are required before the cancer epigenome can be safely manipulated with therapeutics as a treatment modality. In this review, we examine the current literature on epigenetic changes in prostate cancer and discuss the clinical potential of cancer epigenetics for the diagnosis and treatment of this disease.

Carroll PR, Chan JM, D'Amico AV, Gelmann EP, Iversen P, Klotz L, Nelson JB, Nelson PS, Nelson WG, Oh WK, Rosen N, Rubin MA, Sandler H, Sellers WR, Smith MR, Xu J, McMann MC, Kantoff PW. · Department of Urology, University of California School of Medicine, San Francisco 94115-1711, USA. · J Urol. · Pubmed #15535434 No free full text.

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Cooperberg MR, Park S, Carroll PR. · Department of Urology, Program in Urologic Oncology, University of California San Francisco, California 94115-1711, USA. · Oncology (Williston Park). · Pubmed #15526829 No free full text.

Abstract: In 2004, the large majority of prostate cancers are detected via prostate-specific antigen (PSA) screening. Most are diagnosed at an early stage and are amenable to aggressive local treatment. However, the natural history of the disease may be prolonged, and all available active treatments exert a potential negative effect on patients' HRQOL. Management options for localized prostate cancer have become increasingly complex in recent years, and rigorous trials are frequently difficult to perform due to the extended follow-up required to reach meaningful outcomes. In this context, the advent of the national prostate cancer disease registries-Prostate Cancer Outcomes Study (PCOS), Center for Prostate Disease Research (CPDR), Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), and Shared Equal Access Regional Cancer Hospital (SEARCH)-has greatly facilitated clinical research in prostate cancer. This review summarizes key findings from the registries in the areas of risk migration, practice patterns, outcome prediction, and quality-of-life outcomes. The availability of these large databases of patients will be a tremendous asset as prostate cancer management continues to evolve in the coming years.

Cooperberg MR, Broering JM, Latini DM, Litwin MS, Wallace KL, Carroll PR. · University of California, San Francisco, Mount Zion Cancer Center, 1600 Divisadero Street, 6th Floor, San Francisco, CA 94115-1711, USA. · Curr Urol Rep. · Pubmed #15161564 No free full text.

Abstract: The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10,000 patients with prostate cancer treated at 31 primarily community-based sites across the country. The database tracks oncologic and health-related quality-of-life outcomes. Because the urologists participating in the project treat according to their usual practices, CaPSURE facilitates the study of trends in disease-management strategies, offering a reflection of "real world" practice patterns. This review highlights key studies during the past several years that document downward risk migration, validates widely used prognostic nomograms, establishes prostate-specific antigen doubling time as a surrogate endpoint for disease-specific mortality, assesses the impact of treatment on patient-reported quality of life, and presents national trends in imaging test use and primary treatment strategies for localized disease.

Moyad MA, Carroll PR. · Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA. · Urol Clin North Am. · Pubmed #15123409 No free full text.

Abstract: This article provides a foundation for men who want to incorporate lifestyle changes to reduce their risk for prostate cancer and, more importantly, impact all-cause mortality. Table 1 summarizes some of these lifestyle changes that can be recommended to patients in most settings. Minimal time is required to suggest these changes, and a copy of Table 1 can be provided as a reminder to patients. Although these recommendations may seem simple, past studies of men have demonstrated that few (less than 5%) adhere to numerous healthy behaviors simultaneously. It seems to be more common to follow one healthy change in excess than to make multiple changes in moderation. This may be the result of past studies focusing on one lifestyle change to affect disease risk; poor compliance; lack of attention, time, or understanding to this detail; or lack of motivation on the part of the health professional and the patient. Clinical trials of combined moderate lifestyle changes, however, demonstrate that the total effort to make healthy lifestyle changes is more important than one or two behavioral changes in affecting cardiovascular markers, cancer, and all-cause mortality. Recommending a pill is an easy answer, but few supplements for prostate-cancer prevention or total mortality reduction can be recommended, and long-term compliance is a concern with any agent. Additionally, the potential for supplements to increase the risk for prostate cancer or interfere with conventional treatment continues to be a concern, and no dietary supplement has come close to matching the reduction in all-cause mortality observed in clinical trials of lifestyle changes. The time seems ripe to redirect our attention regarding lifestyle changes and prostate cancer risk. What is heart-healthy is prostate-healthy, which makes it more likely that any man concerned about the risk for prostate cancer will make healthy lifestyle changes.

Moyad MA, Carroll PR. · Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA. · Urol Clin North Am. · Pubmed #15123408 No free full text.

Abstract: This article provides a foundation for clinicians willing to provide lifestyle change recommendations for the prevention of prostate cancer. In part II, more general and specific lifestyle recommendations will be provided. It is imperative to provide patients with realistic and practical recommendations that are not only consistent in the medical literature, but will improve overall compliance.

Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, Carroll PR, Anonymous00257. · Department of Urology, University of California-San Francisco/Mt Zion Comprehensive Cancer Center, San Francisco, California 94115-1711, USA. · J Urol. · Pubmed #15017184 No free full text.

Abstract: PURPOSE: The epidemiology and treatment of prostate cancer have changed dramatically in the prostate specific antigen era. A large disease registry facilitates the longitudinal observation of trends in disease presentation, management and outcomes. MATERIALS AND METHODS: The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10000 men with prostate cancer accrued at 31 primarily community based sites across the United States. Demographic, clinical, quality of life and resource use variables are collected on each patient. We reviewed key findings from the data base in the last 8 years in the areas of disease management trends, and oncological and quality of life outcomes. RESULTS: Prostate cancer is increasingly diagnosed with low risk clinical characteristics. With time patients have become less likely to receive pretreatment imaging tests, less likely to pursue watchful waiting and more likely to receive brachytherapy or hormonal therapy. Relatively few patients treated with radical prostatectomy in the database are under graded or under staged before surgery, whereas the surgical margin rate is comparable to that in academic series. CaPSURE data confirm the usefulness of percent positive biopsies in risk assessment and they have further been used to validate multiple preoperative nomograms. CaPSURE results strongly affirm the necessity of patient reported quality of life assessment. Multiple studies have compared the quality of life impact of various treatment options, particularly in terms of urinary and sexual function, and bother. CONCLUSIONS: The presentation and management of prostate cancer have changed substantially in the last decade. CaPSURE will continue to track these trends as well as oncological and quality of life outcomes, and will continue to be an invaluable resource for the study of prostate cancer at the national level.

Cooperberg MR, Small EJ, D'Amico A, Carroll PR. · Department of Urology, UCSF/Mt Zion Comprehensive, Cancer Center, University of California, San Francisco, CA 94115-1711, USA. · Minerva Urol Nefrol. · Pubmed #14765015 No free full text.

Abstract: Androgen deprivation therapy (ADT) plays a central role in the management of prostate cancer. ADT is the mainstay of treatment for metastatic disease; the most common method is gonadal suppression via luteinizing hormone release hormone (LH) agonists, with or without antiandrogens. Antiandrogen monotherapy remains investigational, as is the appropriate role of 5alphareductase inhibition for prostate cancer. Intermittent ADT offers the promise of improved quality of life and reduced cost without a decrease found to date in oncologic efficacy. A growing menu of options exists for secondary androgen deprivation after disease progression on primary therapy: these include high-dose antiandrogens, estrogens, and adrenal androgen suppressants. ADT is being used with increasing frequency as primary monotherapy in patients with localized disease, but only small, nonrandomized studies of highly selected patients have been reported to date. Neoadjuvant ADT (NADT) has been demonstrated in prospective, multi-institutional trials to improve outcomes for patients with high-risk or locally advanced disease undergoing external-beam radiotherapy. Trials for patients with lower-risk, localized disease are still ongoing. Neoadjuvant therapy does not improve outcomes for patients with localized disease opting for radical prostatectomy (RP) and has not been well studied in association with brachytherapy. The side effects of ADT can be managed increasingly successfully; in particular, the introduction of zoledronate may reduce the impact of ADT-associated osteoporosis. Finally, contemporary practice pattern data suggest that use of ADT is increasing across patient risk groups, both in contexts where such therapy is well supported by current evidence and in others where it is not.

Carroll PR, Benaron DA, Blackledge G, Coakley FV, D'Amico AV, Higano CS, Iversen P, Kattan M, Nanus DM, Nelson JB, Oh WK, Roach M, Sellers WR, Smith MR, McMann MC, Kantoff PW. · Department of Urology, University of California School of Medicine, San Francisco 94115-1711, USA. · J Urol. · Pubmed #14610403 No free full text.

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Purohit RS, Shinohara K, Meng MV, Carroll PR. · Department of Urology, 400 Parnassus Avenue, A632, University of California-San Francisco, San Francisco, CA 94143-0738, USA. · Urol Clin North Am. · Pubmed #12735504 No free full text.

Abstract: At this time there is no highly sensitive and specific widespread radiographic test for local staging of prostate cancer. Future developments will likely require a combination of imaging modalities with utilization guided by risk-stratification models (Table 4). Staging data for all imaging tests discussed in this article are summarized in Tables 5 and 6. Clinically, conventional gray-scale TRUS remains the most frequently used tool because of its utility in guiding prostatic biopsies. Modifications of TRUS--including power and color Doppler, 3D imaging, and new ultrasound contrast agents and elastography--show promise in increasing the accuracy of ultrasound. Endorectal MRI may have some value for staging selected patients. The addition of prostatic MRS, which images the differential activity of metabolites, may increase the specificity of MRI. Newer techniques with finer voxel resolution may prove to be clinically useful. A large well-designed study evaluating the utility of MRI/MRS is currently being planned. Cross-sectional imaging of the pelvis with either MRI or CT should be used selectively as should radionuclide bone scans. Similarly, ProstaScint scans should be ordered selectively, either before or after primary therapy, rather than routinely in all patients.

Downs TM, Kane CJ, Grossfeld GD, Meng MV, Carroll PR. · Department of Urology and UCSF/Mt Zion Comprehensive Cancer Center, University of California, San Francisco 94143-0738, USA. · Cancer Metastasis Rev. · Pubmed #12400995 No free full text.

Abstract: Prostate cancer is the most common non-cutaneous malignancy in men and poses a substantial risk to the life and health of patients. Treatment options for patients with prostate cancer are plentiful. Radical prostatectomy is one option that can be performed using several different surgical approaches. It can be performed with limited risk of complications and is likely to be curative in patients with organ-confined disease and those with limited extracapsular extension.

Lubeck DP, Grossfeld GD, Carroll PR. · Department of Urology, University of California San Francisco/Mt. Zion Comprehensive Cancer Center, San Francisco, California, USA. · Urology. · Pubmed #12231054 No free full text.

Abstract: The diagnosis of early-stage prostate cancer cases creates dilemmas for many men diagnosed with the disease each year. Treatment interventions are all associated with significant treatment morbidity, including impotence and incontinence. The basic concept behind patient preferences, or utilities, is to ask patients to make judgments about the value of particular health outcomes. Several preference-based instruments are available, including the visual analog rating scale, the time trade-off utility assessment, and the standard gamble. These assessments result in scores or weights assigned to different health states. From the perspective of the patient with prostate cancer, the treatment that produces optimal outcomes will depend on the relative importance of several domains, which may include pain, urinary functioning, sexual functioning, and general physical health. Patients with similar diagnoses and overlapping clinical characteristics may have markedly different preferences for treatment outcomes.

Grossfeld GD, Li YP, P Lubeck DP, Carroll PR. · Department of Urology, University of California, San Francisco/Mount Zion Comprehensive Cancer Center, University of California, San Francisco 94115-1711, USA. · Urology. · Pubmed #12231051 No free full text.

Abstract: The timing and type of treatment for patients with biochemical disease recurrence after local therapy for prostate cancer remains controversial. This is because of many unresolved issues surrounding the natural history of disease progression in such patients, including the limited ability of clinical measures to accurately define local versus distant disease recurrence. Clinicians generally rely on clinical tumor characteristics, such as tumor stage, grade, and prostate specific antigen (PSA) kinetics after local therapy, to distinguish local from distant recurrence. This determination is important, because patients with local recurrence may be candidates for a second, potentially curative treatment, whereas those with distant recurrence are generally treated with androgen deprivation therapy (ADT). Data from a national disease registry of patients with prostate cancer, the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), suggest that the use of secondary cancer treatment after local therapy for prostate cancer is common. For patients initially treated with radical prostatectomy, secondary treatment appears to be nearly equally divided between postoperative radiation and ADT, whereas >90% of patients receiving a secondary treatment after radiation are treated with ADT. Serum PSA at diagnosis, Gleason score, and type of initial treatment appear to be predictors of secondary treatment use in this setting. Patient age, lymph node status, and margin status appear to be predictors of secondary treatment with ADT or radiation for patients initially treated with radical prostatectomy.

Carroll PR, Kantoff PW, Balk SP, Brown MA, D'amico AV, George DJ, Grossfeld GD, Johnson CS, Kelly WK, Klotz L, Lee WR, Lubeck DP, Mcleod DG, Oh WK, Pollack A, Sartor O, Smith MR, Hart C, Anonymous00147. · Department of Urology, University of California School of Medicine, San Francisco, San Francisco, California, USA. · Urology. · Pubmed #12231036 No free full text.

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Meng MV, Grossfeld GD, Carroll PR, Small EJ. · Department of Urology and the Comprehensive Cancer Center, University of California San Francisco, CA 94115-3006, USA. · Semin Urol Oncol. · Pubmed #12198633 No free full text.

Abstract: Although definitive therapy with either radical prostatectomy or radiation therapy can be effective, the optimal treatment for prostatic adenocarcinoma remains controversial. Patients may be at significant risk for primary treatment failure even with apparent clinically localized disease. Thus, there has been increased interest in initial multimodal therapy in order to maximize the potential for cure. Neoadjuvant hormonal therapy prior to radical prostatectomy has been used for several decades and a large body of literature discusses its use; nevertheless, the current data suggest that it only decreases rates of positive surgical margins without improving prostate-specific antigen (PSA)-free or disease-free survival. Novel neoadjuvant hormonal and chemotherapeutic regimens are under investigation and may improve outcomes for patients undergoing radical prostatectomy.