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Kratzik: Prostate cancer

This issue of the Hamdan Medical Journal deals with prostate cancer (PCa). Everybody in the medical community today understands that PCa is driven by testosterone; nevertheless, we gained a tremendous new insight into molecular pathways in the last decade, showing that even castration-resistant PCa still depends on testosterone and the androgen receptor. In the state-of-the-art review entitled ‘Testosterone and prostate cancer – new insights to help guide therapy’, by Kratzik, I have tried to report, in an understandable manner, the mechanisms involved, as knowledge of these interactions has led to development of new medications with which to treat patients suffering from advanced PCa. In the future, this will gain even more importance.

In the last 25 years, there has been a remarkable increase in the diagnosis of PCa owing to the introduction of PSA testing. In addition, a significant proportion of men harbouring PCa will never die of the disease, which raises the question of overdiagnosis and overtreatment. One must not forget the implications for these patients, since any form of treatment bears a certain risk of morbidity. The state-of-the-art review entitled ‘Biomarkers for screening and early detection of prostate cancer’, by Rieken and Shariat, deals with this subject and provides recommendations for future research to avoid unnecessary diagnosis.

The state-of-the-art review entitled ‘Focal ablation of prostate cancer’, by Schatzl, reports on minimally invasive treatment options such as high-intensity focused ultrasound (HIFU). HIFU is mentioned in the European Association of Urology Guidelines as an experimental therapeutic option in selected cases and may gain further importance in the future. This article describes the potential advantages and limitations of HIFU; however, at present, only a limited knowledge of the long-term results is available.

The gold standard for localized PCa still is radical retropubic prostatectomy (RP), which can be performed via open surgery, laparoscopically or a robotic approach. The final state-of-the-art review, entitled ‘The Martini-Clinic technique of open radical retropubic prostatectomy’, by Haese et al., deals with the experience of RP of the Martini-Clinic in Germany. RP is still the most widely used approach for PCa treatment throughout the world and has undergone remarkable developments, since its invention, to prevent the risk of incontinence and impotence in patients. This article describes the technique of nerve-sparing RP and the results of such surgery.



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