Another group from New York sellectchem suggested instead using

the ratio of testosterone to PCA3.29 In a small group of men undergoing biopsy (n = 177), the testosterone to PCA3 ratio had a higher area under the curve (0.737) than PCA3 alone (0.719) for discriminating biopsy results. These combined findings suggest the need for further investigation into the incorporation of PCA3 in multivariable risk assessment tools. Finally, an important problem with screening and AS is the risk of complications after prostate biopsy, which was addressed by several abstracts. Toi and colleagues30 performed a prospective, randomized trial of the addition of apical anesthetic injection to the standard basal lidocaine Inhibitors,research,lifescience,medical injection. Although there was no difference in complication rates between the groups, it more information failed to reduce pain as measured Inhibitors,research,lifescience,medical by the Visual Analog Scale. In the ERSPC Rotterdam, our group examined 10,474 prostate biopsies and found a 4% frequency of febrile complications.31 Although hospitalizations increased over time, the overall frequency was only 0.8%. As just described, because prostate cancer screening was associated with a substantial reduction in metastatic prostate cancer and disease-specific death

in this Inhibitors,research,lifescience,medical population, 10 we concluded that the low absolute risk of serious complications should not itself deter healthy men from undergoing a recommended prostate biopsy. Moreover, other abstracts looked at ways to improve the safety of biopsy. Santomauro and associates32 from the University of California-San Inhibitors,research,lifescience,medical Diego performed rectal swab cultures prior to biopsy and reported no biopsy-related infections in 235 patients after the initiation of this protocol Inhibitors,research,lifescience,medical (compared with a 9% annual rate of prerectal cultures). This suggests that prostate biopsy complications may be reduced through more targeted prophylaxis, leading to further improvements in the risk-benefit ratio. [Stacy Loeb, MD] Predictors of Outcome in Prostate Cancer With an estimated 242,000 diagnoses and 28,000 deaths in 2012, prostate

cancer is the most common malignancy diagnosed in the United States, and is the second leading cause of cancer death among men. Despite this, most prostate cancer has an indolent natural history Cilengitide and does not progress to a clinically meaningful stage even in the absence of treatment. Indeed, the Prostate Cancer Intervention Versus Observation Trial (PIVOT) has recently demonstrated that men randomized to RP or watchful waiting had indistinguishable all-cause mortality.33 AS is considered by many to be the preferred approach for most men but it is vastly underutilized. Moreover, men with high-risk disease oftentimes fail single modality treatment and may benefit from the addition of adjuvant therapy. Therapeutic decisions in men with prostate cancer are cloaked with uncertainty.