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Prostate-specific Antigen Screening: A Primer for Residents and Medical Students

by Jonathan Klein, MD

Prostate cancer is the most commonly diagnosed cancer in Canadian men and their third-highest cause of cancer death 1. According to the Canadian Cancer Society, Canadian men carry a 14.3% lifetime chance of diagnosis and a 3.7% risk of dying from the disease 2.The discovery of prostate-specific antigen (PSA) in 1970 and subsequent development and approval of measurement assays for the compound have been the subject of immense hope that it could serve as a screening marker for the disease 3,4. However, the definitive answer as to PSA’s usefulness as a screening and detection mechanism for prostate cancer has been elusive and subject to much controversy. Indeed, a recent commentary in the New England Journal of Medicine labeled the PSA-screening debate “the controversy that refuses to die” 5.

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Interview with Dr. Barbara-Ann Millar

Interview by Jonathan Klein, MD

Current Oncology: This is an interview with Dr. Barbara-Ann Millar, staff oncologist at Princess Margaret Hospital and the Hospital for Sick Children in Toronto and the current Program Director of the University of Toronto Radiation Oncology residency program. She has agreed to sit down with Current Oncology to discuss issues relating to radiation oncology in Toronto and elsewhere. First of all thank you for agreeing to speak with me today.

First off, I’m going to ask you a question that you will be asking all prospective radiation oncology residents which is: why radiation oncology?

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Interview with Dr. Meredith Giuliani

 Interview by Jonathan Klein, MD

Meredith Giuliani is the current Chief Resident of the Radiation Oncology residency training program at the University of Toronto. She graciously agreed to sit down with Current Oncology to discuss her experiences in the field and answer questions about applying to radiation oncology residency programs.

Current Oncology: To start, I’m going to ask you the question that you will be asking all prospective radiation oncology residents: why radiation oncology?

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Should There Be a Legal Right to Die?

 

Photo Credit: Stock.Xchnge

by Dr. David Benatar

Just as people value having control over where they live, what occupation they have, whom they marry, and whether to have children, so people value having control over whether or not they continue living when the quality of their lives deteriorates. This is why the right to life and the right to die are not two rights, but two aspects or descriptions of the same right. The right to life is the right to decide whether or not one will continue living. The right to die is the right to decide whether or not one will die (when one could continue living). If a right to life were only a right to decide to continue living, and did not also include a right to decide not to continue living, then it would be a duty to live rather than a right to life.  The idea that we have a duty to continue living, irrespective of how bad our lives become, is an implausible one indeed.

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Combining Radiation Therapy and Androgen Deprivation for Localized Prostate Cancer – A Critical Review

Photo Credit: Wikimedia Commons.

Summary by Dr. Luis Souhami MD – McGill University Health Centre

In our paper we critically reviewed major publications that evaluated the use of radiation therapy (RT) combined with androgen deprivation for localized prostate cancer. Also, a brief summary of some important preclinical studies was made in order to reinforce a better understanding of the biological basis for this approach.  For didactic purposes, we have clustered prospective randomized trials in two major groups: one including studies basically testing hormonal therapy before RT (neoadjuvant therapy) and other using hormonal therapy concomitantly and/or after RT. Based on this scheme, we endeavoured to properly define most appropriate treatment recommendations for each risk category.

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Access to Thalidomide for the Treatment of Multiple Myeloma in Canada

Multiple myleoma stain. Photo credit: Wikimedia Commons

Summary by Dr. Leonard Minuk

Multiple myeloma is an incurable plasma cell neoplasm that is characterized by multiple relapses requiring many lines of therapy to maintain disease control. Therapy has dramatically changed over the last 10 years to include multiple novel agents (such as thalidomide, lenalidomide, and bortezomib) as well as autologous stem cell transplantation, improving outcomes but also increasing the cost and complexity of treatment …

Current standard treatment is divided mainly according to age. Patients who are 65 are treated with standard melphalan and prednisone with the addition of either thalidomide (MPT regimen) or bortezomib (VMP regimen). Relapsed disease is managed with thalidomide, bortezomib, lenalidomide, or alkylating agents, often in combination with steroids. There is much debate and ongoing research into the appropriate sequencing and combination of these various drugs.

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