Prostate Cancer

Basel, Switzerland (UroToday.com) Michael Morris, MD, discussed de novo oligometastatic prostate cancer at the APCCC 2019 session on PSA recurrence after radical local therapy and oligometastatic prostate cancer. According to Dr. Morris, de novo oligometastatic disease represents a unique treatment opportunity, such that it is an untreated primary, untreated metastatic disease with limited distribution. Prolonging OS or achieving a cure is probably most feasible when attempted early before lethal treatment-related biology emerges. We currently have level 1 evidence that AR-directed therapy improves OS in M1 disease, provided by mutually supportive, well-conducted phase III randomized prospective trials: STAMPEDE 1 : M0 or M1 patients treated with ADT vs ADT + abiraterone acetate and prednisone (HR 0.63, 95% CI 0.52-0.76) LATITUDE 2 : M1, high risk patients treated with ADT vs ADT + abiraterone acetate and prednisone (HR 0.62, 95% CI 0.51-0.76) ENZAMET 3 : M1 patients (all comer...

Basel, Switzerland (UroToday.com) Michael Morris, MD, discussed de novo oligometastatic prostate cancer at the APCCC 2019 session on PSA recurrence after radical local therapy and oligometastatic prostate cancer. According to Dr. Morris, de novo oligometastatic disease represents a unique treatment opportunity, such that it is an untreated primary, untreated metastatic disease with limited distribution. Prolonging OS or achieving a cure is probably most feasible when attempted early before lethal treatment-related biology emerges. We currently have level 1 evidence that AR-directed therapy improves OS in M1 disease, provided by mutually supportive, well-conducted phase III randomized prospective trials: STAMPEDE 1 : M0 or M1 patients treated with ADT vs ADT + abiraterone acetate and prednisone (HR 0.63, 95% CI 0.52-0.76) LATITUDE 2 : M1, high risk patients treated with ADT vs ADT + abiraterone acetate and prednisone (HR 0.62, 95% CI 0.51-0.76) ENZAMET 3 : M1 patients (all comer...

Basel, Switzerland (UroToday.com) Dr. Piet Ost from Belgium discussed treatment of oligorecurrent prostate cancer after local therapy at the APCCC 2019 biennial meeting. Dr. Ost notes that this is defined as a patient with a treated (and controlled) primary tumor, is naïve to systemic treatment, and has N1 or M1 metastasis. Currently, there is no consensus definition for oligometastatic disease. Typically, this is defined as five or less lesions, but different terminologies and lesion cut-offs are often used. The EORTC-ESTRO group is working on a consensus working definition that should be used in subsequent trials and studies. According to Dr. Ost, the future is a molecular definition, which is a GAP6 Movember initiative. According to the most recent definition of the European Association of Urology Guidelines, restaging after radical prostatectomy should include a PSMA PET-CT if the PSA level is >0.2 ng/mL and if the results will influence subsequent treatment decisions (str...

Basel, Switzerland (UroToday.com) At the 2019 APCCC meeting, Rob Reiter, MD from UCLA discussed the definitions and concepts of oligometastatic prostate cancer. Certainly, over the last several years with improved imaging, this definition has become important from a terminology and treatment standpoint. According to Dr. Reiter, there are several potential pathways of oligometastasis from the primary tumor: Oligometastasis is hypothesized to represent a state in which a tumor lacks all the necessary “hallmarks of cancer” to metastasize to specific sites, grow rapidly, or metastasize secondarily. However, there is no genomic data to define or classify the oligometastatic state as of yet, although the GAP6 initiative is exploring these pathways. Dr. Reiter notes that there are several definitions for oligometastasis, including: Site of disease – bone only, any site (bone, node, and/or soft tissue), bone and other sites (node and/or soft tissue) Number of lesions – 1-5, in general...

Basel, Switzerland (UroToday.com) Dr. Alicia Morgans presented on disparities in prostate cancer management in the United States. She began her presentation stating that social health is determined by many factors (Figure 1) which could be responsible for these disparities. There were 174650 new cases of prostate cancer in the US in 2019. Black Americans have approximately 2 times higher incidence of prostate cancer vs. white Americans, and ~2.5 times higher mortality. There were 174,650 new cases of prostate cancer in the US in 2019. Black Americans have approximately 2 times higher incidence of prostate cancer vs. white Americans, and ~2.5 times higher mortality. Figure 1 - Determinants of health: In the US disparities exist not only in blacks compared to white Americans, but also by socioeconomic status, age (with improvement in survival more pronounced for younger men), geography, education and more. There are also disparities in cancer-specific outcomes and supportive care del...

BALTIMORE , Aug. 30, 2019 /PRNewswire/ -- Prostate cancer is the second most common cancer for men, both in the United States and worldwide. In 2019, nearly 175,000 US men will be told they have prostate cancer – that is one new case every 3 minutes. Globally, the number increases to one new case every 41 seconds. Experience the interactive Multichannel News Release here: https://www.multivu.com/players/English/8169051-uau-prostate-cancer-awareness-month/ Early detection is key to living prostate cancer free, which is why the American Urological Association (AUA) and Urology Care Foundation are gearing up for September – Prostate Cancer Awareness month – to raise awareness about the disease and encourage men to know their risk and talk to their doctor. "Next to skin cancer, prostate cancer is the most commonly diagnosed cancer in men," said Harris M. Nagler , MD, President of the Urology Care Foundation. "It is important for men to understand their risk of develo...

ELAC2 is a ubiquitously expressed enzyme potentially involved in tRNA processing and cell signaling pathways. Mutations of the ELAC2 gene have been found to confer increased prostate cancer susceptibility in families. ELAC2 protein expression was analyzed by immunohistochemistry in 9,262 patients and Kaplan-Meier curves of PSA recurrence-free survival were calculated in 8,513 patients treated with radical prostatectomy. Nuclear ELAC2 staining was observed in 60.8% of prostate cancers. It was weak in 26.3%, moderate in 26.6% and strong in 7.9%. Strong nuclear ELAC2 expression was associated with advanced tumor stage, nodal metastasis, higher Gleason grade, presence of TMPRSS2:ERG fusion, higher Ki67-labeling index and PTEN deletion. The difference in 1-, 5- and 10-year recurrence-free survival between strong and weak nuclear ELAC2 intensity is 7.2/13.8/17.6% in all cancers, 7.4/16.1/26.5% in the ERG negative subset, and 3.1/5.7/9.8% in the ERG positive subset. Regarding the univariate h...

[embedded content] Transcript:  Judd Moul, MD: I’d like to move on to the topic of metastatic castrate-sensitive prostate cancer [CSPC]. Because I’m the oldest member of the panel, I want to make a comment. I’ve been in the field long enough to remember the late ’80s and early ’90s, when flutamide was first FDA approved. Historically, that was for what, in those days, we called newly diagnosed D2 prostate cancer. That was before TNM [tumor, node, and metastasis] staging, so we now know it as newly diagnosed M1 [distant metastasis] or hormone-sensitive M1. Back in the ’80s, Fernand Labrie, MD, PhD, from Canada was the first guy, to our knowledge, who talked about this concept of adrenal androgen suppression. He was touting flutamide, which is a not very potent oral antiandrogen. Ultimately, the National Cancer Institute [NCI] did the Crawford trial of leuprolide plus or minus flutamide versus placebo in newly diagnosed metastatic prostate cancer. The NCI did that trial to dispro...

Early detection is key to living prostate cancer free, which is why the American Urological Association (AUA) and Urology Care Foundation are gearing up for September – Prostate Cancer Awareness month – to raise awareness about the disease and encourage men to know their risk and talk to their doctor. "Next to skin cancer, prostate cancer is the most commonly diagnosed cancer in men," said Harris M. Nagler , MD, President of the Urology Care Foundation. "It is important for men to understand their risk of developing prostate cancer and to talk to their doctor about whether prostate cancer screening is right for them. Empowering men with the educational tools and resources of the Urology Care Foundation helps men make informed decisions about prostate cancer screening, care and treatment." Aside from age, risk factors for prostate cancer include family history and race. About one out of every nine men in the US will be diagnosed with prostate cancer during their li...

For African American men, the risk of dying from low-grade prostate cancer is double that of men of other races, a new study has found. But, despite the difference, the risk is still small. When a man is diagnosed with prostate cancer, the disease is given a grade, or score, based on how abnormal (or aggressive) the cancer cells look under a microscope. This system for assessing the aggressiveness of a prostate tumor is called the Gleason score. Prostate cancer with a Gleason score of 6 is considered low grade, meaning it is less likely to grow and spread than cancer with a higher score (7 to 10). The vast majority of men diagnosed with localized, low-grade prostate cancer will die of something other than prostate cancer. But, according to the new findings, doctors may be “underestimating the risk” of death from low-grade prostate cancer in African American men, said lead investigator Franklin Huang, M.D., Ph.D., of the University of California, San Francisco. The study finding...

Basel, Switzerland (UroToday.com) At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019 session on PSA recurrence after radical local therapy and oligometastatic prostate cancer, Dr. Christopher Evans from UC-Davis discussed the management of men with PSA recurrence or persistence after radical prostatectomy. Dr. Evans started by highlighting that the AUA definition of biochemical recurrence is remission after prostatectomy defined as nadir PSA <0.2 ng/mL. The NCCN defines biochemical recurrence as a PSA persistence/recurrence after radical prostatectomy such that the PSA fails to fall to undetectable levels (PSA persistence) or undetectable PSA after radical prostatectomy with a subsequent detectable PSA that increases on two or more determinations (PSA recurrence). Between 5-20% of men continue to have persistent PSA after radical prostatectomy, defined in most studies as detectable post-radical prostatectomy PSA of >0.1 ng/mL within 4-8 weeks after surgery. Thi...

Basel, Switzerland (UroToday.com) Dr. Mack Roach presented on  radiotherapy options for patients with clinical node-positive prostate cancer. The talk began with trying to define the optimal candidate for salvage lymph node dissection (SLND) for nodal recurrence of prostate cancer. Fossati et al. 1  published a study that included 654 patients who experienced prostate-specific antigen (PSA) rise and nodal recurrence after radical prostatectomy and underwent SLND at nine tertiary referral centers. Lymph node recurrence was documented by PET/CT scan using either 11C-choline or 68Ga-labeled prostate-specific membrane antigen ligand. The median follow-up was 30 months among patients without clinical recurrence, and 334 patients developed clinical recurrence after SLND. The Kaplan-Meier curve demonstrated that the probability of early clinical recurrence was 25%. Multivariable analysis showed that Gleason grade group 5 (hazard ratio [HR]: 2.04; p<0.0001), time from radical ...

To determine the utility of 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET/CT) in the imaging assessment of therapy response in men with osseous-only metastatic prostate cancer. In this Institutional Review Board-approved single institution retrospective investigation, we evaluated 21 18F-NaF PET/CT scans performed in 14 patients with osseous metastatic disease from prostate cancer and no evidence of locally recurrent or soft-tissue metastatic disease who received chemohormonal therapy. Imaging-based qualitative and semi-quantitative parameters were defined and compared with changes in serum PSA level. Qualitative and semi-quantitative image-based assessments demonstrated > 80% concordance with good correlation (SUVmax κ = 0.71, SUVavg κ = 0.62, SUVsum κ = 0.62). Moderate correlation (κ = 0.43) was found between SUVmax and PSA-based treatment response assessments. There was no statistically significant correlation between PSA-based disease progre...

Researchers have found that inhibiting a kinase in mice leads to the death of prostate cancer cells, providing a potential therapeutic target. A new study has discovered that blocking a particular kinase in mice begins a chain reaction that results in the death of prostate cancer cells that have spread and are resistant to standard therapies. The researchers say their findings show rationale for testing their kinase inhibitor to treat metastatic castration-resistant prostate cancer (CRPC) in humans. The study was conducted by the Abramson Cancer Center at the University of Pennsylvania, US. The team identified the role of the kinase CDK7 as the on/off switch that controls Med-1. This is a process that works in partnership with the androgen receptor to drive prostate cancer growth. Androgen deprivation therapy is a standard therapeutic approach for prostate cancer. However, over the course of treatment, a majority of patients will become resistant to the medication, allowing the...

Each year, more than 164,000 American men are diagnosed with prostate cancer. No one knows if or when the disease will develop, but understanding the risk factors for prostate cancer may help you take preventive measures to reduce the likelihood of getting the disease. Screenings may help detect prostate cancer early, before symptoms occur. What causes prostate cancer? Prostate cancer forms when the DNA in cells in the prostate develop mutations that may disable their ability to control cell growth and division. In many cases, these mutated cells die or are attacked by the immune system. But some mutated cells may escape the immune system and grow out of control, forming a prostate tumor. While the exact cause of prostate cancer may not be known, the risk of developing the disease increases with age. Also, men with a family history of prostate cancer have an increased risk of developing the disease. Some common risk factors for prostate cancer include: General Race: Studies s...

ELAC2 is a ubiquitously expressed enzyme potentially involved in tRNA processing and cell signaling pathways. Mutations of the ELAC2 gene have been found to confer increased prostate cancer susceptibility in families. ELAC2 protein expression was analyzed by immunohistochemistry in 9,262 patients and Kaplan-Meier curves of PSA recurrence-free survival were calculated in 8,513 patients treated with radical prostatectomy. Nuclear ELAC2 staining was observed in 60.8% of prostate cancers. It was weak in 26.3%, moderate in 26.6% and strong in 7.9%. Strong nuclear ELAC2 expression was associated with advanced tumor stage, nodal metastasis, higher Gleason grade, presence of TMPRSS2:ERG fusion, higher Ki67-labeling index and PTEN deletion. The difference in 1-, 5- and 10-year recurrence-free survival between strong and weak nuclear ELAC2 intensity is 7.2/13.8/17.6% in all cancers, 7.4/16.1/26.5% in the ERG negative subset, and 3.1/5.7/9.8% in the ERG positive subset. Regarding the univariate h...

Overexpression of cripto-1 (CR-1), an epidermal growth factor-cripto-1/FRL-1/Cryptic family protein, has been reported in multiple types of malignancy. However, the clinical functions of CR-1 in prostate cancer (PCa) remain largely unclear. The objective of the present study was to investigate the association between CR-1 expression and the clinicopathological features and prognosis of PCa. CR-1 expression was evaluated in 138 PCa tissues and 67 benign prostate hyperplasia (BPH) tissues using immunohistochemistry. The association between the clinicopathological features of patients with PCa and CR-1 expression was analyzed using a χ2 test. Receiver operating characteristic (ROC) curve and Cox regression model were used to analyze the association between CR-1 expression and biochemical recurrence (BCR)-free survival. It was revealed that the protein expression of CR-1 was markedly higher in PCa tissues than in BPH tissues. The mRNA expression of CR-1 in PCa tissue and cells was also sig...

SYDNEY, Australia, Aug. 28, 2019 (GLOBE NEWSWIRE) -- Noxopharm (ASX: NOX) (‘ Noxopharm’ or the ‘ Company’ ) today announced the interim three month results from the second part of the DARRT-1 study on its proprietary treatment Veyonda ®  combined with radiotherapy which resulted in reductions in tumour size; reductions in pain for 45% of the men; and reductions in PSA levels for 55% of these men.  The Company’s DARRT (Direct and Abscopal Response to Radiotherapy) Program is testing the ability of Veyonda ®  to increase tumour response to low-dose radiotherapy in prostate cancer. The effect of this treatment combination on tumours in animals was reported in last week’s announcement on 23 Aug 2019. The Company previously reported on the patients in the dose-escalation or first part of the study on 2 May 2019. Dr Greg van Wyk, Noxopharm CEO and Chief Medical Officer, said: ‘Today’s data builds positively on the previously released figures obtained from the first group of ...