Prostate Cancer

To screen or not to screen for prostate cancer is a question that men aged 55 to 69 should decide themselves in consult with their doctors, according to finalized guidance from an influential panel of health care experts. (Frame grab from Associated Press video)

To screen or not to screen for prostate cancer is a question that men aged 55 to 69 should decide themselves in consult with their doctors, according to finalized guidance from an influential panel of health care experts. (Frame grab from Associated Press video)

Scottsdale, AZ (UroToday.com) Dr. Angelo Gousse presented his experience with 2-stage management for complex refractory bladder neck contracture (BNC) after prostate cancer treatment (PPcaT) associated with urinary incontinence. This was a 12-year retrospective electronic medical record review that was performed on patients with stress urinary incontinence (SUI) associated with complex BNC after PPCaT. Treatment consisted of deep hot-knife Bladder Neck Incision (BNI) or resection (TURBNC), followed by cystoscopy at 2 months. If stable, healed, and patent, an artificial urinary sphincter (AUS - AMS 800) was placed. Recurrent BNC at 2 months was treated with a second BNI or a 3rd BNI until patency was achieved. There were 88 Patients with BNC and urinary incontinence (UI) were identified with a median age of 75 (58 - 93) years, body mass index 31.1 (21.8-66.8) kg/m2, and a median follow-up of 66 (6-118) months. 60/88 (68.1%) underwent Radical Prostatectomy (RRP) and radiation treatment ...

Black Health Matters, a digital health and patient engagement firm, is holding a series of educational programs to raise the awareness of prostate health. The programs are part of the Precision Oncology initiative, which was launched in July 2019 during the Kappa Alpha Psi Fraternity, Inc. Grand Chapter meeting in Philadelphia. The initiative seeks to educate more than 5,000 men about prostate cancer and clinical trials. The firm is hosting forums around the country, where physicians and advocates will talk to African American men about prostate cancer. By working with churches, fraternities, professional and masonic organizations, Black Health Matters seeks to engage men in health-focused conversations. “If we start normalizing male-to-male conversations about health and wellness that’s great start,” said Roslyn Daniels, founder of Black Health Matters. “Who is really talking to guys about how the prostate is supposed to work? There are urological issues that they need to ...

Regrettably, The Baltimore Sun made a grave error in the headline of an op-ed we authored last week (“Insurers should cover full cost of prostate cancer screenings,” Feb. 21). The commentary focused around important, historic legislation that would make Maryland only the second state in the nation to ban cost-sharing for prostate cancer screenings. This legislation has the potential to save thousands of lives, as prostate cancer is the most diagnosed male-only cancer in Maryland. However, in publishing the piece, The Sun’s editorial team wrote a headline that read, “Insurers should cover full cost of pancreatic cancer screening.” This one word, “pancreatic,” caused a world of confusion for readers, and deeply upset advocates who have worked tirelessly in support of this lifesaving legislation.

To assess the feasibility of same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) in the context of enhanced recovery after surgery (ERAS) and prehabilitation pathways. For 1 year, we prospectively assessed the feasibility of SDD RARP in the context of ERAS and prehabilitation pathways. SDD patients were compared to overnight patients operated during the same period by the same surgeon. Primary outcomes were complication and 90-day readmission rates. Of the overall cohort, 51.9% were discharged home the day of surgery. Both cohorts were comparable in terms of pre-operative and intra-operative characteristics. There was a not significant trend towards shorter operative time in the SDD cohort (93.7 versus 105.2 min, p = 0.077). Mean blood loss was comparable between both cohorts. No significant difference in terms of complication (p = 0.606; 16.0% versus 11.1%) and readmission rates (< 4%) was noted. There was a not significant trend towards faster con...

Citing what it called poor study design and execution coupled with a lack of follow-up data, the FDA’s Oncologic Drugs Advisory Committee voted 13-2 against recommending approval of Steba Biotech SA’s NDA for Tookad (padeliporfin dipotassium) for injection in men with localized early stage prostate cancer. The advisory committee also expressed concern that the study’s low-risk patients did not properly fit the therapy’s requested low-risk and intermediate-risk indications. The long-term trade-offs of approval were a subject of much discussion, as some said approving Tookad could cause more harm than good. “We don’t have robust information about the consequences of the procedure and about the longer-term side effects,” said Heidi Klepin, an advisory committee member and professor of hematology and oncology at Wake Forest University Health Sciences, echoing similar concerns of other committee members. The FDA is not bound by the advisory committee’s recommendation and will make the f...

Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights. Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance (which entails checking the tumor periodically and treating it only if it begins to grow). Cancers in all the men were still confined to the prostate when diagnosed. Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the study’s first author, said the intent was to provide information that could help men choose from among the various therapeutic options. “Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an ...

I was always taught that during Black History Month there are two types of history: the one you read about in the history books and the one that you make for yourself. I honor and give reverence to the great leaders, personalities and historical figures and events that shaped the history of African Americans in the United States. However, let me share a moment in time that is history in the making. I have been blessed and honored to be part of The Empowerment Network, an organization that has become history makers in the prostate cancer community of greater St. Louis. From its inception in 2008, we started the first nationally acclaimed, community-based prostate cancer support group in the St. Louis community, followed by the establishment of the first community Cancer Informational and Educational Center. Since then, hundreds of men’s lives have been saved through early testing. We’ve connected survivors to urologists and other medical professionals, as well as giving out coun...

[embedded content] William K. Oh, MD, chief, Division of Hematology and Medical Oncology, professor of medicine and urology, Mount Sinai Hospital, and deputy director of The Tisch Cancer Institute, discusses remaining challenges with the advancing treatments in prostate cancer. A lot of phase III studies have now become mature in this space and have led to physicians using new drugs, such as targeted therapies and chemotherapy in earlier disease settings, said Oh. There have also been many novel agents that were first utilized in castration-resistant prostate cancer that are now being utilized in nonmetastatic CRPC, metastatic hormone-sensitive prostate cancer (mHSPC), and earlier lines of therapy. These advancements leave a situation where physicians do not know what to do when patients relapse after these treatments because, unfortunately, they are not curative, Oh added. The other question that arises is how should physicians sequence these treatments because there are so many t...

SILVER SPRING, Md. -- A light-activated focal therapy for early prostate cancer failed to win over an FDA advisory committee in a bid for market approval. By a 13-2 vote, the Oncologic Drugs Advisory Committee (ODAC) declined to recommend TOOKAD VTP for approval. The FDA is not bound by committee decisions but follows the recommendations more often than not. TOOKAD, developed by Luxembourg-based Steba Biotech, consists of an infusion of padeliporfin di-potassium (derived from an aquatic bacteria), followed by intraprostatic laser activation. Activated TOOKAD leads to a cascade of events involving oxygen radicals, hypoxia, nitric oxide radicals, and endothelin-1, which causes vascular occlusion and, ultimately, self-propagating tumor cell necrosis. Questions about the therapy's pivotal trial design, endpoints, missing data, and adverse events all contributed to the negative vote. Nonetheless, some ODAC panelists expressed ambivalence about their votes. "I get the sense tha...

Martin T. King, MD, PhD The phase III ARAMIS trial showed that darolutamide (Nubeqa) plus androgen deprivation therapy (ADT) significantly improved overall survival (OS) compared with placebo plus ADT in patients with nonmetastatic castration-resistant prostate cancer. Investigators for the phase II INTREPId trial (NCT04025372) are now trying to determine whether darolutamide can be successfully substituted for ADT for use in combination with radiation therapy (RT) for patients with intermediate-risk prostate cancer. The researchers hope to improve patients’ quality of life by replacing ADT, as the treatment is associated with several adverse events, including erectile dysfunction. The INTREPId trial has a target enrollment of 220 patients who will be randomized to oral bicalutamide daily with a gonadotropin-releasing hormone agonist as prescribed and RT starting 8 to 12 weeks after ADT or oral darolutamide twice daily plus RT. ... to read the full story

Prostate cancer occurs in the prostate gland found underneath the bladder. As the cancer grows bigger, symptoms begin to appear. What’s the sign in your feet that could indicate you have the deadly disease? In the early stages of prostate cancer, when the cancer is contained inside of the prostate gland, symptoms don’t typically present themselves. It’s usually when the cancer grows near the urethra (the tube that carries urine and semen out of the body) that an early diagnosis of the disease can be given. The American Cancer Society insists more advanced prostate cancers can cause weakness or numbness in the feet. Related articles The Society adds “blood in the urine or semen” could also signify the later stages of the disease. Additionally, advanced prostate cancer – when the cancer has spread to other parts of the body – can show up in the inability to get or keep an erection. Furthermore, the organisation states “pain in the hips, back (spine), chest (ribs) or other...

Minimally invasive surgery offers reduced pain and opioid use postoperatively compared to open surgery, but large-scale comparative studies are lacking. We assessed the incidence of persistent opioid use after open and robotic-assisted radical prostatectomy. We performed a retrospective claims database cohort study of opioid-naive (i.e., no opioid prescriptions 30-180 days before index surgery) adult males who underwent radical prostatectomy for prostate cancer from July 2013-June 2017. For patients who filled a perioperative opioid prescription (30 days before to 14 days after surgery), we calculated the incidence of new persistent postoperative opioid use (≥1 prescription 90-180 days after surgery). Multivariable logistic regression was performed to investigate the association between surgical approach, patient risk factors and persistent opioid use. 12,278 radical prostatectomy patients filled an opioid prescription perioperatively (1510 [12%] open, 10,768 [88%] robotic-assisted)....

New artificial intelligence (AI) capabilities may make it possible to improve the effectiveness of brachytherapy for men with prostate cancer (PCa) by almost instantly generating dosage plans, according to investigators. In a typical high-dose rate (HDR) brachytherapy procedure for PCa, needle applicators are first inserted by the physician to the tumor target. A planner then develops a treatment plan manually. During this time the patient carries the needles, waiting for the planning to finish. With the current standard of care, it takes up to an hour or more to generate a high-quality plan. New research, however, suggests that this wait time can be substantially reduced with enhanced deep-learning models that streamline the process down to about 10 minutes. Currently, a physician has to manually outline the tumor target that is to be treated as well as the organs nearby. A planner has to manually digitize needles and iteratively tune treatment planning hyperparameters of the plan...

Talazoparib monotherapy induced promising antitumor activity in men with metastatic castration-resistant prostate cancer who previously received docetaxel, according to the first interim analysis of the single-arm, phase 2 TALAPRO-1 study presented at Genitourinary Cancers Symposium. The poly(ADP-ribose) polymerase (PARP) inhibitor appeared well-tolerated overall and particularly effective for men with BRCA1 or BRCA2 mutations, Johann S. De Bono, MD, PhD, MB, FRCP, head of the division of clinical studies and professor of experimental cancer medicine at The Institute of Cancer Research in the United Kingdom, and colleagues noted. Previous studies have demonstrated the efficacy of PARP inhibitors among men with metastatic castration-resistant prostate cancer and DNA damage repair (DDR) mutations who received prior hormonal therapy. Talazoparib (Talzenna, Pfizer Oncology) differs from other PARP inhibitors in that it traps PARP on DNA, inhibiting replication of cancer cells. Rese...

Talazoparib monotherapy induced promising antitumor activity in men with metastatic castration-resistant prostate cancer who previously received docetaxel, according to the first interim analysis of the single-arm, phase 2 TALAPRO-1 study presented at Genitourinary Cancers Symposium. The poly(ADP-ribose) polymerase (PARP) inhibitor appeared well-tolerated overall and particularly effective for men with BRCA1 or BRCA2 mutations, Johann S. De Bono, MD, PhD, MB, FRCP, head of the division of clinical studies and professor of experimental cancer medicine at The Institute of Cancer Research in the United Kingdom, and colleagues noted. Previous studies have demonstrated the efficacy of PARP inhibitors among men with metastatic castration-resistant prostate cancer and DNA damage repair (DDR) mutations who received prior hormonal therapy. Talazoparib (Talzenna, Pfizer Oncology) differs from other PARP inhibitors in that it traps PARP on DNA, inhibiting replication of cancer cells. Rese...

Recent news article have suggested that healthy men don’t need to have routine prostate screenings. At first you might say, “Well I’m healthy. Maybe I’ll skip it this time.” Should you? A few years ago the United States Preventive Services Task Force said in a report that routine “prostate-specific antigen” (PSA) screenings does not save lives. Their conclusion was based on five major clinical studies. The two largest studies conducted in the U.S. and Europe found that the death rates of men who got prostate screenings were virtually the same as those who didn’t. Is this reason enough not to have a routine prostate screenings? What most people and even some doctors don’t understand is that a PSA screening is not a specific test for cancer. It’s a test that can detect abnormalities. It doesn’t identify a particular problem. One doctor put it this way “A PSA screening is like an engine warning light. When it flashes, you can’t tell if a particular spark plug is bad. It tells you on...

Recent news article have suggested that healthy men don’t need to have routine prostate screenings. At first you might say, “Well I’m healthy. Maybe I’ll skip it this time.” Should you? A few years ago the United States Preventive Services Task Force said in a report that routine “prostate-specific antigen” (PSA) screenings does not save lives. Their conclusion was based on five major clinical studies. The two largest studies conducted in the U.S. and Europe found that the death rates of men who got prostate screenings were virtually the same as those who didn’t. Is this reason enough not to have a routine prostate screenings? What most people and even some doctors don’t understand is that a PSA screening is not a specific test for cancer. It’s a test that can detect abnormalities. It doesn’t identify a particular problem. One doctor put it this way “A PSA screening is like an engine warning light. When it flashes, you can’t tell if a particular spark plug is bad. It tells you on...

SILVER SPRING, Md. -- A novel focal therapy that uses a laser-activated agent for treating early prostate cancer will face scrutiny from an FDA advisory committee on Wednesday, as will an add-on targeted agent for the first-line treatment of metastatic EGFR -mutant non-small cell lung cancer (NSCLC). TOOKAD in Early Prostate Cancer In a morning session, the Oncologic Drugs Advisory Committee (ODAC) will decide on whether padeliporfin di-potassium (TOOKAD) as an alternative to active surveillance constitutes a benefit for men with localized, low-risk prostate cancer. According to briefing documents from FDA staff, TOOKAD "is a derivative of bacteriochlorophyll, a photosynthetic pigment of aquatic bacteria." Developed by Steba Oncology, the treatment is administered in a 4 mg/kg dose over a single 10-minute infusion, and then activated by "laser illumination" with fibers placed in the patient's prostate. Primary support for the treatment derives from the rand...

NORFOLK, Va. - Prostate cancer is killing African American men faster than it's killing men of any other race. According to the Centers for Disease Control and Prevention, African American men are more than twice as likely to die from the cancer than white men. Terrance Afer-Anderson understands that statistic personally. The 69-year-old was diagnosed with prostate cancer in 2010. "I saw it as a challenge that I was not going to let beat me," he says. According to the American Cancer Society, African American men are more likely to get prostate cancer than other men. It's reported that one in seven African American men will be diagnosed compared to one in eight white men. Local doctors have been looking into why the racial disparity exists. Dr. Joshua Langston, Chief Medical Officer at Urology of Virginia, says, "We're uncovering the genetics of prostate cancer more and more every year, and there are some significant contributions there." In ot...

Neeraj Agarwal The addition of apalutamide to androgen deprivation therapy provided a subsequent PFS benefit for men with nonmetastatic castration-resistant prostate cancer, according to results of a post-hoc analysis of the randomized phase 3 TITAN study presented at Genitourinary Cancers Symposium. The benefit was observed regardless of the type of first life-extending therapy men received after study treatment, according to the researchers. “Early intensive treatment is important. We cannot treat most of our patients with standard ADT anymore,” Neeraj Agarwal, MD, prostate cancer physician at Huntsman Cancer Institute and professor of medicine at University of Utah, told Healio. “We have to consider intensification of therapy in our patients with nonmetastatic castration-resistant prostate cancer by adding apalutamide to ADT because there is now strong level-one evidence showing continued improvements in PFS and OS with subsequent therapy. The subsequent PFS benefit observed...

We’ve long been schooled on the lifesaving value of early detection of a potentially deadly cancer. So when a simple blood test was introduced in 1994 that could detect the possible presence of prostate cancer, the second leading cause of cancer deaths among American men, it’s not hard to understand why it quickly became hugely popular. Suddenly, in the decades following approval of the test known as the PSA, for prostate-specific antigen, the number of men receiving a diagnosis of prostate cancer skyrocketed, along with the number undergoing biopsies of this walnut-size gland between the bladder and penis that produces the seminal fluid to nourish sperm. The goal of screening is to find aggressive cancers early enough to reduce the risk of death, and national health statistics seem to justify the popularity of PSA screening. Today 90 percent of prostate cancers are found while the disease is still confined to the gland and its nearby neighbors, when nearly 100 percent of men with...