Prostate Cancer

For the first time in its long and storied history, hormonal therapy for advanced prostate cancer has received broad and detailed attention in a clinical practice guideline. The new American Urological Association (AUA) guideline provides direction for the use of hormonal therapy (or androgen-deprivation therapy, ADT) for men with multiple categories of advanced and metastatic prostate cancer. "[ADT] is a mainstay of management that we've known about since the Nobel Prize-winning work in the 1940s," said guideline co-chair Michael Cookson, MD, of the University of Oklahoma Health Sciences Center in Oklahoma City. "It's taken a long time to get there, and that's partly due to the fact that a lot of what we did was empiric. There weren't many trials designed to show the true benefit." Another guideline first reflects the growing recognition of the different stages of disease evolution before the emergence of metastatic castration-resistant prostate ...

Huma Q. Rana, MD, MPH, an assistant professor of medicine at Dana-Farber Cancer Institute and the clinical director of Cancer Genetics and Prevention at Harvard Medical School, discusses the prevalence of pathogenic variants in patients with prostate cancer enrolled on the ProGen study. The ProGen study enrolled patients with prostate cancer and a family history indicative of a pathogenic variant who were then randomized 1:3 to in-person genetic counseling or video education. The goal of the trial was to evaluate completion of the intervention, uptake of genetic testing, satisfaction, knowledge, and distress over time by randomization arm. Investigators also wanted to identify clinical factors associated with presence of pathogenic variants in cancer susceptibility genes. The main actionable finding from the study showed that among men with advanced prostate cancer, pathogenic variants or likely pathogenic variants in genes are responsible for homologous recombina...

New guidelines issued jointly by the American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) focus on men withadvanced stage disease and now include new treatments, including the use of PARP inhibitors in the metastatic castration-resistant (mCRCP) setting. The guidelines were co-presented by William T. Lowrance, MD, MPH, and Michael S. Cookson, MD, MMHC, during the 2020 American Urological Association Virtual Experience. 1 “Men with advanced prostate cancer have exhausted local therapies and are now moving on to systemic options,” said Lowrance, who is an associate professor in the Division of Urology at the University of Utah School of Medicine and an investigator at the Huntsman Cancer Institute. “Specifically, these guidelines focus on men who experience biochemical recurrence, metastatic hormone-sensitive prostate cancer [mHSPC], non-metastatic castration-resistant prostate cancer [nmCRPC], or metastatic cast...

The implementation of systematic germline genetic testing in veterans with metastatic prostate cancer appeared to be feasible due to high consent rates, especially with direct oncologist involvement, according to results from a prospective trial. Additionally, data showed that the frequency of germline DNA damage-repair (DDR) alterations is similar to those with prostate cancer who are not veterans. In the pilot study, investigators studied the feasibility of a systematic workflow that helped oncologists identify veterans with metastatic prostate cancer at VA Puget Sound Health Care System, which cares for veterans who require ongoing cancer therapy. After the patients were prescreened and identified by a research coordinator, an oncologist would discuss germline testing in great detail with both the patients and their families. A total of 227 patients were approached in this trial. Out of these patients, 84% (n = 182) consented to genetic testing and 90% completed it. Results showe...

The implementation of systematic germline genetic testing in veterans with metastatic prostate cancer appeared to be feasible due to high consent rates, especially with direct oncologist involvement, according to results from a prospective trial. Additionally, data showed that the frequency of germline DNA damage-repair (DDR) alterations is similar to those with prostate cancer who are not veterans. In the pilot study, investigators studied the feasibility of a systematic workflow that helped oncologists identify veterans with metastatic prostate cancer at VA Puget Sound Health Care System, which cares for veterans who require ongoing cancer therapy. After the patients were prescreened and identified by a research coordinator, an oncologist would discuss germline testing in great detail with both the patients and their families. A total of 227 patients were approached in this trial. Out of these patients, 84% (n = 182) consented to genetic testing and 90% completed it. Results showe...

SHORT information videos are breaking down healthcare barriers across the wider Grampians region for Ballarat Health Services' prostate care specialists. BHS aims to try and inform general practitioners about the latest in prostate cancer treatment options in a face-to-face forum to better promote smoother collaboration for patients. Like all healthcare, prostate care services have had to adapt in getting the right information to clinicians and patients amid COVID-19 pandemic restrictions. Ballarat-based prostate care nurse Gay Corbett said a suite of raw region-focused informative videos for GPs was actually reaching further across Ballarat and into the region with doctors able to review content when it suited them best, find relevant parts to share with patients and friendly faces in the videos helped too. "Seeing faces of local clinicians has meant they can show patients as well - this is who you might see - and gives ideas for people about what it's going to be like,...

(UroToday.com) Prostate cancer and testosterone deficiency symptoms increase with age. Therefore, patients may suffer from both conditions, and their quality of life could be significantly reduced. The EQUINOXE (NCT02630641) is an observational study in prostate cancer patients initiating GNRH agonist therapy and included 492 patients and their partners. The objective of this currently complimentary presented study was to describe the baseline parameters of patients with testosterone deficiency symptoms at baseline. This was a prospective, multicenter, longitudinal, non-interventional study conducted in France. Patients with histologically confirmed prostate cancer, who were eligible to start GNRH agonist therapy, and their partners were included in this study. Baseline and six-month follow-up data were analyzed, including data from their partners, using various questionnaires. The objective was to evaluate the evolution of the quality of life after six months of agonist hormonal the...

(UroToday.com) The STAMPEDE trial recently demonstrated a survival benefit for selected patients with metastatic prostate cancer who were treated with androgen deprivation therapy plus prostate radiotherapy. 1 This trial demonstrated that the treatment of the primary tumor improved as well as failure-free survival in patients with M1a prostate cancer. Furthermore, radiotherapy was associated with a survival benefit in individuals with M1b disease with a low metastatic burden. However, little is known regarding the efficacy of surgery in the same setting, as patients treated with radical prostatectomy have not been studied. It is hypothesized that tumors in the early chain of progression may have a limited number of metastases because the facility for metastatic growth has not been fully reached. The CHAARTED definition of high metastatic burden was defined as four or more bone metastasis with one or more outside the vertebral bodies or pelvis, or visceral metastasis or both. Ther...

(UroToday.com) Guideline-recommended management of high-risk prostate cancer is radical prostatectomy with pelvic lymph node dissection or radiation therapy with/without systemic therapy. Increasingly, patients with regional (N1) and distant (M1) metastases are being considered for definitive local therapy. However, the oncological value of local treatment in high-risk and metastatic prostate cancer remains controversial. At the AUA 2020 virtual meeting, Brian Lane, MD, PhD, and colleagues presented results of their investigation of the oncologic outcomes of surgery for patients categorized as high-risk, very-high risk, or with suspected metastatic (N1 and/or M1) prostate cancer at the time of radical prostatectomy. For this study, the MUSIC registry was queried for all patients undergoing radical prostatectomy from January 2012 to December 2018. Of the 9,208 patients, 2,086 patients (22%) were classified as having high-risk prostate cancer or higher. High-risk prostate cancer was def...

(UroToday.com) It has previously been demonstrated that objective surgeon performance metrics using a novel recorder can directly capture surgeon manipulations on the da Vinci Surgical System. 1 Subsequently, Hung et al. 2 showed that using machine learning automated performance metrics (kinematic and events data) during robot-assisted radical prostatectomy can predict continence recovery, albeit at a single institution. At the American Urological Association (AUA) 2020 Virtual Meeting, Dr. Andrew Hung and colleagues presented updated results with multi-institutional data – automated performance metrics and clinicopathological data to predict three-month and six-month continence.  Automated performance metrics and clinicopathological data were collected for robot-assisted radical prostatectomies performed at three high-volume robotic centers: The robot-assisted radical prostatectomy was segmented into 12 steps, and for each step, 41 validated automated performance metrics ...

(UroToday.com) Dr. Laurence Klotz gave a presentation elaborating on how to reduce the morbidity and improve the outcomes of androgen deprivation therapy (ADT). The objectives of this talk were to understand the long-term effects of ADT and its association with cardiac disease, metabolic syndrome, bone health, cognitive function, and quality of life. Dr. Klotz also planned to review the importance of serum testosterone levels in men receiving ADT. Additional goals of this talk included a comparison of intermittent versus continuous ADT use in prostate cancer patients, and discussing the role of ADT in the androgen receptor antagonist therapy (ARAT) era. Dr. Klotz began with a detailed outline of ADT adverse effects. The mechanism of action of ADT is summarized in Table 1, outlining the various options of ADT. Table 1 – ADT options and mechanisms: ADT has a multitude of adverse effects, impacting all systems of our body from cardiovascular, bone health, sexual dysfunction, hepa...

(UroToday.com) Historically, it has been felt that there is a relative paucity of important germline mutations in patients with prostate cancer. However, recent work has identified important rates of mutations, particularly in DNA damage repair (DDR) pathways. The initial work in this space focused on men with advanced disease. However, more recent work has looked at this earlier in the disease process. In a podium presentation at the American Urologic Association Virtual Annual Meeting, Randy Vince, MD, and colleagues present an analysis examining rates of germline mutations in men with both metastatic and localized disease undergoing testing for clinical, rather than research, based indications. The authors utilized a single institutional cohort of men diagnosed with prostate cancer at Michigan Medicine and Michigan Institute of Urology (MIU) between 2017 and 2019. These men were offered multi-gene panel testing in accordance with NCCN BRCA-Related Breast and/or Ovarian Cancer Sy...

Adelaide: In a breakthrough study, researchers discovered that a novel formulation of the prostate cancer drug abiraterone acetate - currently marketed as Zytiga - can dramatically improve the quality of life for people suffering from prostate cancer. Pre-clinical trials by the University of South Australia show the new formulation improves the drug's effectiveness by 40 percent. Developed by Professor Clive Prestidge's Nanostructure and Drug Delivery research group at UniSA's Cancer Research Institute, the breakthrough discovery uses an oil-based oral formulation that not only enables a smaller dose of the drug to be effective, but also has the potential to dramatically reduce possible side effects, such as joint swelling and diarrhea. Despite Zytiga being the leading formulation to treat prostate cancer, lead researcher, Dr Hayley Schultz says the new formulation will ultimately provide better treatment for patients with prostate cancer. Prostate cancer is the most com...

(UroToday.com) The AUA 2020 virtual annual meeting was highlighted by an update on the AUA guidelines for advanced prostate cancer, presented by Dr. William Lowrance and Dr. Michael Cookson. Dr. Lowrance notes that this guideline was produced by a multidisciplinary panel with representation from the AUA, ASCO, ASTRO, and SUO was well as a patient advocate. Their systematic review was conducted from 1998 through January 20, 2020, and 192 publications were identified through an initial search, with an additional 46 carried over from the prior AUA CPRC review. During an additional updated review, 26 studies were added to the cohort of studies comprising this guideline. The statement of evidence rating used for the guideline is as follows: A (High): Very confident that the true effect lies close to that of the estimate of the effect B (Moderate): Moderately confident in the effect estimate, whereby the true effect is likely to be close to the estimate of the effect, but there is a p...

Credit: Diana Orey With news about the coronavirus pandemic developing daily, we want to make sure everyone affected by cancer gets the information they need during this time.   We’re pulling together the latest government and NHS health updates from across the UK in a separate blog post, which we’re updating regularly.   Targeted drug to treat multiple cancer types approved in England   A targeted cancer drug has been approved for NHS use in England to treat multiple cancer types , reports The Times and Mail Online . Entrectinib is designed to target specific changes in a cancer cell’s DNA, rather than where the cancer is growing in the body. It’s the second drug of its kind to be approved for NHS use in England, af ter larotrectinib was given the green light in April this year. These innovative treatments have been hailed as ‘revolutionary, but they also post unique and complex challenges for the NHS, as our blog post explains. Targeted drug improves surviv...