Prostate Cancer

False positives, over-diagnosis and a stable mortality rate raise doubts about this kind of screening for healthy men. Get ready. Come November, men will start growing out their moustaches. The stated goal is simple. They want to raise awareness about prostate cancer and want to encourage men to get their PSA level checked. But some people (generally the women who have to look at the men with moustaches) are not fans of the moustaches and feel they are unnecessary. Ironically, the PSA screening may be unnecessary too. Prostate specific antigen, or PSA, is a protein produced by cells in the prostate. Measuring PSA levels became widespread in the late 1980s as a way to detect early stage prostate cancer. In one sense, the test was very successful. The number of new prostate cancer diagnoses per year rose sharply after PSA screening started. But in another sense, PSA screening failed to do something that was even more important. While new cancer diagnoses went up, cancer deaths ...

JOHANNESBURG - Researchers on Monday said their findings on the origins of modern humans brought them a step closer to understanding the cause of prostate cancer in African men. An international team has found that the earliest ancestors of homo-sapiens originated in the south of the greater Zambezi River basin region, which included entire northern Botswana, western Namibia and eastern Zimbabwe. The research also shows that the changes in Africa’s climate triggered the first human exploration and movement, causing many to leave what is today known as the Greater Kalahari region. But researcher Professor Riana Bornman, from the University of Pretoria, said there was more. “We tried to link out genomic heritage to where we originated from, so if we could understand where we come from, that would help us develop treatment accordingly.” The study provides a window into the first 100,000 years of modern humans’ history. Prof Hayes, from the Garvan Institute of Medical Research and the Uni...

Why Treat Prostate Cancer Metastases with Ablative Radiation? Rationale for Metastasis-Directed Therapy (MDT) in Prostate Cancer Traditionally, the management of metastatic cancer has been chiefly through systemic treatments (excellent summary guidelines for systemic management are available[1,2]) while local therapies such as radiation have been used primarily for palliation of symptomatic lesions. Prostate cancer commonly spreads to the bones, causing pain and potentially leading to fractures at weight-bearing sites such as the femoral neck, acetabulum, or vertebral bodies. Radiation is highly effective at reducing pain caused by osseous metastases and can be delivered in one or multiple fractions of external beam radiotherapy (EBRT) or with the systemic radiopharmaceutical radium-223.[3,4] Beyond palliation, radiation may also impact the course of metastatic disease. Three decades ago, Soloway and colleagues[5] correlated 2-year survival rates with extent of metastatic disease ...

Why Treat Prostate Cancer Metastases with Ablative Radiation? Rationale for Metastasis-Directed Therapy (MDT) in Prostate Cancer Traditionally, the management of metastatic cancer has been chiefly through systemic treatments (excellent summary guidelines for systemic management are available[1,2]) while local therapies such as radiation have been used primarily for palliation of symptomatic lesions. Prostate cancer commonly spreads to the bones, causing pain and potentially leading to fractures at weight-bearing sites such as the femoral neck, acetabulum, or vertebral bodies. Radiation is highly effective at reducing pain caused by osseous metastases and can be delivered in one or multiple fractions of external beam radiotherapy (EBRT) or with the systemic radiopharmaceutical radium-223.[3,4] Beyond palliation, radiation may also impact the course of metastatic disease. Three decades ago, Soloway and colleagues[5] correlated 2-year survival rates with extent of metastatic disease ...

Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjust...

In this review, we present an update on the safety and efficacy of prostate-specific membrane antigen (PSMA) radioligand therapy (PRLT) of metastatic castration-resistant prostate cancer (mCRPC). Treatment of mCRPC with approved treatment agents leads to a survival advantage. The disease often progresses despite these treatments. PRLT with Lutetium-177 and Actinium-225 labeled with PSMA (LuPSMA and AcPSMA) have recently been shown to be effective and well tolerated for mCRPC treatment. LuPSMA is currently applied in patients who have exhausted approved treatment options or in whom these approved treatments are contraindicated. In this category of heavily pretreated patients, prostate-specific antigen (PSA) response (≥50% decline) is achieved in about 46% of patients. Side-effects are tolerable with rare reports of grade III-IV treatment-induced toxicity. AcPSMA is currently applied on a smaller scale in patients who relapsed after LuPSMA or in whom LuPSMA is contraindicated. PSA respo...

[embedded content] Neeraj Agarwal, MD, associate professor of medicine, University of Utah School of Medicine; and director, Genitourinary Oncology Program, Oncology Division, co-leader, Urologic Oncology Multidisciplinary Program, associate director of Clinical Trials, Huntsman Cancer Institute, University of Utah, discusses quality of life (QoL) with apalutamide (Erleada) in the treatment of patients with metastatic castration-sensitive prostate cancer. In the phase III TITAN trial, investigators reported an improvement in radiographic progression-free survival and overall survival with the addition of apalutamide to androgen deprivation therapy (ADT) versus ADT alone in patients with newly diagnosed metastatic castration-sensitive prostate cancer. Data from the trial served as the basis for the agent’s approval in this indication. At the 2019 ESMO Congress, Agarwal presented QoL data with apalutamide. QoL was evaluated with Functional Assessment of Cancer Therapy-Prostate and Eu...