Genitourinary Cancers

Durvalumab (IMFINZI) appears to be feasible as neoadjuvant therapy with preliminary evidence of antitumor activity in patients with muscle-invasive bladder cancer who are ineligible for cisplatin-based chemotherapy.

In this interview, Leonard G. Gomella, MD, discusses the increasingly important role genetic testing plays in prostate cancer, current obstacles to testing, and when and how it will be carried out.

“It hasn’t become the gold standard yet. There are still a lot of inter-reader reliability issues. The same MRI scans, read by different radiologists, may be read differently," says one urologist.

ImmunityBio announced that the FDA has granted Breakthrough Therapy designation for its interleukin-15 agonist complex, N-803, in combination with Bacillus Calmette-Guerin (BCG), for the treatment of patients with BCG-unresponsive nonmuscle-invasive bladder carcinoma in situ.

Nanospectra Biosciences, Inc. recently announced the start of a pivotal study to determine the efficacy of using magnetic resonance imaging/ultrasound fusion imaging technology to direct focal ablation of prostate tissue using nanoparticle-directed laser ablation.

Recent research shows contemporary imaging and biopsy techniques often fail to identify contralateral tumors in men presumed to have unilateral prostate cancer-and the results have significant implications for identifying candidates for hemiablation.

The FDA has granted Breakthrough Therapy designation for enfortumab vedotin-ejfv (PADCEV) in combination with the anti-PD-1 therapy pembrolizumab (KEYTRUDA) for the treatment of patients with unresectable locally advanced or metastatic urothelial cancer who are unable to receive cisplatin-based chemotherapy in the first-line setting.

In this video, Scott Eggener, MD, outlines which patients are the best candidates for focal therapy for prostate cancer, and discusses the differences in follow-up for patients treated with focal therapy compared with those undergoing active surveillance.

Martin Gleave, MD, of the University of British Columbia in Vancouver, discusses the Genomic Umbrella Neoadjuvant Study (GUNS) trial, which uses a multi-arm, multistage adaptive design to test targeted therapies in patients with high-risk localized disease by matching neoadjuvant therapies to baseline genomic alterations.

"In this era of BCG shortage, we may be forced to develop new standards and alternative strategies for bladder preservation," writes Badar M. Mian, MD.

"The recently reported change in PCa death rates should prompt men to undergo genetic testing and have a discussion with their doctor regarding the benefits and potential harms of PSA-based screening based on their individualized risk of developing the disease," write Franklin Gaylis, MD, and A. Karim Kader, MD, PhD.

Recommendations on opioid prescribing after endourologic and minimally invasive urologic surgery from an expert panel should help urologists align individual prescribing habits with current evidence, reduce opioid overprescribing, and provide a framework for refining patient-centered guidelines for opioid stewardship in urology, said Kevin Koo, MD, MPH, MPhil.

A multicenter study in the United Kingdom found 5-year prostate cancer control rates following treatment with focal therapy are similar to those of patients who have undergone radical prostatectomy, even when accounting for variation in tumor location, size, and risk.

A simple intervention aiming to curb the contribution of postoperative pain medication prescribing to the opioid crisis was shown to reduce post-discharge opioid prescribing and use and increase opioid disposal without seeming to jeopardize pain control for patients who had undergone radical prostatectomy.

"It certainly looks like these new therapies will provide better results. From the research and literature, it looks like significant improvement," says one urologist.

Several decades of data show that Black men are less likely to be screened and treated for prostate cancer than their white counterparts. In this interview, Kelvin A. Moses, MD, PhD, of Vanderbilt University Medical Center, Nashville, TN discusses the reasons for these disparities and how practicing urologists can address them.

For this installment of “Speak Out,” urologists were asked to discuss recent studies indicating African-American men with prostate cancer may be put on active surveillance without suffering complications and that they respond to radiation and some chemotherapy better than Caucasian men.

“The results of our retrospective study support taking advantage of the Cxbladder test to identify patients who should be further evaluated for cancer and to spare those who likely do not have cancer from an unnecessary workup," says Badrinath Konety, MD, MBA.

“We’re in an era of more personalized or precision medicine, and the ability to target cancer treatment to a patient’s specific genetic mutation or biomarker is becoming the standard,” according to Richard Pazdur, MD.

"A more standardized protocol that is office based, reliable, and reproducible as well as cost- and time-efficient is required to entice more urologists to abandon the TRUS-BX approach," writes J. Brantley Thrasher, MD.

Reduced infection rate may drive increased use of the transperineal approach.

"Irrespective of treatment, fewer than half of men reported the ability to maintain erections sufficient for intercourse at 5 years," writes Badar M. Mian, MD.

A radiolabeled small molecule that binds to prostate-specific membrane antigen is continuing to show promise for treating progressive metastatic castrate-resistant prostate cancer, according to researchers at the University of California, Los Angeles.

Chronic opioid use is rare following radical prostatectomy in Europe. Slightly more than half of men undergoing RP in Sweden between 2007 and 2017 were found to have filled an opioid prescription, but the proportion who became chronic opioid users was less than 1%.

In a study of circulating tumor cells (CTCs) in metastatic genitourinary cancer patients, shorter survival was associated with high CTC counts at baseline and on therapy, specific CTC morphologic subtypes, PD-L1-positive CTCs, and low percent CD4 and percent CD8 T-cells. Heather Chalfin, MD, discusses the data and explains how CTCs may offer an advantage over other forms of liquid biopsy.