Genitourinary Cancers

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.

The FDA has approved the anti-PD-1 therapy pembrolizumab (KEYTRUDA) as monotherapy for the treatment of patients with Bacillus Calmette-Guerin-unresponsive, high-risk, nonmuscle-invasive bladder cancer with carcinoma in situ with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.

The FDA has granted accelerated approval to enfortumab vedotin-ejfv (PADCEV) for the treatment of adults with locally advanced or metastatic urothelial cancer who have previously received a PD-1/L1 inhibitor and a platinum-containing chemotherapy before or after surgery or in a locally advanced or metastatic setting.

"Even in this selected cohort of men with very low-risk features, stable MRI score was not protective against disease progression during surveillance," writes Badar M. Mian, MD.

The FDA has approved a supplemental New Drug Application or enzalutamide (XTANDI) for the treatment of patients with metastatic castration-sensitive prostate cancer.

The BCG shortage, overuse of cystoscopy, and hematuria evaluation approaches are among the topics of the most-read Urology Times articles from 2019 on bladder cancer.

Urologists, oncologists, and prostate cancer patients are entering a new era in prostate cancer therapy-one that is going to be genetically defined.

Urology Times asked Maha H. Hussain, MD: How will the advent of PARP inhibitors change the management of advanced prostate cancer?

Leonard G. Gomella, MD, Tanya Dorff, MD, Scott Eggener, MD, and Jorge Garcia, MD, all reflect on prostate cancer treatment in 2019.

"The relevant professional associations in the field of medicine and/or urology must do their part to inform and educate their members about the appropriate use of finasteride and PSA to eliminate avoidable morbidity and mortality from prostate cancer," writes Badar M. Mian, MD.

In this interview, Chandru P. Sundaram, MD, explains the important patient and tumor characteristics to consider in deciding between partial and radical nephrectomy.

A study investigating discharge destination and perioperative complications after radical cystectomy provides useful data for risk stratification and preoperative counseling of patients 80 years of age and older, said Hayden M. Hill, MD, who presented the research at the American College of Surgeons Clinical Congress in San Francisco.

Financial toxicity is prevalent among patients with bladder cancer, according to findings from a cross-sectional study presented at the American College of Surgeons Clinical Congress in San Francisco.

Urology Times asked Scott Eggener, MD: How should urologists decide between focal therapy and active surveillance in men with low-risk prostate cancer?

The PARP inhibitor olaparib significantly extended radiographic progression-free survival compared with physician’s choice of hormonal therapy in men with metastatic castration-resistant prostate cancer who had defects in genes involved in DNA repair mechanisms.

"It’s critically important to not overemphasize the benefits or overlook the concerns related to new technology or surgical approaches as is too often the case in the marketing campaigns by various centers (both academic and community)," writes Badar M. Mian, MD.

Adding immunotherapy in the form of atezolizumab (Tecentriq) to platinum-based chemotherapy extends progression-free survival compared with chemotherapy alone in patients with previously untreated metastatic urothelial carcinoma, according to results from a phase III study.

Access to novel therapies early in the regulatory process as a result of the FDA’s accelerated approval program can be valuable for many cancer patients, but the clinicians who are responsible for their care must have heightened vigilance for incoming data and FDA guidance about these drugs that have not gone through the “gold standard” of phase III testing.

"Of note, the number needed to treat analysis revealed that 18 patients treated with ADT resulted in one patient being diagnosed with Alzheimer’s and 10 patients treated with ADT resulted in one patient with a dementia diagnosis," writes Badar M. Mian, MD.

Urotronic, Inc. said it has received an investigational device exemption approval from the FDA to begin its U.S. pivotal study for the Optilume BPH Catheter System.

Three novel androgen receptor inhibitors provide an embarrassment of riches when it comes to treatment options for nmCRPC patients, but there are still questions to be answered-including the extent of these drugs’ clinical benefit.

The FDA has approved apalutamide (Erleada) for the treatment of patients with metastatic castration-sensitive prostate cancer, a new indication for the next-generation androgen receptor inhibitor.

A preliminary study of the use of salvage lymph node dissection in patients with nonmetastatic, castration-resistant prostate cancer indicates the potential to delay disease recurrence as well as the use of systemic therapies through this approach.

A new study suggests that prostate-specific membrane antigen positron emission tomography/computed tomography may be a highly beneficial tool for initial staging of high-risk and high-intermediate-risk prostate cancer.

Researchers say the use of apalutamide (Erleada) in patients with high-risk, nonmetastatic castration-resistant prostate cancer improves metastasis-free survival in patients who have previously undergone radical prostatectomy or external radiotherapy-regardless of the type of treatment they received.

"The last several years have been particularly exciting in the area of metastatic castrate-resistant prostate cancer," writes J. Brantley Thrasher, MD.