Genitourinary Cancers

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.

Analyses of data collected in PROCEED, a large real-world registry, corroborate phase III study findings demonstrating that sipuleucel-T (Provenge) treatment for metastatic castrate-resistant prostate cancer has a particular benefit for improving overall survival in African-American men.

A 63-year-old African-American male presents to the emergency department with sudden onset of painless gross hematuria for one day. He reports dark red urine with clots causing occasional dysuria, difficulty emptying, and light-headedness.

Patients with CVD taking abiraterone or enzalutamide have a 43% higher risk of hospitalization, according to a recent study.

A survey of low-risk prostate cancer patients found men who choose active surveillance over definitive treatment have similar mental health outcomes.

Study findings have implications for noninvasive markers to predict the course of UCC

Analyses based on number needed to treat benefit show that the overall survival benefit is similar when using abiraterone acetate (ZYTIGA), enzalutamide (XTANDI), or sipuleucel-T (Provenge) to treat men with chemotherapy-naïve metastatic castration-resistant prostate cancer. The data, however, favor sipuleucel-T for having the lowest direct cost.

Pembrolizumab (Keytruda) is showing encouraging antitumor activity in an ongoing phase II study including patients with high-risk, nonmuscle-invasive bladder cancer that is unresponsive to bacillus Calmette-Guérin treatment.

"There appears to be a strikingly high likelihood of increased morbidity and poor outcomes in patient who are not receiving definitive therapy," writes Badar M. Mian, MD.

Mark Frydenberg, MD, of Australia's Monash University, discusses whether multiparametric MRI is ready to be used as a screening modality for prostate cancer.

In this interview, Mark Frydenberg, MD, discusses the evolution of PET scanning, its clinical indications, its advantages and drawbacks, and key questions that remain about its use.

"While much work is still to be done, we have excellent evidence that there is a beneficial class-like effect for the androgen inhibitors enzalutamide, apalutamide, and darolutamide used within the current definition of men with M0 CPRPC," write Michael Cookson, MD, and Tony Rodriguez, MD.

Neoadjuvant chemohormonal therapy warrants consideration in the management of men undergoing radical prostatectomy for clinically localized high-risk prostate cancer, said James Eastham, MD, at the American Society of Clinical Oncology annual meeting in Chicago.

Results of a phase III trial show the benefit of darolutamide (Nubeqa) in reducing the risk of metastases or death compared with placebo in men with nonmetastatic castration-resistant prostate cancer.

Race does not affect oncologic response to treatment with docetaxel (Taxotere)/prednisone in men with metastatic castrate-resistant prostate cancer, according to research presented at the American Society of Clinical Oncology annual meeting in Chicago.

Adding enzalutamide (XTANDI) to androgen deprivation therapy significantly improves outcomes for men with metastatic hormone-sensitive prostate cancer regardless of whether they received prior chemotherapy.

The largest analysis of active surveillance for metastatic renal cell carcinoma presented to date shows that a proportion of patients can be safely observed without need to start systemic therapy right away.

18F-DCFPyL PET/CT imaging demonstrated excellent performance in identifying regional or distant metastases in men with prostate cancer in the prospective OSPREY study.

"While the safety and feasibility of the renal mass biopsy procedure has been established, if or when to obtain the biopsy remains a topic for active discussion," writes Badar M. Mian, MD.

A pivotal phase II trial of a novel MRI-guided ultrasound ablation treatment exceeded its primary efficacy endpoint of PSA decline in men with organ-confined prostate cancer.

On the basis of findings from the KEYNOTE-426 study, the combination of pembrolizumab (KEYTRUDA) plus axitinib (Inlyta) represents a new standard as front-line treatment for metastatic clear cell renal cell carcinoma, said Thomas Powles, MD.

"KEYNOTE-426 marks an exciting breakthrough in the management of advanced and metastatic RCC. Indeed, the study’s aftershocks are sure to be felt in the mRCC space for years," write Fern Anari, MD, and Alexander Kutikov, MD.

"This report brings to light an often-suspected but previously undocumented clinical issue in great and alarming detail," says Badar M. Mian, MD.

Other products in this round-up include treatments for advanced renal cell carcinoma, metastatic urothelial cancer, and more.

A significant proportion of men who progress radiologically while on the androgen receptor inhibitor enzalutamide (XTANDI) do not meet standard criteria for PSA progression, reported Fred Saad, MD.

"Deciding what care is appropriate is already extraordinarily difficult but will be a growing problem for the next generation of physicians and society," writes Peter C. Albertsen, MD.

Integration of tumor genetic testing and genomically-informed therapies into clinical practice for patients with advanced prostate cancer are featured in updated National Comprehensive Cancer Network guidelines on the management of prostate cancer (version 2.2019).

More research is needed to determine the value of using magnetic resonance imaging to predict pathology outcomes following radical prostatectomy, according to a study presented at the AUA annual meeting in Chicago.

Alterations in DNA damage response genes, excluding ATM, correlate with improved outcomes in relapsed/advanced urothelial cancer.