Genitourinary Cancers

Inflammatory bowel disease increases the risk of any and clinically significant prostate cancer, according to an examination of data from a large, single medical network.

"Patients with favorable-risk disease who have a DNA repair mutation should be counseled that there is a significantly increased risk of reclassification with AS," writes Stacy Loeb, MD, MSc.

Men with prostate cancer who are carriers of germline pathogenic mutations in the DNA repair genes BRCA1/2 and ATM are at increased risk for grade reclassification during active surveillance, according to research reported by H. Ballentine Carter, MD, at the 2018 AUA annual meeting in San Francisco.

This article explores the current and potential future use of immunotherapy in prostate, kidney, and bladder cancer.

Cabozantinib (Cabometyx) demonstrated consistent improvement in progression-free survival and overall survival (OS) over everolimus (Afinitor) and sunitinib (Sutent), irrespective of PD-L1 status, across two randomized controlled clinical trials in patients with metastatic clear cell renal cell carcinoma. 

Compared to an open approach, minimally invasive radical cystectomy was associated with a near 2-day shorter hospital stay in bladder cancer patients treated at diverse institutions across the United States, according to authors of a recent retrospective analysis of Medicare claims.

"Biochemical recurrence after radical prostatectomy may occur in 20% to 50% of cases and salvage radiation therapy is considered the best treatment in most cases. But the questions about whether to add androgen deprivation therapy, as well as its dose and duration, remain subjects of active clinical debate," writes Badar M. Mian, MD.

Surgery was associated with improved cancer-specific and overall mortality compared with radiation therapy, according to a recent study.

Agents for bladder cancer, overactive bladder, and hyperoxaluria are among the other products discussed in this round-up.

Poor outcomes in women may stem from diagnostic, therapeutic, and biologic factors.

Dr. Kutikov discuss several noteworthy studies about kidney cancer from 2018.

"2018 was an exciting and productive year for kidney cancer research," write Amr A. Elbakry, MBBCh, MSc, and Ketan K. Badani, MD.

"This study highlights the need for each practice to perform a self-audit of its AS protocol and take all necessary measures to ensure that patients are not lost during the monitoring period," writes Badar M. Mian, MD.

Christopher P. Filson, MD, MS, Adam Kibel, MD, and Stacy Loeb, MD, MS, highlight the year’s most important advances in the disease state.

Other urology pipeline-related news includes published data from a randomized controlled trial of a complicated urinary tract infection agent as well as level 1 evidence of partial gland ablation for prostate cancer.

"Utilization analysis of health care resources must be free of bias, methodologically sound, and relevant to current practice," writes Deepak A. Kapoor, MD.

"Urologists in practice now need to have at least some working knowledge in this area because I’ve seen it several times in my academic practice," says one urologist.

Patients who receive a radiation oncology consultation after being diagnosed with localized prostate cancer are much more likely to receive active therapy than men managed only by a urologist, and the men seen by a radiation oncologist are particularly likely to be treated with radiation therapy, according to a Canadian population-based, retrospective cohort study.

Phase III data indicate benefit only for a subset of patients.

"The list of methods and biomarkers to help patients and physicians decide whether to perform biopsy is continuously evolving," writes Sigrid Carlsson, MD, PhD, MPH.

Results of a prospective, multicenter study validate the clinical performance of a PSA isoform assay (IsoPSA) for predicting high-grade prostate cancer, Eric A. Klein, MD, reported at the AUA annual meeting in San Francisco.

In men undergoing prostate biopsy, use of prophylactic antibiotics has been increasing appropriately over time, and fluoroquinolones still dominate, results of an insurance claims database analysis show.

"Proper patient selection, including those with low-/intermediate-risk disease, is paramount," writes Badar M. Mian, MD.

Compared with other treatment approaches, definitive surgical extirpation provides the best survival outcomes in patients with invasive, non-urachal adenocarcinoma of the bladder, results of a recent study suggest.

"While there was no further reduction of prostate cancer risk after finasteride was discontinued, there was also no evidence that stopping finasteride resulted in more cases of prostate cancer," writes Badar M. Mian, MD.