Genitourinary Cancers

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.

Retrospective cohort study identifies wide variation in treatment rates, spending.

Both the efficacy and safety of abiraterone acetate (ZYTIGA) treatment for metastatic castrate-resistant prostate cancer (mCRPC) appear to differ depending on race, according to results of Abi Race, a prospective, multicenter trial presented at the American Society of Clinical Oncology annual meeting in Chicago.

Median overall survival for African-American men with advanced prostate cancer who are treated with docetaxel (Taxotere) is similar to that of Caucasian men, according to an analysis of pooled data from nine randomized phase III clinical trials.

"Two provocative studies reported at the 2018 ASCO annual meeting provide additional insight into prostate cancer racial disparities in a different group of patients, namely men with advanced prostate cancer who participated in a variety of clinical trials," writes Leonard G. Gomella, MD.

In this interview, John W. Davis, MD, discusses the advantages and limitations of focal therapy, the ideal candidate, and what current guidelines say about its use.

Treatment with apalutamide (Erleada) resulted in a rapid and substantial decline in PSA, and greater magnitude of PSA decline correlated with improvement in several oncologic endpoints, results from the phase III SPARTAN study showed.

A study investigating associations between statin use and prostate cancer outcomes provides further evidence that the medication may have race-related benefit, providing protective effects among Caucasian men but not in African-Americans.

Studies show moderate alcohol intake has surprising links to prostate disease.

Findings of a multi-institutional cohort study provide further evidence that favorable outcomes can be achieved by carefully selected patients with muscle-invasive bladder cancer who forgo radical cystectomy after achieving a clinical complete response to neoadjuvant chemotherapy.

Other pipeline products discussed in this round-up include agents for metastatic urothelial cancer, clear cell renal cell carcinoma, and stress urinary incontinence.

Other topics covered in this year's take-home messages for basic science (benign) include interstitial cystitis/bladder pain syndrome and bladder cancer.

Radical prostatectomy can provide superior survival compared with radiation therapy, especially in young and healthy men.

Personally tailored intervention generates patient interest, QoL improvements.