Prostate Cancer

Expert urologists discuss the impact of their formulary on prescribing abiraterone for metastatic castration-resistant prostate cancer (mCRPC), emphasizing its use in special patient populations and the importance of accessibility. They highlight the role of educational support and collaboration with manufacturers in facilitating access to treatments not typically included in the formulary, especially for unique patient groups. They emphasize the importance of manufacturer collaboration, Medicare changes, and specialized programs for aiding low-income seniors, underscoring the commitment to enhancing patient access and compliance in healthcare.

The panel recommended that baseline PSA testing be done in Black men between the ages of 40 to 45.

“The more informed the patients are, the more likely they are to participate in decision making…Patient engagement in decisions reduces decisional regret and fosters patient satisfaction with treatment outcomes,” the researchers wrote.

"It adds to the evidence base that is building that shows that improving your fitness levels is a positive thing to do to reduce your risk of developing prostate cancer," says Kate A. Bolam Enarsson, PhD.

In this episode, experts share their perspectives from their urology practices on addressing challenges such as insurance coverage, access issues, and the frequency of prior authorization (PA) denials and subsequent appeals. Co-panelists emphasize the need for additional information required by physicians to effectively appeal PA denials. Dr De La Cerda highlights the support his urology practice provides to meet the needs of his unique patient population.

In this episode, Dr. Christopher M. Pieczonka and Dr. Jose De La Cerda discuss the nuances of prescribing abiraterone acetate related to strategies for patient counseling on prednisone and methylprednisolone use and managing steroid-related side effects, dosing adjustments in patients with liver issues, emphasizing the importance of close monitoring and individualized care in prostate cancer treatment.

Expert oncologists give an overview of prostate-specific membrane antigen (PSMA) and discuss its utility for the treatment of prostate cancer.

A panel of expert oncologists in prostate cancer give an overview of the evolution of imaging techniques used for patients with prostate cancer.

The clearance will initiate the phase 2 CELLVX-230 trial, which will assess the therapy in patients with prostate cancer with a high risk of recurrence following prostatectomy.

Clinical benefit with olaparib plus abiraterone was observed in patients with BRCA2, ATM, and CDK12 mutations, which were the most prevalent single-gene HRR mutations across all patients treated.

"Certainly germline and somatic is recommended for all mCRPC patients to detect HR gene mutations, and consider options for PARP inhibitors,” says Neal Shore, MD, FACS.

In this episode, Dr. Christopher M. Pieczonka and Dr. Jose De La Cerda explores the differences in dosing and administration of abiraterone acetate products, including the impact of food effects, and optimizing therapy for special populations with comorbidities like diabetes, hypertension, and obesity. They share insights from their clinical experience on patient compliance, tolerability, and quality of life improvements with micronized abiraterone.

Dr. Christopher M. Pieczonka and Dr. Jose De La Cerda discuss the various formulations of abiraterone, including micronized and non-micronized forms in combination with prednisone or methylprednisolone, including safety and effectiveness. They share insights on the specific patient populations for whom micronized abiraterone is particularly beneficial, how patient specific needs or comorbidities influence treatment appropriateness. They also delve into the accessibility of these formulations, emphasizing the importance of proper diagnosis codes to enhance medication approval processes.

Dr. Jose De La Cerda and Dr. Christopher M. Pieczonka shed light on their approach to prescribing medicines for patients with metastatic castration-resistant prostate cancer (mCRPC). They highlight the importance of patient access to care, discuss the availability of various therapies, including novel hormonal agents and infusions, and anticipate a positive shift in treatment accessibility in the coming years due to government initiatives.

“HRR testing in patients before or at the time of mCRPC [diagnosis] would allow for olaparib therapy earlier in the disease course and potentially greater clinical benefit," wrote Daniel J. George, MD, and colleagues.

Drug-related hematological treatment-emergent adverse events were proportionately similar between the EBRT cohort and the those who did not receive EBRT to the bone.

"These data really show that even in the patients who upgrade and have more severe disease than were initially expected, even if their surgery was delayed for 12 months after having this upgraded diagnosis, these patients did just as well from a recurrence perspective, compared to patients who got surgery right away," says Kevin Shee, MD, PhD.

The expert panel concludes their discussion with a look toward the future of prostate cancer treatment and the evolving role of rectal spacers.

Data showed that treatment with radical prostatectomy was associated with worse urinary incontinence but not worse sexual function compared with other treatment options, regardless of cancer risk.

"Many men are quite reluctant to go to a specialist, specifically the urologist, because of the fear or reluctance to undergo an invasive test, [such as] a rectal exam," says Shahrokh F. Shariat, MD.

Patients were less likely to choose active surveillance when their decision was influenced by their treatment goals of achieving “cure” or to “live longer,” or when they perceived their diagnosis of low-risk prostate cancer to be more serious.

"We investigated and compared the risk of infection after transperineal MRI-targeted biopsy vs a transrectal MRI-targeted biopsy," says Jim C. Hu, MD, MPH.

"In deciding whom to discharge within hours of a less invasive but major surgery, we must ask ourselves which master we are serving: the insurer, the administrator, or our own ego," writes Badar M. Mian, MD.

"I tried to cover the focal therapies, at least just review some of the new ones that are coming in, even though they're still not necessarily 100% mainstream," says Andrew L. Siegel, MD.

A group of urologists and radiation oncologists detail how they were trained on the utilization of rectal spacers and offer practical advice for other clinicians treating patients with prostate cancer.