Prostate Cancer

"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.

The panel provides clinical insights on the placement of rectal spacers, the management of toxicities, and the counseling of patients with prostate cancer following rectal spacer placement.

"In our multivariate analysis, we actually found that there was no significant difference between the groups," says Kevin Shee, MD, PhD.

In this companion article, Jaideep S. Sohi, MD, shares insights on PSMA-PET imaging’s impact on real-world diagnosis and management of prostate cancer.

"It's no surprise that there are many people interested in active surveillance and how we can be doing it better," says Kevin Shee, MD, PhD.

"This is just another way that we can exploit the body's own natural system to take care of cancer," says Daniel P. Petrylak, MD.

Neeraj Agarwal, MD, discusses an analysis from the phase 3 TITAN trial that explored the correlation between PSA response and survival among patients with metastatic castration-sensitive prostate cancer receiving apalutamide.

Zeyad Schwen, MD, a urologic oncologist at Cleveland Clinic, discusses how patient factors and cancer characteristics are key to deciding between focal therapies and whole gland treatment for prostate cancer.

Urologists and radiation oncologists discuss the multidisciplinary approach to treating patients with prostate cancer and how they address treatment complications.

A detailed overview of clinical trials and ongoing research in prostate cancer investigating rectal spacers.

The phase 1/2 study is scheduled to commence in the first half of 2024.