Prostate Cancer

In the first article of this series, Juan Montoya, MD, discusses advances in perirectal spacing in the treatment of prostate cancer.

“We are now doing more testing on the RNA side,” says Brittany M. Szymaniak, PhD, CGC.

"The beauty is, now we can deliver a cisplatin-based chemotherapeutic orally, which is usually never done. And by targeting the prostate, we can reduce kidney and liver toxicity and the risk of peripheral neuropathy," says Shanta Dhar, PhD.

The prospective cohort study seeks to enroll 200 patients from the South Florida region and 1800 patients from international sites.

"My predominant role as a genetic counselor is really to serve our patient population and help support our providers," says Brittany M. Szymaniak, PhD, CGC.

"Within the Inflation Reduction Act, there is a provision that will cap the out-of-pocket contribution for Medicare beneficiaries, dropping to $3250 in 2024, as well as $2,000 in 2025," says Brian Cortese.

Experts summarize how the use of PSMA-PET imaging has impacted the field to date and share their hopes for the future.

The panel discusses the possibility of PSMA-PET becoming the standard-of-care imaging modality for prostate cancer, which may obviate the need for conventional imaging and bone scans, and then touches on the increasing availability of PSMA-targeted radiotherapies.

"Our most significant finding may be that patients experience financial toxicity despite their ability to remain compliant with treatment," says Daniel D. Joyce, MD.

“To our knowledge, these results are the first to suggest an association between second-generation [antiandrogens] and cognitive and functional toxic effects based on data from prospective [randomized controlled trials],” the investigators wrote.

Drs Cookson and Sellinger discuss the remaining unmet needs in imaging for patients with prostate cancer.

The panel shares their perspectives on the transition to virtual multidisciplinary tumor boards for patients with prostate cancer after the COVID-19 pandemic.

"I would say that the take-home message of the study is that these immunosuppressive medications have alterations in the microbiology in a lot of these organs and a lot of these tumors," says Conor Driscoll, MD.

"Northwestern Madison's urology program has a very robust clinical research enterprise," says Edward M. Schaeffer, MD, PhD.

Anthony V. D’Amico, MD, PhD, discusses the choice between external beam radiation therapy and brachytherapy in patients with prostate cancer.

"The NCCN guidelines are unique in that they're almost constantly updated in real time," says Edward M. Schaeffer, MD, PhD.

"Prostate cancer showed a decreased risk, which we thought was very interesting, because it was the only cancer for which that signal existed, that there is possibly a protective effect of these medications," says Conor Driscoll, MD.

In the first installment of this series, Juan Montoya, MD, discusses the results of the phase 3 pivotal trial of a polyethylene glycol-based hydrogel spacer, reviews real-world data on this product, and provides insights on the evolving practice standards for perirectal spacing in prostate cancer.

Karim Fizazi, MD, PhD, discusses safety data from the phase 3 TALAPRO-2 trial, which explored talazoparib plus enzalutamide in patients with metastatic castration-resistant prostate cancer.

The new space includes a clinical laboratory for IsoPSA testing, labs for research and development, offices, and manufacturing spaces for production and distribution of in vitro diagnostic kits.

"Catheters go in, [and] they come out within 2 to 3 days for my patients. Therefore, the perioperative period is very easy for patients, whereas radical surgery requires catheters for 7 to 10 days," says Kevin R. Basralian, MD.

Delving deeper into PSMA-PET results interpretation and information sharing, panelists outline the most critical information needed from radiologists and urologists on a patient’s multidisciplinary care team.

Experts share potential solutions to overcome the clinical challenges of using PSMA-PET in practice, including use of reader training programs.

"About 29% of our high-risk patients tested AI biomarker negative, and they could thus be spared the long-term [adverse] effects of ADT for 2 to 3 years," says Andrew J. Armstrong, MD, MSc.

“The take-home message of this research is that, given the importance of partners in the prostate cancer sexual recovery process and the impact of prostate cancer on partners' sex lives, we should seek to include partners in the sexual recovery process as part of routine survivorship care,” says Natasha Gupta, MD.

"Clinicians have opportunities to reduce patient subjective and objective financial burden if they continue to self-educate and communicate with patients and consider [financial toxicitiy] an adverse effect of treatment," write Alexandria A. Spellman, MD, MS, and Deborah R. Kaye, MD, MS.

“We found some BRCA1 and BRCA2 mutations, as well as CDK12 mutations, in our cohort of patients with intraductal carcinoma of the prostate. Those are things that you could use now for clinical decision-making with PARP inhibitors with their approved indications,” says Benjamin Miron, MD.

“These are high-risk patients and they do have a high likelihood of having advanced or metastatic disease in the future,” says Benjamin Miron, MD.

The approval is based on findings from the phase 3 TALAPRO-2 trial.

Dr Cookson discusses the challenges of using PSMA-PET imaging in prostate cancer, including reimbursement and patient access.