Prostate Cancer

Based on current studies and anecdotal evidence, many of today’s urologists think it’s relatively safe to administer testosterone replacement in hypogonadal men on active surveillance or in those who have been treated with prostatectomy or cryosurgery. But these men should be closely monitored, they stress.

“The bulk of what we’re all grappling with are these new data for combining PARP inhibitors with androgen receptor–targeted agents in molecularly unselected populations,” says Tanya Dorff, MD.

"It’s apparent that reducing overdiagnosis alone may not necessarily reduce over treatment, and that separate and specific focus on prevention of over treatment is still needed," Badar M. Mian, MD, writes.

“The number of views, viewer engagement, and the length of the video didn't have an impact on the score at all when we did our analysis,” says Daniel Bockelman.

“It's important to put out information that's both accurate and helps to supplement in-office decision making in an outpatient setting,” says Daniel Bockelman.

As the year comes to a close, we revisit some of this year’s top content on prostate cancer.

Patients can now undergo prostate surgery with epidural anesthesia and light sedation, known as twilight sleep, without the need for a ventilator general anesthesia.

Catch up on all the notable drug and device approvals in urology over the past year.

The European Commission based its approval on results from the phase 3 PROpel trial, which showed that adding olaparib to frontline abiraterone acetate and prednisone/prednisolone significantly improved radiographic progression-free survival in patients with mCRPC.

Dr Shore closes his discussion by highlighting remaining unmet needs in mCRPC treatment and providing advice for community oncologists.

Neal Shore, MD, FACS, speculates on how the utilization of AR-pathway inhibitors and docetaxel in earlier lines of mCRPC treatment has also influenced treatment with cabazitaxel.

Dr Shore details how he approaches treatment selection between cabazitaxel and radiotherapy for patients with mCRPC.

Neal Shore, MD, FACS, explains the treatment regimen he would have chosen for the patient with mCRPC in the presented case, and what factors he uses to inform treatment decision-making.

Dr Shore continues his review of data on cabazitaxel for the treatment of mCRPC by highlighting efficacy data from the CARD trial and real-world data that could impact practice.

Neal Shore, MD, FACS, discusses data from the PROSELICA and FIRSTANA trials investigating cabazitaxel for the treatment of mCRPC, including a look at the post-hoc analyses of PROSELICA.

Dr Shore reviews the available treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC), visceral disease, and no actionable genomic alterations, who received prior treatment with docetaxel and AR-targeted therapy.

Neal Shore, MD, FACS, presents the case of a 74-year-old man diagnosed with metastatic prostate cancer.

The application is supported by the phase 3 PROpel trial, which showed that adding olaparib to frontline abiraterone acetate and prednisone/prednisolone significantly improved radiographic progression-free survival in patients with metastatic castration-resistant prostate cancer.

“I would say that we did not anticipate the degree of potential cost savings,” says Ruchika Talwar, MD.

“One of the things that drives me to be a part of advanced prostate cancer care is that literally every 6 months, we are having major trials read out guideline-based changes in care,” says Jason Hafron, MD.

Panelists review the recent FDA approval of the PSMA-targeted therapy Lutetium Lu 177 vipivotide tetraxetan for patients with metastatic castration-resistant prostate cancer and discuss additional settings in which it, and other PSMA-targeted treatments, might be used in the future.

Drs Albala, Andriole, Ross, and Ulaner sum up recent advances and remaining unmet needs in the field of prostate cancer imaging and share hopes for the future.

“iQuest combines existing patient-specific diagnostic information and deep-learning algorithms to create a tailored [3D] map of where cancer is within the prostate,” according to Avenda Health.

Chad Tang, MD, discusses the EXTEND trial, which explored the addition of metastasis-directed therapy to intermittent hormone therapy in patients with oligometastatic prostate cancer.

Thought leaders discuss the possibility of using artificial intelligence to help interpret PSMA-PET results.

Panelists discuss how they typically document prostate cancer patient eligibility when ordering PSMA-PET imaging, and share strategies to optimize insurance coverage and reimbursement.

Approval of the treatment was based on the placebo-controlled phase 3 ARASENS trial, which showed that adding darolutamide to standard ADT and docetaxel boosted overall survival versus ADT/docetaxel alone in patients with metastatic hormone-sensitive prostate cancer.

Gary Ulaner, MD, PhD, FACNM provides practical advice for radiologists who are generating PSMA-PET imaging reports, as well as for the urologists who are interpreting PSMA-PET results.

Shared insight from the panel on how they typically select radiotracers when ordering PSMA-PET scans in their clinical practice.

“To our knowledge, this study represents the first time a significant association has been demonstrated between concurrent and adjuvant ADT sequencing and overall survival rates among prostate cancer patients," says Amar Kishan, MD.