Prostate Cancer

Continuing its participation in the Choosing Wisely campaign, the AUA has added five new recommendations about tests and treatments that physicians and patients should question.

“We strongly believe that PSA-based prostate cancer screening should be made available, especially to men 70 years and older to decrease the morbidity and mortality of prostate cancer,” write Navin Shah, MD, and Vladimir Ioffe, MD.

“Abiraterone should change the treatment paradigm for patients with newly diagnosed metastatic prostate cancer and largely displaces chemotherapy from the current paradigm,” said Sumanta Kumar Pal, MD.

Administering bone supportive therapy within 1 month prior to starting radium Ra 223 dichloride (Xofigo) may increase the likelihood of achieving pain palliation with the radionuclide therapy and reduce the chance of pain flare, according to the findings of a retrospective study.

Among the guideline’s recommendations is that active surveillance should serve as the preferred method of care for low-risk localized prostate cancer.

Diagnostic magnetic resonance imaging strategies for the diagnosis of prostate cancer should be considered prior to biopsy of suspicious lesions, according to a recent study.

Although theory and preliminary clinical data indicated that intraoperative regional hypothermia could improve the return to potency and continence after robot-assisted radical prostatectomy, the intervention did not have any significant benefits when put to the more rigorous test of a randomized controlled trial.

"For low-grade disease, it’s certainly worth a try because nothing is really lost. For high-grade disease, I don’t know that it’s appropriate-we don’t have the data," says one urologist.

"The nurse practitioner, nurse, and other ancillary providers who make up the urology team are an essential and valuable asset in the consideration of adding oral androgen receptor inhibitors into the office setting," writes Gwendolyn Hooper, PhD, APRN.

More than 96% of urologists surveyed said that incorporating abiraterone acetate (ZYTIGA) treatment into practice for patients with metastatic castrate-resistant prostate cancer is easy or manageable after overcoming initial barriers, according to new research presented at the Genitourinary Cancers Symposium in Orlando, FL.

While close to 90% of men diagnosed with prostate cancer between 1998 and 2012 had stage 1 and stage 2 disease, more than 90% underwent surgery or radiation to treat the cancer, according to a study presented at the Genitourinary Cancers Symposium in Orlando, FL.

“From our results, the Decipher test helps reassure low-risk patients that observation may be warranted or confirm that high-risk patients need additional treatment,” says study author John L. Gore, MD, MSHS.

"As a urologic community, we should promote the use of AS for favorable-risk disease to reduce the downstream harms of screening while preserving the benefits of early detection for life-threatening cases," writes Stacy Loeb, MD, MSc.

“We believe that aggressive loco-regional resection may be worth considering in well-selected patients as a part of a multimodal approach in the management of men with node-positive prostate cancer,” says study author Bimal Bhindi, MD.

Men who use the Internet as their primary source for prostate cancer treatment decision-making are more likely to regret those decisions a year after treatment than those whose primary sources of information are radiation oncologists or urologists.

The American Society of Clinical Oncology’s provisional clinical opinion on the use of second-line hormonal therapy for chemotherapy-naïve men with castration-resistant prostate cancer issued by uncovered some surprising findings and issues.

Results of a recent study support a growing body of evidence that factors associated with circadian rhythm disruption might play a role in prostate carcinogenesis.

Participants in an outreach event for prostate cancer screening preferred education about prostate cancer prior to undergoing screening, and thought the use of an informed decision-making model was beneficial, researchers reported at the Genitourinary Cancers Symposium in Orlando, FL.

In this article, urologists Scott E. Eggener, MD, and Stacy Loeb, MD, MSc, discuss the current applications for prostate cancer biomarkers and MRI, their impact on clinical practice, and future developments.

This article discusses the current status and potential future developments in immunotherapy for genitourinary malignancies with insights from urologic oncology specialists Hyung L. Kim, MD, and Daniel P. Petrylak, MD.

This article highlights the key points of two urologic cancer guidelines (which provide evidence-based guidance) and two consensus statements (which provide consensus recommendations by a multidisciplinary panel of experts) that have been published in the past year.

While no resource is perfect, it is worthwhile to familiarize yourself with some contemporary methodology and predictive tools to help determine life expectancy in localized prostate cancer patients.

Three out of four patients with prostate cancer with an 18F-choline positron emission tomography/computed tomography–detected recurrence were potentially salvageable with local therapy or metastasis-directed therapy (MDT), according to results of the screening phase of the phase II STOMP randomized trial.

Two recent JAMA studies confirm a higher rate of sexual and urinary side effects with radical prostatectomy compared with radiation therapy and surveillance.

The update provides evidence-based recommendations for different patient risk groups and specifies the most effective forms of the treatment for patients with prostate cancer.

Other pipeline developments include efficacy results for a bladder and prostate cancer drug, an infertility tool to predict sperm quality, the initiation of an immunotherapy combination for mUC, and more.

In the arena of focal therapy for prostate cancer, standardization of management will be a key component of quality data going forward, says Scott Eggener, MD.

Phase III study results suggest that a hydrogel spacer developed to separate the rectum and prostate during radiotherapy for prostate cancer works to maintain bowel and urinary quality of life and reduces late rectal toxicity by 78% at 3 years post radiotherapy.

Clinicians may soon be able to improve the risk stratification of men with prostate cancer with the help of a genomic classifier or a biopsy-based reverse transcription polymerase chain reaction assay, according to the results of two studies presented at the Genitourinary Cancers Symposium in Orlando, FL.