Prostate Cancer

This review focuses on primary prevention of BPH and prostate cancer.

Sexual function/dysfunction topics discussed at the 2016 AUA included the findings of multiple studies on the effects of collagenase clostridium histolyticum (Xiaflex) treatment for Peyronie's disease, causes and treatments for ED, along with a study on patient satisfaction with implantable penile prostheses.

Other products discussed in this roundup include a plasma vaporization device, a laser fiber safety device, and more.

“It appears that baseline PSA is a lot more predictive than either family history or race alone and should be used to risk stratify screening,” the co-lead author of a recent study tells Urology Times.

A recent study comparing 8 weeks of conventional radiation therapy with hypofractionated RT over 4 weeks appears to have practice-changing implications for men with intermediate-risk prostate cancer.

Other basic science research pearls include preliminary evidence from a porcine model suggesting botulinum toxin type A facilitates ureteral stone passage and the identification of two different microdeletions in the NELL1 gene on chromosome 11 in men with Peyronie's disease.

Studies about ProPublica's Surgeon Scorecard, urology participation in accountable care organizations, and Twitter were among the take-home messages in outcomes analysis at the 2016 AUA annual meeting. The take-homes were presented by Christopher Saigal, MD, MPH, of the University of California, Los Angeles.

There is no excess risk of death, prostate cancer diagnosis, or cardiovascular events with long-term testosterone replacement therapy, Canadian researchers have found in a population-based matched cohort study.

Concordance with National Cancer Comprehensive Network recommendations about follow-up during active surveillance for low-risk prostate cancer is generally low across urology practices in Michigan, reported researchers from the Michigan Urological Surgery Improvement Collaborative at the AUA annual meeting in San Diego.

A Veterans Administration Cooperative Study investigating chemotherapy after prostatectomy for high-risk prostate cancer was underpowered to show a statistically significant benefit of early adjuvant chemotherapy versus observation as the standard of care in the primary endpoint analysis of progression-free survival.

Fusion biopsy, salvage versus adjuvant radiation therapy, and superextended versus extended pelvic lymph node dissection are also covered in the take home messages on prostate cancer from the 2016 AUA annual meeting.

The authors of a recent NEJM letter question the validity of the controversial Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

An academic center/community practice collaboration increases use of surveillance among prostate cancer patients “through use of provider education and a standardized report card,” a study author said.

Expression of androgen receptor splice variant 7 (AR-V7) in whole blood predicts worse cancer-related outcomes in patients with metastatic castration-resistant prostate cancer who are treated with abiraterone acetate (ZYTIGA).

"With all this uncertainty, the good news is that men will no longer need to travel to Canada or elsewhere for prostate HIFU therapy," writes Leonard G. Gomella, MD.

Paradoxically, the authors of a large study did not find a negative effect in functional outcomes analyzed.

Transrectal HIFU shows a statistically significant increase in per-core negative biopsy rates.

A CMS quality measure needs to be bidirectional, “specifying a rate of observation for low-risk disease and a rate of treatment for high-risk disease,” researchers say.

A retrospective analysis looks at the short-term morbidity associated with transfusion among patients in the National Surgical Quality Improvement database.

Large study examines surveillance results in men with very low-, low-, intermediate-, and high-risk disease.

Specific clones may have the potential for grade conversion, research suggests.

No significant relationship was found between use of a phosphodiesterase type-5 inhibitor and prostate cancer recurrence after treatment in a nested case-control study.

High-intensity focused ultrasound as salvage therapy allows for intermediate-term disease control in selected patients with recurrence following radiation therapy for prostate cancer.

In men with metastatic prostate cancer, those assigned to intermittent androgen deprivation therapy have more ischemic and thrombotic events than those assigned to continuous androgen deprivation, according to Columbia University researchers.

Treatment options for high-risk prostate cancer perform similarly. In a single-institution study, radical prostatectomy was associated with worse biochemical failure, less clinical failure, and superior prostate cancer-specific mortality compared with radiation therapy and brachytherapy, reported Jay P. Ciezki, MD, at the 2016 Genitourinary Cancers Symposium in San Francisco.

Four current clinical practice guidelines on prostate cancer provide urologists with valuable, evidence-based decision points about diagnosis and treatment while raising questions that will likely be addressed by future research.

A meta-analysis of 6,884 men with prostate cancer who underwent external beam radiation therapy reveals surprising findings about dose escalation.

The three-gene expression assay could “reduce hundreds of thousands of invasive biopsies each year,” a study author says.

In May 2013, the AUA and the American Society for Radiation Oncology released a joint guideline for radiotherapy after prostatectomy (J Urol 2013; 190:441-9). As a framework for practitioners caring for men who undergo surgery for treatment of prostate cancer, the evidence-based guideline contains nine statements that address use of adjuvant and salvage radiotherapy, conduct of a restaging evaluation, patient counseling, and a definition for biochemical recurrence

New clinical practice guidelines for the management of prostate cancer from the National Comprehensive Cancer Network expand the number of patients who may be considered for active surveillance to those with favorable intermediate-risk prostate cancer.