Prostate Cancer

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.

Years ago, decisions about screening men for PSA looked relatively straightforward. You offered screening to patients aged 40 or older, performed a biopsy on the ones with a total PSA >4.0 ng/mL, and offered treatment to those with positive biopsies. Today, conflicting guidelines and new techniques in cancer detection and treatment have left clinicians with a more complicated puzzle. The good news, experts say, is that physicians who put these pieces together stand a better chance of protecting their patients’ health than ever before.

In its current iteration, the AUA's CRPC guideline contains 20 statements relating to treatments for six index patients defined by the presence or absence of metastatic disease, presence and degree of symptoms, ECOG performance status, and prior treatment with docetaxel (Taxotere) along with two statements on the use of preventive treatments for bone health.