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.

To guide you through the 2016 AUA annual meeting and help maximize your time, Urology Times’ editorial board has reviewed the program to identify the key trends and noteworthy research at this year’s meeting.

A novel oral TRT agent, bladder control system, and localized prostate cancer agent are among other treatments in the pipeline discussed in this round-up.

In this interview, Daniel W. Lin, MD, discusses the practical use of currently available molecular and genomic tests, cost and reimbursement considerations, the role of MRI, and what the future holds for biomarkers.

Findings from preoperative multiparametric magnetic resonance imaging may enhance risk stratification, surgical planning, and patient counseling for men with prostate cancer, according to researchers from the National Institutes of Health, Bethesda, MD.

C-11 choline positron emission tomography and multiparametric pelvic magnetic resonance imaging (pMRI) can be used successfully to identify recurrence patterns in patients with biochemical recurrence after radical prostatectomy.

Many approaches have been tried for reducing the rectal toxicity of radiotherapy (Radiat Oncol 2013; 8:96; Int J Radiat Oncol Biol Phys 2012; 82:1918-22; Radiat Oncol 2014; 9:96). This article discusses a newer therapy that involves the injection of a temporary hydrogel in the plane between the prostate and rectum.

The patient sued, alleging, that the urologist should not have performed surgery on the patient, and that the second bowel perforation should have been detected and repaired during the original operation. He also claimed he should not have been discharged from the hospital in 3 days.

Also look for coverage of products in the pipeline for bladder pain syndrome/interstitial cystitis, prostate cancer, and male infertility.

Radium 223 dichloride (Ra 223 [Xofigo]) can be safely combined with abiraterone acetate (ZYTIGA) for the treatment of patients with metastatic castration-resistant prostate cancer with symptomatic bone metastases, and appears to result in decreased bone pain and improved quality of life, according to the interim results of an open-label prospective study known as eRADicAte.

Urology Times SUO internship program member Cory Hugen, MD, reports on a recent Mayo Clinic study on familial history’s impact on post-RP outcomes and survival.

A leader in urologic oncology discusses four currently available molecular tests in this report from Urology Times SUO internship program member Brandon Manley, MD.

In a recently published study, researchers analyzed data from nearly 20,000 high-risk prostate cancer patients at more than 1,000 facilities.

Findings from a recent study emphasize the need for imaging with CT or MRI and bone scan to determine the pattern of spread in men with advanced prostate cancer.

Check out the latest products. From an MRI System that improves lesion conspicuity, a biopsy device receives FDA clearance and an App that tracks stent implants.

Surveillance “should be more commonly used for patients with low-risk prostate cancer,” argues an author of the endorsement.

Physicians at Vanderbilt University Medical Center, Nashville, have opened a dedicated cardio-oncology service, including urology, medical oncology, radiation oncology, and cardiology.

"What we need most are markers that selectively identify significant cancers, in order to reduce unnecessary biopsies and over-diagnosis," writes Stacy Loeb, MD, MSc.

Two urinary biomarkers for detection of prostate cancer have differing utility in African-American men undergoing prostate biopsy.

New findings from the Johns Hopkins University School of Medicine in Baltimore should be useful to clinicians looking to counsel anxious prostate cancer patients who are undergoing active surveillance.

Four PCa studies presented at the 2015 AUA annual meeting in New Orleans shed some light, with researchers emphasizing the need to optimize screening and to improve treatment selection in older men.

“Both physicians and patients should take into account remaining life expectancy before adopting screening pathways,” a study author says.

The investigational modality was compared with surgical pathology in men undergoing radical prostatectomy.

Urology Times SUO internship program member Brandon Manley, MD, reports on an SUO presentation highlighting several interesting findings on advanced prostate cancer with variant histology.