Top 9 peer-reviewed prostate cancer papers of 2017

December 13, 2017

Multiparametric MRI, USPSTF’s updated PSA screening recommendation, and the landmark STAMPEDE and LATITUDE trials were among this year’s highlights in the peer-reviewed literature for prostate cancer, according to Leonard G. Gomella, MD; Stacy Loeb, MD, MS; and J. Brantley Thrasher, MD.

Multiparametric magnetic resonance imaging, the U.S. Preventive Services Task Force updated PSA screening recommendation, and the landmark advanced prostate cancer trials STAMPEDE and LATITUDE were among this year’s highlights in the peer-reviewed literature for prostate cancer, according to Urology Times Editorial Advisory Board members Leonard G. Gomella, MD; Stacy Loeb, MD, MS; and J. Brantley Thrasher, MD. As part of our continuing review of 2017, Urology Times asked Drs. Gomella, Loeb, and Thrasher to identify the most noteworthy peer-reviewed papers on prostate cancer from this year.

Their complete selections and comments follow.

Leonard G. Gomella, MD, professor and chairman of urology, Thomas Jefferson University, Philadelphia

Intratumoral and Intertumoral Genomic Heterogeneity of Multifocal Localized Prostate Cancer Impacts Molecular Classifications and Genomic Prognosticators. Eur Urol 2017; 71:183-92.

Genomic analysis of localized prostate cancer has become commonplace in clinical decision-making and has been supported by groups such as the National Comprehensive Cancer Network. This paper identified significant genomic diversity in an individual patient with multiple tumor loci. The authors conclude that genomic analysis from a single biopsy site may not be sufficient to guide treatment decisions and suggest reconsidering how this genomic data is analyzed.

 

What Are We Missing? False-Negative Cancers at Multiparametric MR Imaging of the Prostate. Radiology 2017; Oct 20:152877.

Multiparametric magnetic resonance imaging can provide useful information in the management of localized prostate cancer. However, there are growing data that clinically important lesions can be missed or their size can be underestimated on prostate MR imaging. Objective recognition of the limitations by leaders in the field will lead to new approaches to reduce these false-negative rates.

 

Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J Clin Oncol 2017; 35:1884-90.

Multiple studies have suggested the duration of radiation therapy can be decreased for many men with localized prostate cancer without compromising efficacy, a concept known as hypofractionation. This long-term study, known as the PROFIT trial, together with evidence from other randomized studies, demonstrates there is the potential for cost savings and enhanced convenience for patients with this radiation approach for localized intermediate-risk prostate cancer.

Next: Dr. Loeb's picks

 

Stacy Loeb, MD, MSc, assistant professor of urology and population health at New York University Langone and the Manhattan VA, New York.

 

The US Preventive Services Task Force 2017 Draft Recommendation Statement on Screening for Prostate Cancer: An Invitation to Review and Comment. JAMA 2017; 317:1949-50.

In 2012, the U.S. Preventive Services Task Force recommended against prostate cancer screening. This year, the USPSTF published a new draft recommendation based on an updated systematic evidence review. It recommends individualized decision-making about screening for prostate cancer for men ages 55 to 69 years after discussion with a clinician (C recommendation).

 

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med 2016; 375:1415-24.

and

Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2016; 375:1425-37.

These studies report on the oncologic and functional outcomes from ProtecT, which randomized men with screen-detected prostate cancer to active monitoring, radical prostatectomy, and radiation therapy. At a median of 10 years, there was no difference in prostate cancer-specific mortality among the groups. The active monitoring group had a higher rate of metastasis, but had less impact on urinary, sexual, and bowel function.

 

Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 2017; 377:338-51.

and

Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2017; 377:352-60.

Two major randomized trials led to practice-changing results for men diagnosed with advanced prostate cancer. The STAMPEDE trial found that the addition of abiraterone (ZYTIGA)/prednisone to androgen deprivation therapy (ADT) led to improved survival for men with locally advanced and metastatic prostate cancer compared to ADT alone. Similarly, the LATITUDE trial found that using abiraterone/prednisone plus ADT significantly increased overall survival and radiographic progression-free survival in men with castration-sensitive metastatic prostate cancer.

Next: Dr. Thrasher's picks

 

J. Brantley Thrasher, MD, professor of urology, University of Kansas, Kansas City

Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 2017; 377:338-51.

This trial tested the use of abiraterone with ADT versus ADT alone in men with locally advanced or metastatic prostate cancer and showed a significant survival benefit to those receiving abiraterone as first-line therapy in lieu of late in the disease.

 

Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer. N Engl J Med 2017; 376:417-28.

This trial showed that the addition of 24 months of antiandrogen therapy, in the form of bicalutamide (Casodex) daily, to salvage radiation therapy in men with biochemical recurrence following radical prostatectomy improved long-term survival and lowered the incidence of metastatic disease and death from prostate cancer.

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