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A Step Towards Personalized Medicine: PSMA PET Imaging in Prostate Cancer

Contemporary Treatment Strategies for ADT in prostate cancer

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Transformative Evidence
Level 1 Evidence: Practice-Changing Clinical Trials View all
PROfound Study

We previously reported that olaparib led to significantly longer imaging-based progression-free survival than the physician's choice of enzalutamide or abiraterone among men with metastatic castration-resistant prostate cancer who had qualifying alterations in homologous recombination repair genes and whose disease had progressed during previous treatment with a next-generation hormonal agent.

HERO Study
Injectable luteinizing hormone–releasing hormone agonists (e.g., leuprolide) are the standard agents for achieving androgen deprivation for prostate cancer despite the initial testosterone surge and delay in therapeutic effect. The efficacy and safety of relugolix, an oral gonadotropin-releasing hormone antagonist, as compared with those of leuprolide are not known.
Conference Coverage
Conference Highlights from Recent Conference Coverage
Presented by Sima Porten, MD, MPH
The plenary session of the last day of the 2020 Annual Meeting of the Society of Urologic Oncology (SUO) began with a panel discussion stepping through the case of a patient with non-muscle invasive bladder cancer. Dr. Sima Porten, the moderator, introduced the case: a 60-year-old otherwise healthy male
Presented by Max Kates, MD

There have been several recent single-arm trials in the Bacillus Calmette-Guerin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) setting. The first question that arises is whether these single-arm trials are enough or do we need to randomize patients for our future trials.

Presented by Surena F. Matin, MD
Dr. Surena Matin presented the final results of the OLYMPUS trial, Optimized DeLivery of Mitomycin for Primary UTUC Study (Olympus) at the Best of Bladder Cancer poster session.
Presented by Matthew R. Cooperberg, MD, MPH and Tanya B. Dorff, MD
To conclude the advances in prostate cancer session Drs. Matthew Cooperberg and Tanya Dorff debated whether prostate-specific membrane antigen (PSMA) imaging should be routinely used in the clinical management of prostate cancer.
Presented by Alicia Morgans, MD, MPH 
In a stand-alone session at this year’s Society of Urologic Oncology (SUO) virtual annual meeting, titled Understanding the Evolving Treatment Landscape in Prostate Cancer: How to Leverage the Latest Advances and Strategies to Optimize Patient Outcomes,
Presented by Declan Murphy, MB, BCH, BaO, FRACS, FRCS, Urol
At the 2020 virtual Society of Urologic Oncology's (SUO) prostate cancer session, Dr. Declan Murphy discussed the role of prostate-specific membrane antigen (PSMA) scanning in prostate cancer staging. Dr. Declan Murphy states that PSMA PET/CT is an obvious challenger to conventional imaging.
Presented by Neal Shore, MD, FACS, and Robert Dreicer, MD
At the 2020 Society of Urologic Oncology (SUO) Annual Virtual Meeting, Dr. Neal Shore chaired a session examining the use of newer and emerging agents in bladder cancer, which highlighted a presentation by medical oncologist Dr. Robert Dreicer discussing novel treatment options for patients with advanced bladder cancer.
Presented by Maha H.A. Hussain, MD, FACP, FASCO
In the second Prostate Cancer session at this year’s Society of Urologic Oncology virtual annual meeting, Dr. Hussain discussed the role of PARP inhibitors, particularly Olaparib, in metastatic castration-resistant prostate cancer.
Presented by Neal D. Shore, MD, FACS, and Ashley Evan Ross MD, PhD
During the second prostate cancer session at the 2020 Annual Meeting of the Society of Urologic Oncology (SUO), Drs. Neal Shore and Ashley Evan Ross debated the use of relugolix as a new standard of care for androgen deprivation therapy (ADT) for the treatment of prostate cancer.
Presented by Ashish M. Kamat, MD, MBBS
The Society of Urologic Oncology (SUO) 2020 virtual meeting featured a session examining the new and emerging agents in bladder cancer chaired by Dr. Neal Shore, which included a presentation by Dr. Ashish Kamat discussing the evolving role of checkpoint inhibition in nonmuscle-invasive bladder cancer (NMIBC).
Presented by Ian Davis, MBBS, PhD, FRACP, FAChPM
The 2020 Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) Mini Annual Scientific Meeting featured a session on ANZUP trial updates, including an update of the critical Phase III ENZAMET trial provided by Drs. Ian Davis, Arun Azad, and Lisa Horvath.
Presented by Andrea Necchi, MD,
In an oral presentation in a session examining neoadjuvant versus adjuvant strategies in locally advanced bladder cancer at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Andrea Necchi led a discussion of neoadjuvant strategies in advanced bladder cancer.
Presented by Tamim Niazi, MDCM
Patients with high-risk localized prostate cancer who receive radiotherapy for management of their primary disease also receive LHRH analog therapy for at least one year or longer.
Presented by Michiel S. van der Heijden, MD, PhD
Platinum-based chemotherapy is the mainstay of first-line treatment for medically eligible patients with advanced urothelial carcinoma (UC). Unfortunately, up to 50% of patients are unable to receive cisplatin, and disease progression often develops even for patients who receive cisplatin.
Presented by Casilda Llacer Perez, MD
The CARD trial was a randomized open-label study of cabazitaxel versus the alternative anti-androgen therapy in patients with metastatic castration resistant prostate cancer (mCRPC) who had progressed on docetaxel and also progressed on either enzalutamide or abiraterone within 12 months of therapy initiation.
Presented by Cora Sternberg, MD
Many immunotherapy strategies have been pursued in metastatic castration-resistant prostate cancer (mCRPC) to date, with the dendritic cell vaccine sipuleucel-T representing the only approved therapy in this space.
Presented by Ben Tran, MBBS, FRACP
There is an urgency to develop therapies with novel mechanisms of action to treat prostate cancers resistant to chemohormonal and radiation therapies. Unfortunately, to date, immune therapies have offered limited efficacy in patients with metastatic castration-resistant prostate cancer (mCRPC).
Presented by Yohann Loriot, MD, MSc
Treatment options for advanced urothelial cancer that has progressed through platinum chemotherapy and immune checkpoint blockade consist of (1) single agent chemotherapy, (2) FGFR inhibitor therapyfor tumors harboring susceptible alterations, and (3) the antibody-drug conjugate enfortumab vedotin.
Presented by Toni K. Choueiri, MD
The treatment landscape for first-line therapy among patients with metastatic renal cell carcinoma (mRCC) has changed dramatically over the past 2 years.
Presented by Ronald De Wit PhD
(UroToday.com) It is well known that inflammation is a hallmark of cancer, harboring a critical role in tumor development and metastatic progression in many cancers, including prostate cancer.
Presented by Thomas Powles, MBBS, MRCP, MD
Advanced urothelial carcinoma resulted in over 200,000 deaths across the world in 2018. Though the majority of patients eligible for such therapy respond to platinum-based chemotherapy, disease progression occurs relatively quickly and half or less of patients receive second line treatment.
Presented by Michael J. Morris, MD
Radium-223 is a bone-targeted alpha therapy that prolongs survival in patients with symptomatic metastatic castration-resistant prostate cancer (mCRPC) to the bone based on results from the phase III ALSYMPCA trial.
Presented by Michael J. Morris, MD
Biochemical recurrence is not an infrequent occurrence following local therapy for prostate cancer, utilizing either radiotherapy or radical prostatectomy. Following biochemical relapse, patients may have disease either locally in the pelvic or more distantly.
Presented by Bertrand F. Tombal, MD, PhD
The CARD trial, initially presented at ESMO 2019 and subsequently published, addressed the question of appropriate third line therapy in mCRPC for patients who had previously received docetaxel and also progressed on an anti-androgen therapy (either abiraterone or enzalutamide) within 12 months.
Presented by Cora N. Sternberg, MD, FACP
Prostate cancer is the 2nd and 3rd leading cause of cancer death in the USA and in Europe, respectively,1,2 with most deaths occurring in men over the age of 75. In men with metastatic castrate-resistant prostate cancer (mCRPC), there are multiple treatment options available today,
Presented by  Antoine Thiery-Vuillemin, MD, PhD
The randomized Phase 3 PROfound trial showed that olaparib significantly prolonged radiographic progression-free survival compared with physician’s choice of new hormonal agent (enzalutamide or abiraterone) in men with mCRPC and HRR gene alterations, whose disease had progressed on prior new hormonal agent.
Presented by Elena Castro, MD
 In this session, Dr. Elena Castro, discussed the contemporary clinical impact of genetic and genomic testing in prostate cancer.
Presented by Karim Fizazi, MD, PhD
San Francisco, California (UroToday.com) During the Rapid Abstract Session A: Prostate Cancer session at the Annual ASCO GU 2020 meeting in San Francisco, CA,
Everyday Urology™ – Oncology Insights
Review Articles Focusing on Urologic Oncology View all
Everyday Urology™ – Oncology Insights
Everyday Urology: Volume 5, Issue 4
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The State-of-the-Evidence in Brief Reviews by Experts
Written by Charles Ryan, MD
June 30, 2020
June 26, 2020, marked the 20th anniversary of the publication of the first working draft from the Human Genome Project. At a special White House event to commemorate the results of this 10-year public effort (it was really more like 50 years since the discovery of DNA, but I digress), then-President Bill Clinton called the project “the most wondrous map ever created by humankind”, and touted its promise to detect, prevent, and treat disease.
June 24, 2020
Despite the recent disruptions in health care delivery due to the COVID-19 pandemic, patients at risk for developing prostate cancer as well as those diagnosed with prostate cancer still deserve timely and optimal decision making. Unfortunately, the uncertainty of the pandemic requires urologists to adopt innovative strategies in order to prioritize patient care while being mindful to mitigate the potential infectious risks of COVID-19 to their patients as well as to their healthcare team.
Written by Arpit Rao, MBBS and Charles Ryan, MD
June 29, 2020
In this review, we will summarize the current indications for PARP inhibitor monotherapies and combination(s), review data from clinical trials in prostate cancer, discuss management of commonly encountered side effects, and highlight exciting clinical research on expanding the role of PARP inhibitors in prostate cancer.
Written by Veda N. Giri, MD
June 29, 2020
Understanding the role of germline testing in prostate cancer is now critical to urologic and oncology practice for metastatic castration-resistant prostate cancer. Here, we will address who should be considered for germline testing, when germline testing may influence treatment and management, and how to implement germline testing involving provider practices and genetic counseling.
Written by Patrick G. Pilié, MD
June 29, 2020
Men with advanced prostate cancer have a 10-15% risk of carrying a hereditary, or germline, variant in a DNA damage response gene. Pathogenic or deleterious variants in these same DNA damage response genes can also be found at the somatic, or tumor-associated level, in up to 25% of metastatic castrate-resistant prostate cancer.
Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
June 17, 2020
Prostate cancer is a clinically heterogeneous disease with many patients having an indolent course requiring no interventions and others who either present with or progress to metastasis. While underlying dominant driving mutations are not widespread, there have been a number of key genomic mutations that have been consistently identified in prostate cancer patients, across the disease spectrum
Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
May 14, 2020
The coronavirus has the potential to impact the integrity and patient safety of ongoing trials as well as increase the operational burden on trial programs, therefore potentially limiting access to trials and new therapies for oncology patients. Opportunities for clinical trial enrollment may still be provided to patients during the COVID-19 outbreak, but likely require thorough evaluation on a case-by-case basis.
May 20, 2020
The purpose of this document is to describe the appropriate use of imaging in the diagnostic evaluation of patients with BCR after definitive primary treatment. The imaging modalities that were considered included CT, bone scan, and the U.S. Food and Drug Administration (FDA)–approved PET radiotracers that track malignancy-induced lipogenesis (11C-choline) and amino acid metabolism (18F-fluciclovine). The prostate-specific membrane antigen (PSMA)–targeted monoclonal antibody, 111In-capromab pendetide, is also included for historical perspective because it is neither available nor used clinically.
Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
April 20, 2020

The rapid spread of Coronavirus Disease 2019 (COVID-19), caused by the betacoronavirus SARS-CoV-2, throughout the world has had dramatic effects on healthcare systems with impacts far beyond the patients actually infected with COVID-19. Patients who manifest severe forms of COVID-19 requiring respiratory support typically require this for prolonged durations,