FOIU 2018: FSH as a Modulator of Cardiovascular Events in ADT Recipients
Tel-Aviv, Israel (UroToday.com) Jehonathan Pinthus, MD gave a discussion on the topic of cardiometabolic implications of androgen deprivation therapy (ADT). ADT is known to induce obesity and glucose intolerance. Metabolic syndrome is associated with an increased risk of death from all causes but not prostate cancer-specific mortality, in patients treated with ADT. ADT is known to induce de-novo atherosclerosis (Figure 1). Most acute cardiovascular disease events are caused by the rupture of a vulnerable atherosclerotic plaque.
FOIU 2018: How ADT Accelerates Cardiovascular Disease
Tel-Aviv, Israel (UroToday.com) Bertrand Tombal, MD was invited to give an overview of the mechanism of cardiovascular disease (CVD) acceleration by androgen deprivation therapy (ADT). Observational studies consistently demonstrate an increased risk of CVD in patients treated with LHRH agonists (Figure 1). Some randomized trials have also shown a similar increased risk (Figure 2). In general, it is accepted that there is a short-term risk of CVD in men with the pre-existing disease, and there are long-term metabolic changes in everybody.
FOIU 2018: Testosterone and Cardiovascular Mortality
Tel-Aviv, Israel (UroToday.com) Claude Schulman, MD discussed the topic of testosterone and its effect on cardiovascular mortality. Testosterone has significant roles in several organs, including skin, liver, bone, male sexual organs, brain, muscle, kidney, and bone marrow (Figure 1). In the “HIM” study low testosterone levels were associated with a myriad of chronic diseases (Table 1). 1 Lower volumes of testosterone are risk factors for hypertension, diabetes, cardiovascular disease (CVD), and metabolic syndrome.
FOIU 2018: Novel Targeted Androgen Ablation Prior to Radical Prostatectomy
Tel-Aviv, Israel (UroToday.com) Adam Kibel, MD gave an overview of the neoadjuvant usage of targeted androgen ablation prior to radical prostatectomy. He began his talk with two premises:
- Local therapy only cures non-metastatic patients
- The timing of systematic therapy affects the prognosis
FOIU 2018: The Role of Radical Prostatectomy in Locally Advanced and Oligometastatic High Risk Prostate Cancer
Tel-Aviv, Israel (UroToday.com) Manfred Wirth, MD, gave an overview of the role of radical prostatectomy (RP) in locally advanced oligometastatic high-risk prostate cancer (PC). Dr. Wirth began elaborating on some of the different definitions for high-risk disease (Table 1). The use of radical treatment for locally advanced and very high-risk disease has been rising through recent years (figure 1). The beneficial role of extended pelvic lymph node dissection over standard pelvic lymph node dissection has been shown as well (figure 2). 1
FOIU 2018: Optimizing the Management of High Risk Prostate Cancer with Radiotherapy
Tel-Aviv, Israel (UroToday.com) Michael Zelefsky, MD gave a talk on the optimization of radiotherapy in the management of high-risk prostate cancer (PC). He began his talk with the fact that there is clinical evidence demonstrating the importance of dose intensification using combined brachytherapy and external beam radiotherapy (EBRT) for high-risk disease.
FOIU 2018: Should the Primary Be Treated in Patients with Metastatic Disease? - Testicular Cancer
Tel-Aviv, Israel (UroToday.com) Joel Sheinfeld, MD gave a short briefing discussing whether the primary tumor should be treated in metastatic testicular cancer patients. In short, the answer is Yes. Dr. Sheinfeld gave some data on delayed orchiectomy following chemotherapy. Teratoma is evident in 19-31% of cases, and a viable tumor is present in 13-30% of cases. Chemotherapy does not reliably treat germ cell tumors (GCT) in the testicle, nor does it treat germ cell neoplasia in situ (GCNIS), common in more than 90% of GCT patients. The morbidity in treating the primary tumor in testicular cancer is minimal and there is no contraindication to it.