FOIU 2018: Aggressive and Unusual Subtypes of Prostate Cancer

Tel-Aviv, Israel (UroToday.com) Jonathan Epstein, MD gave a talk on the aggressive and unusual subtypes of prostate cancer. 

His first topic was prostatic duct adenocarcinoma, which may arise in large periurethral ducts and project into the urethra around the verumontanum, clinically mimicking urothelial carcinoma. Patients usually present with LUTS and hematuria, and the diagnosis is usually made on TURP. It can also arise in secondary peripheral ducts and may present as ordinary (acinar) adenocarcinoma with abnormal DRE or elevated serum PSA levels, and diagnosed on needle biopsy. This type of tumor is graded as:

FOIU 2018: Should the Primary Be Treated in Patients with Metastatic Disease? - Upper Tract Urothelial Cancer

Tel-Aviv, Israel (UroToday.com) Seth Lerner, MD discussed the topic of treating the primary tumor in patients with metastatic upper tract urothelial carcinoma (MUTUC). The outline of his talk included the unique biology of UTUC disease, the incidence and patterns of metastasis of UTUC, the efficacy of systematic chemotherapy, the outcomes of post systemic treatment, and locoregional surgical consolidation.

FOIU 2018: Should the Primary Be Treated in Patients with Metastatic Disease? - Kidney Cancer

Tel-Aviv, Israel (UroToday.com) Gennady Bratslavsky, MD gave a talk discussing the question of whether we should treat the primary tumor in metastatic renal cell carcinoma (MRCC).  The outline of his talk included these topics: 

  1. Current guidelines for metastatic RCC.
  2. Rational behind cytoreductive nephrectomy (CN).
  3. Historical evidence supporting current guidelines
  4. Discussion on the CARMENA trial.

FOIU 2018: Bladder Cancer – Oncologist’s View

Tel-Aviv, Israel (UroToday.com) Raya Leibowitz-Amit, MD discussed the topic of whether we should treat the primary tumor in patients with metastatic bladder cancer. First, Dr. Leibowitz presented the potential harm in treating the primary tumor. Detrimental oncologic sequalae (discovered in mice models) include:

FOIU 2018: Oncologist View - Local Treatment of Metastatic Prostate Cancer

Tel Aviv, Israel (UroToday.com) Michael Zelefsky, MD, gave a talk about the oncologist’s view on local treatment of metastatic prostate cancer (MPC). The hypothesis that local therapy (LT) could prolong survival in MPC is based on several points. First, tumor cytokine production reaches a critical threshold related to tumor volume and disease burden. Second, increased cytokine production leads to angiogenesis facilitation invasion and metastasis. Third, local therapy could reduce cytokine production and circulating tumor cells. Lastly, LT may reduce further metastasis emanating from the primary tumor.

FOIU 2018: Should the Primary Be Treated in Patients with Metastatic Disease? - Prostate Cancer

Tel-Aviv, Israel (UroToday.com) Derya Tilki, MD gave a talk on whether local treatment should be given to M1 prostate cancer (PC). According to Dr. Tilki, treatment of the primary tumor in patients with metastatic PC is not ready for prime time. The reasons include:

FOIU 2018: Does Checkpoint Inhibition Work in Prostate Cancer?

Tel-Aviv, Israel (UroToday.com) Raanan Berger, MD gave an overview of the utility of immune checkpoint inhibitors (ICI) in prostate cancer (PC). Immunotherapy in PC is not a new concept. The phase-3 study assessing Sipuleucel-T, demonstrated a 4 months survival benefit to this vaccine. This caused this vaccine to be FDA approved for metastatic castration-resistant prostate cancer (MCRPC) patients (Figure 1). Other additional vaccines have been tested such as GVAX, and PROSTVAC, however, they did not seem to have a survival benefit compared to placebo.