FOIU 2018: A PSA Threshold of 1.5 ng/ml for Further Diagnostic Tests - AGAINST
Tel Aviv, Israel (UroToday.com) With the introduction of PSA testing, death from prostate cancer (PC) was reduced by 20%, whereas metastatic disease was reduced by nearly half. Unfortunately, the US preventive services task force (USPSTF) gave a recommendation of ‘C’ for PSA screening among men aged 55-69, and a grade ‘D’ for men older than 70. No recommendation was made for men younger than 55.
The clinical needs of PC can be summarized in 4 main points:
FOIU 2018: A PSA Threshold of 1.5 ng/ml for Further Diagnostic Tests - FOR
Tel Aviv, Israel (UroToday.com) Leonard Gomella, MD, debated why a PSA cutoff of 1.5 ng/ml should be used. He began with presenting data demonstrating that from 1990 to 2009, PSA has helped to diagnose more localized prostate cancer (PC) and decreased the metastasis rate. PSA screening has caused a reduction in mortality (Figure 1).
FOIU 2018: Intermediate Risk Prostate Cancer Case with a 1 cm PZ Lesion on MRI - What is the Preferred Treatment?
Tel-Aviv, Israel (UroToday.com) In this session Laurence Klotz, MD presented a case of a 65-year old man, non-smoker, with mild hypertension, and a mild decrease in erectile function, with an IPSS of 12. His father was diagnosed with prostate cancer (PC) at the age of 75. This man’s DRE revealed a 40-cc gland, benign feeling. His PSA was 5.5 (increased from 3 to 4.2 in 2015-2017). His transrectal ultrasound revealed a 45-cc prostate gland, which was homogenous. The man was referred for a systematic prostate biopsy. This revealed 2/12 cores positive for Gleason 7 (3+4). The involved cores were in the right mid-peripheral zone (PZ), with 10% pattern 4, 20% of core involved. The other core was at the right apex PZ, Gleason 6 (3+3), 15% of the core involved. The remainder of the cores were uninvolved. The prostate MRI is shown in Figure 1, demonstrating 13 mm PIRADS 3 right mid-posterior PZ, minor restriction on diffusion-weighted imaging, and ADC.
FOIU 2018: Evidence and Anecdotal Based Approach for High-Risk Bladder Cancer: Is Bladder Preservation an Option? A Tale of Two Cities
Tel Aviv, Israel (UroToday.com) Mitchell Benson, MD, gave a discussion on high-risk bladder cancer. The therapeutic options for muscle-invasive bladder cancer (MIBC) include radical transurethral resection, primary radiation therapy, chemo-radiation therapy, primary radiation therapy, radical cystectomy (RC), neoadjuvant chemotherapy + radical cystectomy, and primary chemotherapy.
FOIU 2018: Trimodal Therapy for Muscle Invasive Bladder Cancer
Tel-Aviv, Israel (UroToday.com) Adam Feldman, MD discussed the therapeutic option of bladder preservation therapy (BPT). This includes maximal TURB combined with chemoradiation, partial cystectomy, or TURBT +/- chemotherapy. The option of organ conservation by trimodal therapy (TMT) is common in other organs including larynx, anus, breast, esophagus, and limb.
FOIU 2018: Cytoreductive Nephrectomy in the Tyrosine Kinase Inhibitors Era: The CARMENA Study
Tel-Aviv, Israel (UroToday.com) Arnaud Mejean, MD presented the CARMENA trial and what led to the creation of this trial. In the past cytoreductive nephrectomy (CN) has been a treatment option for carefully selected patients with metastatic renal cell carcinoma (MRCC). Clinical trials have demonstrated that those patients with an estimated survival of less than 12 months or those with four or more IMDC criteria (anemia thrombocytosis, Neutrophilia, Karnofsky Performance Status (KPS) <80 percent, and less than 1 year from diagnosis to treatment) may not benefit from nephrectomy.1
FOIU 2018: Robotic Assisted Radical Cystectomy
Tel-Aviv, Israel (UroToday.com) Alejandro Rodriguez, MD gave a presentation on the usage of robotic radical cystectomy. Although open radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC) and some non-MIBC (NMIBC), it is still a procedure that is associated with high morbidity. Recent publications demonstrate a complication rate of 31.5%, with 40.7% requiring blood transfusions. The average length of stay decreased from 10.6 days to 9.2 days, but readmission increased to 21.4% in 2015. 1