ASCO GU 2018: The Association Between Physician Trust and Prostate Specific Antigen Screening: Implications for Shared Decision Making.
San Francisco, CA (UroToday.com) Following the poor feedback in response to the 2012 USPSTF recommendations regarding PSA screening, updated USPSTF guidelines have pulled back their grade recommendation from a “D” to a “C” – “the USPSTF recommends that clinicians inform men ages 55 to 69 years about the potential benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer. The decision about whether to be screened for prostate cancer should be an individual one.”
ASCO GU 2018: The Perineural Invasion Paradox: Is Perineural Invasion an Independent Prognostic Indicator of Biochemical Recurrence Risk in Patients with pT2N0 Prostate Cancer?
San Francisco, CA (UroToday.com) Perineural invasion (PNI), a pathologic finding on final pathology reports for prostate cancer, either at the time of biopsy or radical prostatectomy, may be a harbinger of worse disease, similar to lymphovascular invasion. It is evident in up to 19% of prostate cancers, per prior reports. Some reports indicate rates up to 84%! However, there is little evidence that PNI is a prognostic factor in patients with localized prostate cancer, specifically as it relates to biochemical recurrence (BCR). Recent series have provided contradictory results.
ASCO GU 2018: Radiotherapy after Prostatectomy: Adjuvant vs Early Salvage
San Francisco, CA (UroToday.com) In this session, Dr. Amling and Dr. Shipley debate adjuvant and early salvage radiotherapy following prostatectomy. As opposed to traditional debates where the urologist argues for salvage therapy and the radiation oncologist for adjuvant, they actually switched roles!
ASCO GU 2018: Case-Based Debate: Magnetic Resonance and Magnetic Resonance-Directed Biopsy: Where is the Field Moving?
San Francisco, CA (UroToday.com) In this opening session of the Genitourinary Cancers Symposium 2018, Drs. Emberton and Pedrosa shared their data and experiences with MR and MR directed biopsy in evaluation of prostate cancers. Three patient scenarios were then discussed with the panel. The current AUA and SAR standard strongly considers MRI for a patient with continuing concern for prostate cancer and a previous negative biopsy. However, the method of MR directed biopsy is under debate.
ASCO GU 2018: Adjuvant Radiotherapy and Chemotherapy in Node-Positive Prostate Cancer
San Francisco, CA (UroToday.com) The use adjuvant treatment for patients with high risk or node-positive prostate cancer patients remains controversial despite level 1 evidence demonstrating a benefit. The controversy revolves around the risk of overtreatment in addition to the lack of evidence demonstrating the superiority of adjuvant over early salvage therapy.
ASCO GU 2018: Ten-year final results of the TROG 03.04 (RADAR) randomized phase-III trial
San Francisco, CA (UroToday.com) Historical data from RTOG 92.02 and EORTC 22961 have shown that long-term androgen deprivation therapy (ADT) is more effective than short-term ADT in men undergoing radiotherapy for clinically localized intermediate or high risk prostate cancer. However, long-term ADT carries with it a range of side-effects including sexual dysfunction, weight gain, bone density loss, cognitive dysfunction, and sarcopenia, to name a few.
ASCO GU 2018: Newly Diagnosed High-Risk Disease Treatment: Summarizing Neoadjuvant Trials
San Francisco, CA (UroToday.com) There are approximately 60,000 cases of clinically localized, high risk prostate cancer in the United States yearly. This number may increase in the future, as prostate cancer screening has declined in recent years. Men with high risk disease have a Gleason score of 8-10, a PSA of >20, or pT3 disease. Despite treatment, men with high risk disease have a significant risk of death from prostate cancer, with one study showing a rate of 31% at 15 to 20 years.