ASCO GU 2019: Pembrolizumab in Men With Heavily Treated Metastatic Castration-Resistant Prostate Cancer

San Francisco, CA (UroToday.com) Immune checkpoint inhibition for prostate cancer has been met with significant challenges in the immunotherapy era. Unlike the dramatic and responses seen in melanoma, lung, kidney, and bladder cancer, prostate cancer has not had the same success in unselected patients. Even in patients with MSI high (microsatellite instability) disease, 7/11 patients did not have an objective response and 5/6 did not have a PSA50 (decline in PSA by 50%)1. This study evaluates the off-label use of pembrolizumab in a heavily pre-treated population of patients with mCRPC.

ASCO GU 2019: Prevention of Symptomatic Skeletal Events with Denosumab: REDUSE Trial

San Francisco, CA (UroToday.com) Osteoblastic bone lesions are the most common site of metastasis in men with prostate cancer and may contribute significant comorbidities including pathologic fractures and epidural spinal cord compression. Quality of life is significantly impacted by bone metastasis and thus palliative treatment of bone metastases is one of the cornerstones of management for men with advanced prostate cancer. For the treatment of bone metastases as well as the prevention of complications, osteoclast inhibition may be helpful. 

ASCO GU 2019: Enzalutamide and ADT with Salvage Radiation in Men with High-Risk PSA Recurrent Prostate Cancer: The STREAM trial

San Francisco, CA (UroToday.com) Standard of care therapy for men with biochemical recurrence of radical prostatectomy is salvage external beam radiotherapy (EBRT) followed by androgen deprivation therapy (ADT)1. Unfortunately, 51% of men may have PSA recurrence at 2 years, even after salvage EBRT and docetaxel based chemotherapy2. This phase II study evaluates the addition of enzalutamide to standard of care EBRT + ADT. 

ASCO GU 2019: A Comparison of Fluorocholine-PET/CT and Conventional Imaging in Prostate Cancer

San Francisco, CA (UroToday.com) Standard of care imaging for patients with prostate cancer in the United States includes standard CT imaging and technetium-99 bone scans to evaluate for bony metastatic disease. However, recent advances have introduced new radiotracers and nuclear imaging which may increase the sensitivity for metastatic disease detection. 18-F choline, prostate-specific membrane antigen (PSMA), 18-F sodium fluoride, fluciclovine F-18, and 11-C acetate have all been evaluated for prostate cancer and are under variable use across the world, much of which depends on insurance coverage.  In a study of 100 consecutive patients with PSA increase after prostatectomy, radiotherapy, or hormonal therapy, fluorocholine PET picked up 54 patients with malignant recurrence, all of which was confirmed except one case1.

ASCO GU 2019: TALAPRO-2: A Two-Part, Placebo-Controlled Phase III Study of Talazoparib with Enzalutamide in Metastatic Castration-Resistant Prostate Cancer

San Francisco, CA (UroToday.com) Enzalutamide is an androgen-axis targeted therapy with established efficacy in the treatment of advanced prostate cancer (PCa), including metastatic castration-resistant PCa (mCRPC) and non-metastatic CRPC (nmCRPC).

ASCO GU 2019: The P-Value Debate: Lower Them or Leave Them?

San Francisco, CA (UroToday.com) The breakout session at ASCO GU 2019 discussing controversies in data interpretation was standing room only. In 2018, based on a viewpoint published in JAMA1 there has been much discussion in the academic literature regarding possibly lowering the p-value threshold to 0.005. This paper lead to a flurry of editorial comments. The viewpoint highlighted three major problems noted by the American Statistical Association’s recommendation of lowering the p-value threshold from 0.05 to 0.005 for new discoveries.

ASCO GU 2019: Results of a 50 Patient Single-Centre Phase II Prospective Trial of Lutetium-177 PSMA-617 Theranostics in mCRPC

San Francisco, CA (UroToday.com) PSMA is over-expressed in all prostate tissue, including prostatic carcinoma. Lutetium-177 (177Lu)-PSMA617 (LuPSMA) is a small radiolabeled molecule which binds to PSMA and delivers a dose of β radiation. Lutetium-177 is a good partner to help deliver the radiation because of the short range β radiation (maximal tissue penetration of <2mm), thereby decreasing the potential collateral damage to nearby organs. 
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