AUA 2018: Development and Validation of a Novel Prognostic Model for Predicting Overall Survival in Treatment Naïve Castration-Sensitive Metastatic Prostate Cancer

San Francisco, CA (UroToday.com) The treatment paradigm for the of management castration sensitive prostate cancer (mCSPC) has changed dramatically over the last 5 years with the publication of the CHAARTED, STAMPEDE and LATITUDE trials. These trials have also demonstrated a survival heterogeneity in patients with castrate sensitive metastatic prostate cancer, arguing that some patients may be overtreated by these aggressive regimens.  A risk stratification system for patients with mCSPC is currently lacking. Dr. Akamatsu, from Kyoto University Hospital, presents a novel prognostic model aimed to predict overall survival (OS) for patients with mCSPC treated with hormone deprivation therapy.  

AUA 2018: Is PSA Density Useful in Predicting Low-Risk Prostate Cancer in African American Men?

San Francisco, CA (UroToday.com) In African-American (AA) men the incidence of prostate cancer is almost 60% higher, and the mortality rate is two- to three-times greater than that of Caucasian men. Over the last 10 years, there has been a significant push to offer active surveillance to patients who are diagnosed with low-risk prostate cancer. PSA density (PSAD) has been one of the main criteria utilized to help differentiate patients at low risk for prostate cancer progression. The current recommendation is that patients with group 1 disease (Gleason 3+3=6) and a PSADT < 0.15 ng/ml/gm have a low potential for prostate cancer progression. However, this value was derived from historical cohorts of mostly Caucasian (CA) men, and the PSAD remains to be validated in an AA cohort. Dr. Babaian, from LSU Shreveport, presents data validating the role of PSAD in identifying men with low-risk prostate cancer.  

AUA 2018: The More You See, The More You Miss: Association Between PI-RADS Score of the Index Lesion and Multi-Focal, Clinically Significant Prostate Cancer

San Francisco, CA (UroToday.com) An extremely important consequence of our growing comfort with MRI-fusion targeted prostate biopsies is that systematic biopsies appear to be less important in some men. The results of the recent PRECISION trial, in fact, show that targeted biopsies alone may be a suitable way to detect clinically significant prostate cancer (csPC) in men undergoing diagnostic biopsies. The question lingers, though, about how much these targeted biopsies are potentially missing.

AUA 2018: Multi-Institutional External Validation of the EAU Guidelines for the Use of Staging mpMRI Prior to Radical Prostatectomy in Men with Intermediate and High-Risk Prostate Cancer

San Francisco, CA (UroToday.com)  Current EAU guidelines advocate for the use of mpMRI for patients with high risk disease (defined as high risk on D’Amico criteria or >=ISUP Grade 3) for local staging purposes. These recommendations are based on evidence that has not previously been externally validated, though. The presenters, therefore, used a 4-institutional cohort of men in Europe to evaluate the utility of mpMRI for these high-risk men in a real-world setting.

AUA 2018: Association of Systematic Biopsy vs. Magnetic Resonance Imaging/Ultrasound Fusion Targeted Biopsy with Prostate Cancer Upstaging at Radical Prostatectomy

San Francisco, CA (UroToday.com)  Multiparametric prostate MRI (mpMRI) has clear utility for many aspects of prostate cancer diagnosis, staging, and preoperative planning. However, given that it is a relatively newly-adopted modality, little is known regarding how mpMRI might predict downstream outcomes for patients undergoing treatment for prostate cancer.

AUA 2018: Evaluation of Gallium-68 PSMA PET/CT Imaging in Individuals with Biochemical Recurrence Following Radical Prostatectomy

San Francisco, CA (UroToday.com)  Ga-68 PSMA PET is growingly seen as one of the most important breakthroughs in prostate cancer imaging over the past decade. Its ability to detect metastatic disease that was previously invisible to conventional CT and bone scan imaging makes it a very attractive imaging modality for both clinical and research use. 

AUA 2018: Local Immune Modulation by Decreasing CD4+/CD8+ T Cells Ratio after Prostate Cancer Hemi-Cryoablation

San Francisco, CA (UroToday.com)  Leonardo Reis MD, and colleagues sought to answer a unique question with regard to the effect of thermal ablation on prostate immune infiltrates following therapy. Thermal ablation is known to increase antigen presentation, thereby possibly activing tumor-specific T cells, but little is known about the immune response within the local prostatic environment.