AUA 2018: Correlation Between Genomic Index Lesions, Multi-parametric MRI and 68Ga-PSMA-PET/CT Imaging Features in Primary Prostate Cancer
San Francisco, CA USA (UroToday.com) Over the past several years, multi-parametric magnetic resonance imaging (mpMRI) and 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT)-based imaging of prostate cancer have emerged as valuable techniques for assessing the presence of significant disease and/or tumor progression. To date, no studies have assessed how anatomic imaging correlates with disease biology, particularly at the genomic level. Dr. Claudia Kesch presented their group’s results attempting to correlate imaging (mpMRI and 68Ga-PSMA-PET/CT) with genomic index lesions for prostate cancer. The objective of their study was to define a molecular index lesion based on chromosomal copy number alterations (CNAs) in prostate biopsies in direct correlation to mpMRI and 68Ga-PSMA-PET/CT imaging.
AUA 2018: Early Experience of a Randomized Controlled Trial of Radical Prostatectomy for Oligo-Metastatic Prostate Cancer: Challenges to Patient Recruitment and Effective Solutions
San Francisco, CA (UroToday.com) Standard of care for oligo-metastatic prostate cancer is currently ADT +/- chemotherapy. However, over the last several years, some retrospective studies have assessed the feasibility and safety of men undergoing radical prostatectomy in the setting of metastatic disease [1-3]. The general consensus of these studies is that radical prostatectomy is safe in highly selected patients, and decreases side-effects of locally advanced disease.
AUA 2018: The First Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Men Staged with mpMRI for Clinically Localized Prostate Cancer
San Francisco, CA USA (UroToday.com) There is a plethora of prostate cancer nomograms that have been developed and validated for predicting risk of adverse pathology at the time of radical prostatectomy, including risk for lymph node invasion. A few of the more commonly used nomograms include the Memorial Sloan Cancer Center nomogram, Briganti nomogram, and Partin tables. All of these models for predicting lymph node invasion for patients treated with radical prostatectomy and extended pelvic lymph node dissection are based exclusively on clinical variables.
AUA 2018: Interim Analysis of an Open Label Phase II Study of Enzalutamide and Radium-233 in Symptomatic, mCRPC
San Francisco, CA (UroToday.com) Five years ago, in a landmark trial, Radium-223 (compared to placebo) demonstrated a significant improvement in overall survival (OS) (median 14.9 months vs. 11.3 months; HR 0.70, 95%CI 0.58-0.83) among men with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases . Given the plethora of treatment options that have been approved for mCRPC since the 2013 publication of the ALSYMPCA trial, there is interest in combining different therapeutic modalities with Radium-223.
AUA 2018: Statin Use is Associated with Improved Prostate Cancer-Specific Outcomes in White but Not Black Men Initiating ADT
San Francisco, CA (UroToday.com) Statins are medications that inhibit production of cholesterol, the precursor for sex hormone synthesis, which may sustain androgen-dependent tumor growth despite castrate serum levels after ADT. Statins and their use among patients with prostate cancer are well-established: statins have been linked with (i) lower risk of advanced prostate cancer , (ii) reduced risk of recurrence , and (iii) decreased prostate cancer specific mortality . However, most studies were conducted in white men, and very few examined the effect of statin use on outcomes after ADT.
AUA 2018: Superior Efficacy of Degarelix as Neoadjuvant Hormone Therapy in Control of Acute Genitourinary Toxicity Associated with Radiation Therapy for Prostate Cancer
San Francisco, CA (UroToday.com) Degarelix, sold under the brand name Firmagon, is a GnRH antagonist that competes with the natural GnRH decapeptide for binding to GnRH receptors in the pituitary gland. Results of a systematic review and meta-analysis found that degarelix offers superior control of lower urinary tract symptoms compared to luteinizing hormone-releasing hormone (LHRH) agonists, such as leuprolide .
AUA 2018: Salvage High-Intensity Focused Ultrasound For Locally Recurrent Prostate Cancer after Low-Dose-Rate Brachytherapy: Oncologic and Functional Outcomes
San Francisco, CA (UroToday.com) According to the EAU-ESTRO-SIOG 2018 guidelines, the biochemical disease-free survival for Gleason 6 prostate cancer at 5 years ranges from 71-93% and at 10 years from 65-85%. However, there is a lack of studies evaluating salvage therapies for locally recurrent prostate cancer after low-dose-rate (LDR) brachytherapy. The majority of cases receive androgen deprivation therapy, which is essentially palliative treatment and associated with significant adverse effects such as depression, osteopenia, fatigue, loss of libido, etc.