AUA 2018: Phase II Clinical Trial in Prostate Cancer Evaluating 68Ga-PSMA-11 Detection on both Preoperative PET-CT and Immediate Postoperative Specimen Scanning

San Francisco, CA (UroToday.com) Active surveillance and focal therapy for prostate cancer depend on accurate biopsies for safe and effective treatment. Second, whole gland therapy, such as prostatectomy or radiation therapy, also depend on accurate biopsies for negative margins and precise application of radiation. As such, the question is: What does PSMA PET-CT see and not see in prostate cancer?

AUA 2018: Patient Reported Outcomes in SPARTAN, a Phase 3, Double-Blind, Randomized Study of Apalutamide plus ADT vs placebo plus ADT in Men with nmCRPC

San Francisco, CA (UroToday.com) The U.S. Food and Drug Administration approved Erleada (apalutamide) for the treatment of patients with prostate cancer that has not spread (non-metastatic), but that continues to grow despite treatment with hormone therapy (castration-resistant). This is the first and only FDA-approved treatment for non-metastatic, castration-resistant prostate cancer.   In this presentation by Dr. Eric Small, on the SPARTAN trial, treatment with Apalutamide (APA) vs placebo (PBO) improved metastasis-free survival (MFS) (median 40.5 vs 16.2 mo; HR=0.28; 95% CI, 0.23-0.35; P < 0.0001). The aim of this analysis was to assess HRQoL for men with nmCRPC receiving APA and ADT.

A total of 1207 pts (median age, both arms: 74 y) with nmCRPC and PSA doubling time of 10 mo were randomized 2:1 to APA (240 mg QD) or PBO. ADT was continued. HRQoL and symptoms were assessed using PRO questionnaires, including the Functional Assessment of Cancer Therapy-Prostate (FACT-P), Euro QoL Group EQ-5D3L. PROs were completed at baseline, Day 1 of Cycles (C) 2-7, C9, C11, C13, and then every 4 mo for the duration of treatment and 1 y after treatment discontinuation. Analyses were conducted on FACT-P total score and all subscales, including FACT-G, a more general evaluation of HRQoL.

AUA 2018: MRI Imaging - AUA Statement on its Use for Diagnosis, Staging, and Management

San Francisco, CA (UroToday.com) Peter Pinto, MD gave an overview of prostate multiparametric MRI (mpMRI). He began his talk discussing transrectal US (TRUS). Few urologists use TRUS to look for areas suspicious for cancer. 60% of ultrasound morphologically suspicious lesions are not cancer. Data from the PROMIS study, comparing TRUS to mpMRI for prostate cancer diagnosis, show that the sensitivity and specificity of TRUS is 48% and 74%, respectively. In contrast, the sensitivity and specificity of MRI is 93% and 89%, respectively. 

AUA 2018: Prostate Cancer: What PET to GET?

San Francisco, CA (UroToday.com) Thomas Hope, MD presented the different PET radiotracers available today for prostate cancer.  He began with the NaF PET/CT. This radiotracer has a good spatial resolution, high signal to the background with CT available for correlation, and has a short time from injection to imaging.

AUA 2018: Can Active Surveillance Really Reduce the Harms of PSA Testing? PRIAS-Study Implicates Caution

San Francisco, CA (UroToday.com) Prostate cancer screening using the prostate specific antigen (PSA) serum test has proven controversial in part due to the large burden of over diagnosis and over treatment. Active surveillance has been proposed as a way of mitigating the harms of PSA screening while retaining its potential benefits. In fact, the US Preventative Services Task Force has recently recommended selective PSA screening on the basis of such an approach. Dr. Drost and colleagues report of data from the PRIAS study, focusing on the limitations of active surveillance (AS) to achieve such reductions in over treatment.

AUA 2018: Long-Term Outcomes of Active Surveillance for Prostate Cancer - Memorial Sloan Kettering Cancer Center Experience

San Francisco, CA (UroToday.com)  Active surveillance is a well accepted treatment paradigm for patients with low risk prostate cancer. However, long-term outcomes are limited to a relatively small number of centers with differing inclusion criteria. Therefore, increasing knowledge regarding these outcomes is valuable. In a podium presentation at the American Urologic Association Annual Meeting, Dr. Benfante and colleagues present a 17-year experience with active surveillance (AS) at the Memorial Sloan Kettering Cancer Center. 

AUA 2018: Effect of Selection and Referral Biases for the Treatment of Localized Prostate Cancer with Surgery or Radiation

San Francisco, CA (UroToday.com) Multidisciplinary consultation has been widely advocated in many oncologic tumor sites. This is notably true for patients with localized prostate cancer for whom a number of viable treatment options, surgery, radiotherapy, and surveillance, exist. While it may be expected that multidisciplinary consultation involving both radiation oncologists and urologists would change the distribution of active treatment choices compared to consultation with a urologist alone, the effect of surveillance rates is unclear. In a podium presentation at the American Urologic Association Annual Meeting presented by Dr. Nam on behalf of his colleagues, population-based data from Ontario, Canada were used to assess this question. 

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