AUA 2018: Can Free PSA Be Used as a Biomarker in Biochemical Recurrence after Surgery to Predict Castration Resistant Prostate Cancer?

San Francisco, CA ( Most serum PSA is complexed to proteases, but 5%-45% of PSA exists as enzymatically inactive free PSA (fPSA). PSA produced from prostate cancer (PC) cells escape proteolytic processing, resulting in a greater fraction of complexed PSA and a lower %fPSA. This resulted in fPSA/total PSA ratio (fpsa ratio) being used as an adjunct marker to improve PSA accuracy in screening.

AUA 2018: Active Surveillance of Prostate Cancer in African Americans during the MRI Era

San Francisco, CA ( Active surveillance has received relatively widespread uptake. However, uptake has been slower in the United States than in many other Western countries. One of the reasons for this may relate to the fear of undiagnosed aggressive disease. As African American men are more likely to have adverse pathologic findings at the time of radical prostatectomy and increased rates of biochemical recurrence after RP, urologists may be wary of the risk of aggressive disease in these men. Such concern may however expose these men to a greater risk of over treatment. In a podium presentation at the American Urologic Association Annual Meeting, Dr. Bloom and colleagues examined the role the AS in African-American men undergoing MRI-fusion biopsy. 

AUA 2018: Risk of Men with Intermediate Risk Prostate Cancer Going On To Definitive Treatment During Active Surveillance: Does a High PSA Predict a Worse Outcome?

San Francisco, CA ( Prostate specific antigen (PSA) level is an integral part of prostate cancer risk stratification. However, for patients with otherwise low risk disease characteristics (grade and stage), an elevated PSA (>10 ng/mL) may classify patients at intermediate risk. Whether such rises in PSA portend a worse prognosis is unclear. In a podium presentation at the American Urologic Association Annual Meeting, Dr. Burns and colleagues assess the time to definitive therapy for patients with intermediate risk prostate cancer (defined on the basis of PSA alone), low risk prostate cancer and favourable intermediate risk disease. 

AUA 2018: Comparative Genomic Analysis of African American and Non-African American Prostate Cancers: A Report from the Decipher GRID Collaborative

San Francisco, CA ( Racial disparities in prostate cancer incidence and mortality are well known. In this study, the authors present initial results from the largest study of race and prostate cancer genomics. 

AUA 2018: Impact of Transient ADT with Leuprorelin 11.25 Mg on the Histological Progression of Indolent Prostate Cancer–Results of a Phase III Trial vs Active Surveillance

San Francisco, CA ( Olivier Cussenot, MD, and colleagues presented results of their phase III trial randomizing men with indolent prostate cancer to Leuprorelin 11.25 mg vs active surveillance. Indolent forms of prostate cancer, or low-risk prostate cancer, represent 50% of newly diagnosed disease. The optimal definition of low-risk prostate cancer and active surveillance candidates remains problematic due to the lack of relevant markers of low-risk prostate cancer aggressiveness and difficulties in assessing disease progression under surveillance. 

AUA 2018: Analysis of Methylated DNA Markers for Prediction of Cancer Progression after Radical Prostatectomy

San Francisco, CA ( Therapeutic decisions for prostate cancer (CAP) are often guided by Gleason grade, which is subjective and lacks precision. In discovery and early validation, the authors identified methylated DNA markers (MDMs) with prognostic association (AUA 2017). In this study, the authors assessed the value of novel MDMs in predicting recurrence using archival tissue from an independent group with > 12 years follow-up after radical prostatectomy (RP).

AUA 2018: Four-year Follow-up of a Phase-3 Prospective Randomized Trial of Vascular-Targeted Phototherapy Versus Active Surveillance for Low-Risk Prostate Cancer

San Francisco, CA ( Dr. Inderbir Gill and colleagues presented four-year follow-up results from a phase III trial assessing vascular-targeted phototherapy (VTP) vs active surveillance for men with low-risk prostate cancer. Because of the well-known side effect profile of radical treatment for localized prostate cancer, there is an ever-present desire to be able to treat men with minimally invasive techniques without compromising the opportunity for cure. Furthermore, active surveillance fails 50% of the time and within 5-10 years 70% of patients will have radical therapy, thus lending clinical equipoise for pursuing other minimally invasive modalities according to Dr. Gill. Partial gland ablation for prostate cancer is one such modality. While safety has been reasonably established, there is limited, if any, Level I evidence of efficacy.

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