SIU 2017: Non-Androgen-Receptor-Targeted Options for mCRPC
Lisbon, Portugal (UroToday.com) The CHAARTED and STAMPEDE studies demonstrated that administration of Docetaxel in metastatic hormone sensitive prostate cancer (mHSPC) reduced the risk of death by 39%, creating a trend of giving these advanced lines of treatment earlier than in the past. Dr. Saad therefore asks the following question: Since androgen deprivation therapy (ADT) is the standard first line treatment of metastatic castrate resistant prostate cancer (mCRPC), is chemotherapy effective after hormonal therapy? The COU-AA-302 study examined this question by administration of docetaxel post abiraterone, and demonstrating a PSA fall by 50% in almost 50% of the patients. Another study – TROPIC, analyzed administration of Cabazitaxel after docetaxel and compared it to mitoxantrone. This study also had positive results with increase of overall survival by a median of 2.4 months.
SIU 2017: Role of Cytoreductive Surgery in CRPC
Lisbon, Portugal (UroToday.com) There has been a paradigm shift in several solid tumors, emphasizing locoregional treatment in the presence of metastatic disease. The question Dr. Hammerer raises in this presentation is whether local therapy should be performed in CRPC men or/and men with oligometastatic disease with a rising PSA on androgen deprivation therapy (ADT).
SIU 2017: Advances in Imaging in CRPC: New Ligands for Pet Imaging
Lisbon, Portugal (UroToday.com) Small molecules serving as optimal tracers for molecular imaging must have several properties to be considered a good tracer. These include high specificity for receptors, fast circulation through the body, fast clearance, easy to produce and label, high stability and to not trigger a host immune response.
SIU 2017: Optimal Sequencing and Monitoring of Androgen Receptor (AR) Pathway Inhibitors in mCRPC
Lisbon, Portugal (UroToday.com) Dr. Gleave began his presentation with the fact that in hormone naïve prostate cancer, it has recently been shown in the STAMPEDE and LATITUDE trials that Abiraterone and prednisone was a well-tolerated treatment. Furthermore it improved overall survival by 37%, failure free survival by 70%, and symptomatic skeletal events by 30%-55%. These studies have demonstrated that abiraterone and prednisone should be the standard of care for men starting long term ADT.
SIU 2017: Mechanisms of Treatment Induced Resistance
Lisbon, Portugal (UroToday.com) Dr. Evans gave an elaborate talk on the various mechanisms of treatment induced resistance in castrate resistant prostate cancer (CRPC). He began his talk by describing the many potential targets for treatment in the androgen axis, and resistance mechanisms. These include androgen receptor (AR) mutations, loss of AR, AR DNA binding, CYP17A1 expression, and more.
SIU 2017: Towards Precision Medicine in Advanced Prostate Cancer
Lisbon, Portugal (UroToday.com) Dr. Beltran began her presentation asking how we should translate genomics and molecular biomarkers into clinical practice. She also asked when we should think about metastatic biopsy. In a study where 150 metastatic CRPC biopsies were performed, DNA alterations were found in 22%, with 8% having germ line mutations. This brings us to ask several important questions, including when to test and who? And what gene panel to use. Should we test all patients with mCRPC for DNA repair mutations? We need to understand the functional and prognostic role of the less common mutations as well. This will give us the answer to other questions, including whether we should screen for prostate cancer (PC) among family carriers, and what the optimal management of carriers with localized PC should be.
SIU 2017: The Utility of Subsequent Prostate Biopsies for the Active Surveillance of Prostate Cancer when Genomics and MRI Are Negative
Lisbon, Portugal (UroToday.com) In this panel discussion, led by Dr. Cooperberg, the focus of the talk was on the utility of subsequent prostate biopsies for active surveillance (AS) patients when genomics and mpMRI are negative.
As an introduction, Dr. Cooperberg noted that AS has finally been recognized as the standard of care for low-risk PCa, as opposed to an option. However, those same guidelines do NOT mention high-risk groups, such as African-Americans, younger men, and high volume disease. While AS currenty entails an initial biopsy and a confirmatory biopsy at 6-12 months, following by surveillance regimens that vary significantly, most surveillance protocols still call for repeat biopsies during follow-up. However, along this management course, there are numerous new genomic tests that can be utilized to alter risk level as well as mpMRI. How do these tests affect decision making and can they replace biopsy?