Published Date: December 2019
The choice of initial treatment for newly diagnosed metastatic castration-resistant prostate cancer (mCRPC) is far more complex than it was even a decade ago. Today, many patients with mCRPC have already received intensive upfront therapies during the hormone-sensitive stage— a “leftward” shift in treatment (based on the clinical states model we so frequently employ) which can spur a “rightward” shift in disease biology due to the earlier emergence of treatment-resistant clones.
Published Date: December 2019
Metastatic hormone-sensitive prostate cancer (mHSPC) has become increasingly prevalent in the United States. Between 2009 and 2020, experts have projected a nearly 17% increase in the number of newly diagnosed mHSPC cases and a more than 18% increase in cases of mHSPC occurring after failure of local (curative-intent) treatment.1 This increase is likely multifactorial, reflecting changes in prostate-specific antigen (PSA) screening practices, the increased use of more sensitive imaging modalities, and other factors.2, 3
Published Date: December 2019
Prostate-specific membrane antigen (PSMA) is expressed 100 to 1,000 times more highly in prostatic adenocarcinoma than in benign prostate tissue, particularly in the setting of androgen deprivation.1 Around the world, we are seeing the rapid adoption of PSMA PET-CT/MRI, which is able to detect metastatic disease that is inapparent on conventional imaging (CT and bone scintigraphy). It remains unclear, however, if the earlier detection of asymptomatic metastatic disease improves clinical outcomes for patients. Various questions and controversies also surround the emerging field of PSMA-based targeted therapies.
Published Date: December 2019
Bone health is a critical area of unmet need among men with advanced prostate cancer. Age increases the risk for fragility fractures among both men and women, and older men with fragility fractures are at higher risk of subsequent death than are women.1-3 Systemic anti-androgen therapies for prostate cancer, while life-prolonging, accelerate bone loss by tipping the balance of bone homeostasis toward bone resorption, which further increases patients’ risk of fragility fractures.4
Published Date: September 2019
Androgen deprivation therapy (ADT) is the longstanding initial treatment for advanced hormone-sensitive prostate adenocarcinoma. Nonetheless, patients who are initiated on ADT will invariably progress by developing prostate cancer cellular clonal populations, which creates a phenotype of more castration-resistant disease with more aggressive biology.1
Published Date: September 2019
Patients whose metastatic castration-resistant prostate cancer (mCRPC) has progressed on taxane chemotherapy and second-generation anti-androgen agents have few alternatives to palliative care. However, radiolabeled prostate-specific membrane antigen (PSMA) conjugates are now in latephase studies. In this article, I discuss theranostics, the phase 3 VISION trial, and the questions we will need to consider when PSMA-targeted radioligand therapies become available for use in our advanced prostate cancer clinics.
Published Date: September 2018
A 62-year-old man presents with a one-week history of hematuria. Ultrasound and computed tomography identify a 7-cm exophytic anterior left renal tumor, adenopathy, and two
small lung nodules. No bone or central nervous system lesions are detected. His Eastern Cooperative Oncology Group (ECOG) performance-status (PS) and Memorial Sloan-Kettering Cancer Center (MSKCC) scores are 1. The patient asks whether to undergo cytoreductive nephrectomy. What do you tell him?
Published Date: September 2018
More than 81,000 individuals are diagnosed with bladder cancer in the United States every year, of whom 75% have non-muscle invasive disease.1,2 Unfortunately, half these cases recur despite transurethral resection of bladder tumor (TURBT), and from 5% to 25% of repeated recurrences progress to muscle-invasive disease.3,4,5
