Optimizing Bone Health in Prostate Cancer

Protecting and improving bone health is critical when managing all stages of prostate cancer. Androgen deprivation therapy (ADT) accelerates bone resorption, which compromises bone mass and integrity starting early in treatment.1 Metastatic prostate cancer is associated with a marked increase in risk of skeletal events (fracture, spinal cord compression, and bone surgery or radiotherapy) associated with both bone metastases and treatment-induced bone loss.

Genetic Evaluation of Hereditary Prostate Cancer

During much of the past 30 years, genetic tests for heritable disorders have assessed limited numbers of genes and have often employed serial testing algorithms in which the next test was determined by the results of the prior test.¹ The advent of next-generation (also known as massively parallel high-throughput) sequencing has transformed this picture by making it possible to sequence the entire human genome for less than $1,000.1,2

Optimizing TURBT and Optical Diagnostics in Bladder Cancer

The detection of recurrent tumor is a benchmark by which the success of intravesical agents is determined. Because the U.S. Food and Drug Administration (FDA) will now consider data from single-arm trials for patients with Bacillus Calmette-Guérin (BCG)-unresponsive bladder cancer, the complete response (CR) rates (i.e. absence of disease on biopsy) is a key factor that impacts the success of many registration studies.2,3,4 In addition, several trials in the neoadjuvant setting focus on p0 rates, meaning that disease is not detected in the final pathologic specimen.5 Since the extent of disease detected depends on the quality of the cystoscopy and an optimally performed TURBT can achieve P0 in up to 15% of patients even without enhanced cystoscopy,5 – clearly this has the potential to impact result. 

Immuno-Oncology: The Urologist's Role

Published in Everyday Urology - Oncology Insights: Volume 4 Issue 1
This is an extraordinary time in urology. After decades of relative stagnation, patients with urothelial carcinoma are receiving approved immuno-oncologic drugs that significantly extend survival and are safer and more tolerable than chemotherapy.  The success of these treatments in metastatic bladder cancer has generated strong interest and promising early results for their use in localized disease.

Update on ADT in Advanced Prostate Cancer

Prostate cancer is the leading incident cancer among men, and population growth and aging have fueled a 40% rise in global case burden since 2006.1,2 Despite recent improvements in treatment, patients with locally advanced and advanced prostate cancer experience significant emotional distress, diminished quality of life, and increased risk of cancer-specific mortality.1,2,3

Practice-Changing Applications of Radiology and Nuclear Medicine in Genitourinary Malignancies

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 4
Experts at Harvard Business School first coined the term disruptive innovation to describe how small, poorly resourced companies could successfully challenge larger ones.1 More than two decades later, this concept is central in medicine, where innovations in everything from proteomics and wearables to electronic health records and health economics are upending our status quo.2,41

Nephrectomy in the Era of Targeted Therapy: Takeaways from the CARMENA Trial

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 3

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? 

Spacers and Prostate Radiation Therapy: What Urologists Should Know

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 4
Radiation has been used to treat prostate cancer since the early 1900s.¹ In recent decades, advances in radiation delivery systems and the advent of computed tomography and magnetic resonance imaging have spurred the development of targeted, high-dose radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), image-guided radiation therapy (IGRT), stereotactic radiation therapies, proton beam

Blue Light Cystoscopy: Insights on Recurrence, Progression, and Clinical Management

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 3

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

Immuno-oncology for Bladder Cancer

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 2
Initial Considerations
From BCG to interferon gene therapy, physicians have treated bladder cancer with immunotherapy for decades. Treatment particulars generally depend on whether bladder cancer is non-muscle invasive, muscle-invasive, or metastatic. About 75% of patients have non-muscle invasive bladder cancer (NMIBC),1 which is considered high-risk if it consists of non-invasive papillary carcinoma (TaHG),

Imaging Controversies for Localized and Advanced Prostate Cancer

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 2
Imaging in prostate cancer (PC) remains a controversial topic that can be challenging to navigate. In this article, I focus on some of the best tools in our current armamentarium: multiparametric prostate magnetic resonance imaging (mpMRI) for local prostate cancer (PC) and positron emission tomography-computed tomography (PET/CT) for advanced disease. In research settings, these modalities often overlap, but here I take a more practical approach by focusing on the use of PET/CT for the detection of metastatic disease.

An Unmet Need is Met: (The PROSPER Study): Evaluating the Safety and Efficacy Study of Enzalutamide in Patients with Nonmetastatic Castration- Resistant Prostate Cancer

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 1
For men with non-metastatic, castration-resistant prostate cancer (nmCRPC), who are invariably at risk of metastasis, the PROSPER trial clearly demonstrated that combining enzalutamide to androgen-deprivation therapy (ADT) resulted in prolonging metastasis-free survival by a median of 22 months compared with ADT plus placebo

How I Manage First-Line Therapy for Advanced Kidney Cancer

Published in Everyday Urology - Oncology Insights: Volume 1, Issue 2
Urologists are primed to acquire the knowledge to use targeted agents and immuno-oncologic (IO) therapies for the treatment of advanced and metastatic renal cell carcinoma (RCC). Toxicities are manageable given appropriate patient/caregiver education, on-call and nursing support, and multi-disciplinary care with consulting specialists. 

Bladder Cancer Immunotherapy: Establishing a Clinic of Excellence

Published in Everyday Urology - Oncology Insights: Volume 3, Issue 1
Until recently, decades had elapsed with little progress in treating metastatic urothelial cancer (mUC). Cisplatin-based chemotherapy, the best available treatment option, had a median overall survival (OS) of 12-15 months, an overall response rate (ORR) of 50-60%, and was curative in about 10% of cases, but also was associated with potentially serious toxicities.12, 13, 2, 7, 3 

The Importance of Clinical Trials for Genitourinary Malignancies

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 4
As we counsel our patients about the importance of clinical research, there are two key messages to send. The first is that without clinical trials, we would not have access to the large number of life-prolonging therapies that we have for genitourinary cancers and others. That translates into more family trips, birthday parties, time spent with grandchildren and graduations attended.

Sequencing and Combining CRPC Therapies - What Does the Future Hold?

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 4
The European Association of Urology defines castration-resistant prostate cancer (CRPC) as serum testosterone < 50 ng/dL or < 1.7 nmol/L plus either biochemical progression (three consecutive rises in prostate-specific antigen [PSA] one week apart, resulting in two 50% increases over the nadir, and PSA > 2 ng/mL) or radiologic progression

Chemotherapy in Prostate Cancer- When, Why and How

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 4
Until 2010, our treatment armamentarium for prostate cancer (PC) was fairly limited. Patients received local therapy for non-metastatic disease, androgen deprivation therapy (ADT) for hormone-naïve metastatic disease, denosumab and zoledronic acid for metastatic castration-resistant prostate cancer (mCRPC), and bisphosphonates or docetaxel for symptomatic mCRPC.

Updates on Immunotherapy for Urothelial Cancer

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 3
Urothelial cancer (UC), also known as transitional cell carcinoma, is the 5th most common cancer in the United States, and it arises more commonly in the bladder than in other parts of the urinary tract. An estimated 79,030 new cases of UC are expected in 2017. Of these cases, there will be about 12,240 deaths in men and 4630 in women.

The Five-Take Home Messages of the LATITUDE and STAMPEDE Studies

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 3
LATITUDE was a phase III trial of men with high-volume metastatic prostate cancer (PC) that had not been previously treated with androgen deprivation therapy (ADT).1 The patients were randomized to receive standard ADT with placebos vs. ADT plus abiraterone and prednisone. The primary endpoint is overall survival (OS).

A Review On The Development of Targeted Alpha Therapy in the Treatment of Cancer

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 2
Focusing on The First and Only FDA Approved Targeted Alpha Therapy Radium-223 in the Treatment of mCRPC

The Tenth Symposium on Targeted Alpha Therapy (TAT-10) opened on Wednesday, May 31, 2017 in Kanazawa Japan. The symposium was jointly organized by the Joint Research Centre (JRC) of the European Commission and Kanazawa University
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