Articles

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 Many of these disruptors are exciting—they aim to advance diagnostics, treatment, outcomes, and multidisciplinary patient-centered care. But they come with risks, too: Their popularity can outpace their efficacy and safety, and they can impede clinical workflows.^3,4

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 radiation therapy, and high-dose rate (HDR) brachytherapy.^2,3,4,5 These modalities have significantly improved biochemical disease-free survival in patients with localized prostate cancer and have added to the armamentarium of interventional localized prostate cancer options.^⁶

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), carcinoma in situ (CIS), or T1 (minimally invasive) tumor of the lamina propria.^2,3 For high-risk NMIBC, multiple peer-reviewed trials and meta-analyses support 1-3 years of intravesical immunotherapy with bacillus Calmette-Guérin (BCG) to significantly lower the risk of recurrence,^4,5,6,7,8 progression, and death.^{^9,10,11}

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 in a global, double-blind, phase III study (Safety and Efficacy Study of Enzalutamide in Patients With Nonmetastatic Castration-Resistant Prostate Cancer), presented at the plenary session of ASCO GU 2018.^¹

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. It translates into more time spent being productive at work, and net increase into societal wealth. These have meaningful impact. The second is that enrolling on a clinical trial is largely about altruism. The typical patient wants to receive a therapy that will help him/her. That is reasonable; however, the greatest reason to enroll in a clinical trial is that new knowledge will be gained regardless of the outcome.

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 (at least two new bone scan lesions or a soft tissue lesion using Response Evaluation Criteria in Solid Tumors [RECIST]).¹ Symptomatic progression alone is not enough to diagnose CRPC; instead, it should trigger further investigation.

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

INTRODUCTION

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. Bladder cancer accounts for approximately 5% of all new cancers. For the past 30 years, bladder cancer-related mortality had remained unchanged.^1,2

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

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 3

Brief high-level review of the LATITUDE and STAMPEDE Studies:

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

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

INTRODUCTION
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 as a forum for presentations on the latest developments in radiotherapy with alpha emitters in cancer. With over 200 participants the symposium covered advances in cancer treatment using alpha emitters as targeted therapy, clinical and preclinical research, radionuclide production, instrumentation and dosimetry.¹

The Multidisciplinary Approach to Prostate Cancer Management: From Diagnosis and Beyond

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 2

Everyday Urology-Oncology Insights: Volume 2, Issue 2

When patients receive a diagnosis of cancer it can be devastating. Suddenly their world is turned upside down, populated by doctors, diagnostic tests, and treatments.

The standard process for newly diagnosed patients with prostate cancer is a chronologically linear and often one-dimensional process managed by urologists.³ If the patient’s diagnosis is based on biopsy results, the urologist discusses treatment options with the patient and his family. This may be followed by referral to another specialist such as a medical and/or radiation oncologist depending on their risk stratification.⁴

Assessment of Cardiovascular Risk With the Use of Androgen Deprivation Therapy for Prostate Cancer

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 1

Everyday Urology-Oncology Insights: Volume 2, Issue 1

Heart disease and cancer are the leading causes of death in the United States.¹ Prostate cancer (PC) is the most common cancer in American men, and PC is most frequently diagnosed among men aged 65 to 74 years.² The American Cancer Society’s estimates for PC in the United States for 2017 are about 161,360 new cases. Of these, about 26,730 are expected to die of the disease.¹

Enhanced Recovery After Surgery, Radical Cystectomy and Urinary Diversion

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 1

Everyday Urology-Oncology Insights: Volume 2, Issue 1

Bladder cancer presents an ever increasing health care burden across the globe. The large majority of patients diagnosed with bladder cancer are over the age of 55, with an average age at the time of diagnosis of 73 and an increasing percentage 80 years and older.¹ Men are about three to four times more likely to get bladder cancer during their lifetime than women.¹

Radium-223:The Only Approved Targeted Alpha Therapy (TAT) in mCRPC- Outcomes, Opportunities and Lessons Learned

Published in Everyday Urology - Oncology Insights: Volume 2, Issue 1

Everyday Urology-Oncology Insights: Volume 2, Issue 1

More than 90% of patients with metastatic castration-resistant prostate cancer (mCRPC) develop bone metastases which leads to a significant increase in morbidity and mortality.^1,2 Patients with metastatic prostate cancer and bone involvement have only a 3% five-year survival, whereas the five-year survival of patients without bone metastases is 56%. Skeletal-related events (SRE) in mCRPC patients may cause potentially devastating effects, such as decreased survival and pain, impaired mobility and spinal cord compression.² Bone metastases and SREs diminish a patient’s quality of life and increase medical costs.^3,4

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