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From the Desk of the Editor: Volume 2, Issue 4

Welcome to Issue 4 of Everyday Urology - Oncology Insights.  This month, Evan Yu, M.D. and Sumanta (Monty) Kumar Pal, M.D. will review and analyze the impact of current clinical trials on patient care, as described by the cover article, The Importance of Clinical Trials for Genitourinary Malignancies. Drs. Yu and Pal will address numerous and important key clinical questions embracing four main genitourinary malignancies: prostate, bladder/urothelial, renal and testicular germ cell cancers, explaining that if not for the dedication of researchers, investigators, and patients (trial subjects) who collectively dedicate their energies to clinical trials, we would not have the evidence-based information which results in regulatory approval and subsequent US and global access for life-prolonging therapies for the genitourinary cancers we diagnose and manage. Given that most trials do not achieve the desired clinical and statistically positive results aimed at regulatory approval, nonetheless, the knowledge gained will still often times advance clinical and scientific progress. As clinicians, we must embrace these goals and be continuously vigilant in promoting and educating patients regarding their need to participate in clinical research, as we are all physician-scientists at our core. 

Also, within this issue of Everyday Urology are two outstanding articles presented as lectures during this past November in Chicago, IL at the Large Urology Group Practice Association (LUGPA) 2017 CME Session: Updates for Optimizing GU Oncology Cancer Clinics of Excellence. Dr. Fred Saad and Dr. Charles Ryan discussed prostate cancer treatments and the issues involving sequencing of various therapies. Dr. Saad’s presentation, Chemotherapy in Prostate Cancer: Why, When and How? provides perspective on the use of chemotherapy in patients with prostate cancer and the role that different therapies play throughout the progression of advanced prostate cancer. Dr. Saad sites data from multiple clinical trials, noting that almost all patients with mCRPC benefit from the use of hormonally-based therapy. Dr. Saad also noted that for patients with metastatic PCa, chemotherapy plays an essential role upfront in specific patients. Urologists and Medical Oncologists dedicated to advanced prostate cancer care will enjoy his thorough and thoughtful review of the existing published trials and the possibilities for both specialties to administer chemotherapy as well via a multidisciplinary model. Assuredly, clinicians must recognize resistance patterns early so that patients can access the optimal number of approved lines of therapy or well suited clinical trials, thereby promoting precision and personalized medicine. 

Dr. Charles Ryan carefully reviews the many sequences that exist in the treatment of prostate cancer, with his presentation, entitled, Sequencing and Combining CRPC Therapies: What Does the Future Hold? Dr. Ryan describes the CRPC patient population as a broad-spectrum of disease patterns, and thus the importance to recognize the principles of personalizing CRPC management. He reviews AR targeting in CRPC which provides the opportunity for clinical benefit with relatively low morbidity; however, resistance patterns will emerge via different routes of pathophysiology and thus are drivers of changes in tumor biology, requiring a nimbler approach toward therapeutic strategies. Dr. Ryan also discusses the role for tissue biopsies of metastases as well as “liquid biopsies” or ctDNA, which will assuredly impact future clinical evaluation and treatment decision making. 

Concluding this month’s issue is extensive coverage from Société Internationale d’Urologie (SIU) Congress 2017 held in October in Lisbon, Portugal, where a number of compelling abstracts were presented from genitourinary experts worldwide including Martin Gleave’s Optimal Sequencing and Monitoring of Androgen Receptor (AR) Pathway Inhibitors in mCRPC. 

We greatly appreciate your support for Everyday Urology, and we look forward to bringing you the latest in hot topics, emerging treatments and expert opinions from our colleagues around the world throughout 2018. 

Sincerely,

Neal Shore,MD,FACS