Welcome to Volume 3, Issue 2 of Everyday Urology – Oncology Insights. This edition’s cover story by Phillip Koo, MD, Imaging Controversies for Localized and Advanced Prostate Cancer explores the challenging topic of imaging modalities for Prostate Cancer. He discusses the use of multiparametric magnetic resonance imaging (mpMRI) as well as positron emission tomography-computed tomography (PET/CT), C-11 Choline, and 18F-Fluciclovine for both localized and advanced prostate cancer disease management. Dr. Koo also reviews the ability of scoring systems, such as the Prostate Imaging Reporting and Data System (PIRADS) as well as similar tools to enhance stratification assessments and interdisciplinary communication.
This issue also includes Current Perspectives: Immunooncology for Bladder Cancer in which I discuss the burgeoning use of immunotherapy and its revolutionary impact upon the treatment of bladder cancer, inclusive of high risk non-muscle invasive bladder cancer, muscle invasive bladder cancer, and metastatic urothelial cancer(UC). FDA approvals for first and second-line UC treatment, including atezolizumab and pembrolizumab, and various PD-1/PD-L1 pathway inhibitors, respectively, provide alternatives to traditional chemotherapeutic options. The article also reviews exciting ongoing trials as well as potential research pipeline for numerous aspects of bladder cancer investigation, examining the entirety of the disease spectrum, whereby immune-oncology treatments may ultimately include earlier stage disease applications as well as a multitude of therapeutic combination regimens.
This edition’s spotlight features key highlights and coverage on prostate, bladder and renal cancer from the 2018 AUA and ASCO annual meetings. A few important and notable examples from this year’s meetings include: the AUA presentation by E. David Crawford, MD: PSA 1.5 is the new 4.0, on the value of screening and his team’s work to show that patients presenting with a PSA greater than 1.5 should be evaluated for cancer risk, without necessarily requiring a biopsy; Michele Marchioni’s presentation: Effect of African-American Race on Cancer Specific Mortality Differs According to Clear-Cell vs Non-Clear Cell Histologic Subtype in Metastatic Renal Cell Carcinoma, which found that African-Americans have a worse cancer specific mortality than Caucasians for clear cell metastatic renal cell carcinoma (ccmRCC). At ASCO, Arnaud Mejean, MD, presented the CARMENA study: Sunitinib Alone Shows Non-inferiority Versus Standard of Care in mRCC, which was followed by a discussion led by Daniel George, MD. Also, Freddie Hamdy, MD, gave a presentation on ProtecT and other prospective trials and their impact on the use and understanding of Active Surveillance for low risk PCa. Clearly, the aforementioned presentations are only the tip of the vast array of important research and analyses presented at this year’s AUA/ASCO . We hope our summary reviews provide you with educational benefit.
Thank you for reading this edition of Everyday Urology - Oncology Insights.
Neal Shore, MD, FACS