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Canadian Urological Association 2017

CUA 2017: A Cost-Effectiveness Analysis of Hexaminolevulinate Blue Light-Assisted Transurethral Resection of Bladder Tumors in a Universal Healthcare System
Toronto, Ontario (UroToday.com) Bladder surveillance for tumor recurrence and treatment of eventual recurrences account for 60% of the total costs of managing bladder cancer (BCa) patients¹ – additional cost effective measures for surveillance and treatment are necessary.

Published June 26, 2017
CUA 2017: A Propensity Score Analysis of Radical Cystectomy vs. Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic
Toronto, Ontario (UroToday.com) Muscle-invasive bladder cancer (MIBC) drives the mortality of bladder cancer as a disease, and until now, the only level 1 evidence for its management supports the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, NAC + RC is a highly morbid intervention, particularly in the elderly population that entails the bladder cancer patient pool.

Published June 27, 2017
CUA 2017: Adjuvant vs. Salvage Radiotherapy for Patients with Adverse Pathological Findings After Radical Prostatectomy: A Decision Analysis
Toronto, Ontario (UroToday.com) Dr. Christopher Wallis and colleagues presented results from their decision analysis for adjuvant vs salvage radiotherapy for patients with adverse pathological findings after radical prostatectomy at the prostate cancer poster session at the 2017 CUA annual meeting. Patients undergoing radical prostatectomy who have adverse pathological findings experience high rates of recurrence.

Published June 26, 2017
CUA 2017: Analysis of Real-World use of Radium-223 in Ontario
Toronto, Ontario (UroToday.com) Dr. Urban Emmenegger and colleagues presented their study assessing real-world utilization of the alpha emitter Radium-223 at the prostate cancer poster session at the 2017 CUA annual meeting. Based on the ALSYMPCA trial, we know that Radium-223 improves survival and delays skeletal related events (SREs) among patients with metastatic castration-resistant prostate cancer (mCRPC) to the bone.¹

Published June 26, 2017
CUA 2017: Association Between Germline Genetic Variation and Progression in Men with Low-Risk Prostate Cancer on Active Surveillance
Toronto, Ontario (UroToday.com) Viranda Jayalath, a medical student from Princess Margaret Cancer Center in Toronto, Canada, elegantly presented his study assessing the association between germline genetic variation and progression in men with low risk prostate cancer (PC) on active surveillance (AS). AS is the preferred initial treatment strategy for men with localized, low-risk PC.

Published June 25, 2017
CUA 2017: Changes in the Outcome of Prostate Biopsies after Preventive Task Force Recommendation Against PSA Screening.
Toronto, Ontario (UroToday.com) In 2012, the United States Preventative Services Task Force (USPSTF) updated its recommendations on prostate cancer screening, specifically recommending against PSA screening. The Canadian Task Forces on Preventive Health Care (CTFPHC) followed suit. While the criticisms of these recommendations are well-recognized (in particular, the lack of urology input in the decision making process), the recommendations stood for the past 5 years. In the past year, updated recommendations were issued again recommending PSA screening, but as a shared decision making process between patient and physician.

Published June 26, 2017
CUA 2017: Chemotherapy and Novel Hormones in “Low Volume” Hormone-Sensitive Metastatic Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Oliver Sartor from Tulane University provided a comprehensive talk today during the CUA-CUOG Multidisciplinary GU cancer meeting at the CUA 2017 annual meeting. According to Dr. Sartor, the definition of metastatic prostate cancer disease is imaging dependent, as CT and bone scan are limited to detecting 1cc lesions (or 1 billion cells). How do we improve detection of disease compared to CT and bone scan?

Published June 25, 2017
CUA 2017: Correlation of Transperineal Prostate Biopsy-Detected Cancer with Magnetic Resonance Imaging-Predicted Lesion in Patients with Previous Negative Transrectal Ultrasound-Guided Prostate Biopsies
Toronto, Ontario (UroToday.com) Introduction of multiparametric MRI (mpMRI) has drastically changed the landscape of prostate cancer (PCa) diagnostics. However, as with any diagnostic tool, learning to better select patients for appropriate use, especially in a cost-effective manner, is critically important. While originally touted to be an excellent discriminator between clinically significant prostate cancer and indolent disease, more recent results have been sobering; false negatives still persist in the range of 10-20%. In contrast, template mapping biopsies done via a transperineal approach (TPB) reported have a yield of approximately 38% in men with prior negative TRUS biopsies.

Published June 26, 2017
CUA 2017: Creation of a Prediction Tool for Renal Function After Partial and Radical Nephrectomy: Personalizing Decision-Making for Renal Cancer Surgery
Toronto, Ontario (UroToday.com) This study aimed to create a preoperative prediction tool for renal function outcomes at various time points following partial nephrectomy (PN) and radical nephrectomy (RN) in order to help guide the choice of surgical approach.

Published June 26, 2017
CUA 2017: Cystic Renal Masses: Is the Bosniak Classification System an Adequate Predictor of Survival?
Toronoto, Ontario (UroToday.com) Dr. Thenappan Chandrasekar and colleagues presented their assessment of cystic renal masses and implications of the Bosniak classification system at this morning’s GU oncology poster session at the CUA 2017 annual meeting. Previous studies have suggested that although malignancy rates may be >50%, mortality rates from these lesions are quite low.^1,2The objective of this study was to evaluate intervention rates and survival outcomes of complex renal cysts in a single-center (University Health Network, Toronto) experience.

Published June 26, 2017
CUA 2017: Defining a Cohort of Men Who May Not Require Repeat Prostate Biopsy Based on Negative Predictive Value of PCA3 and MRI Combined: The Double-Negative Effect
Toronto, Ontario (UroToday.com) At the prostate cancer podium session at the 2017 CUA meeting, Dr. Nathan Perlis from the University of Toronto presented early results of men with a negative prostate biopsy who then subsequently had a negative PCA3 biomarker test and negative multiparametric MRI (mpMRI) to assess if they require a repeat biopsy.

Published June 25, 2017
CUA 2017: Early Cardiovascular Morbidity in a Pilot Prospective Randomized Trial Comparing Luteinizing Hormone-Releasing Hormone Agonist and Antagonist Among Patients with Advanced Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Jehonathan Pinthus from McMaster University and colleagues presented their results of cardiovascular morbidity in a pilot study comparing luteinizing hormone-releasing hormone (LHRH) agonist and LHRH antagonist use at the CUA 2017 prostate cancer poster session.

Published June 26, 2017
CUA 2017: Fatigue in Men with Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated with Enzalutamide: Data from Randomized Clinical Trials.
Toronto, Ontario (UroToday.com) Enzalutamide (Enza) is a novel androgen inhibitor with established efficacy in metastatic castration-resistant prostate cancer (CRPC). The AFFIRM and PREVAIL trials established its efficacy in the post-chemotherapy and pre-chemotherapy phases (***). Along with abiraterone (Abi), it is one of two approved oral agents for this disease state. However, the decision to utilize one over the other is often determined by adverse event profiles and contraindications.

Published June 26, 2017
CUA 2017: Four vs. 10 Months of Induction Androgen-Deprivation Therapy for Intermittent Therapy (the FIT trial): A Prospective Canadian Urology Research Consortium Randomized Trial
Toronto, Ontario (UroToday.com) Men with metastatic prostate cancer (PCa) are placed on androgen-deprivation therapy (ADT) for control of their disease. However, long-term ADT can have consequences on men’s health, including risk of osteoporosis and heart disease, along with the adverse events associated with it.

Published June 27, 2017
CUA 2017: Germline Mutations in the Kallikrein 6 Region and Predisposition for Aggressive Prostate Cancer
Toronto, Ontario (UroToday.com) Prostate Cancer (PCa) is a highly heterogeneous disease, ranging from indolent to rapidly progressing life-threatening metastatic disease. There is a need for markers identifying patients at increased risk of harbouring aggressive forms of PCa. Dr. Alexandre Zlotta presented a study surveying the Kallikrein (KLK) region (KLK1-15) for single nucleotide polymorphisms (SNPs) associated with aggressive PCa (Gleason score ≥8) in 1858 PCa patients.

Published June 25, 2017
CUA 2017: Immuno-Oncology Update in Advanced Bladder Cancer
Toronto, Ontario (UroToday.com) Dr. Kala Sridhar gave an all-encompassing presentation on the recent immunotherapy trials in advanced bladder cancer. Urothelial carcinoma (UC) the fifth most commonly diagnosed cancer, with 2300 deaths in Canada. Incidence rates are 3 times higher in men with an average age at diagnosis of 73.

Published June 25, 2017
CUA 2017: Impact of Abiraterone Acetate in Post-Docetaxel Setting on the Survival of Metastatic Castration-Resistant Prostate Cancer Patients: A Population-Based Study in Quebec
Toronto, Ontario (UroToday.com) Abiraterone acetate (Abi) is a novel steroidal CYP17A inhibitor that is approved for use for patients with metastatic castration-resistant prostate cancer (CRPC). The COU-AA-301 study¹ established its efficacy in a post-docetaxel setting, and ultimately, it was shown to be efficacious in men prior to chemotherapy treatment. Recent results from ASCO 2017 have now demonstrated its efficacy even in hormone-naïve metastatic prostate cancer, when given in conjunction with androgen deprivation therapy (ADT).

Published June 26, 2017
CUA 2017: Incidence and Predictors of Clinical Depression in Men with Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Robert Siemens and colleagues presented their results of incidence and predictors of clinical depression in men with prostate cancer at the prostate cancer poster session at the CUA 2017 annual meeting. Although depression in prostate cancer was previously linked only to men receiving androgen deprivation therapy (ADT), previous studies have demonstrated that up to 20% of men with prostate cancer report clinical depressive symptoms.¹

Published June 26, 2017
CUA 2017: Intraductal Prostate Cancer: Marker of Aggressive Disease?
Toronto, Ontario (UroToday.com) Dr. Van der Kwast, a recognized uro-pathologist from the Princess Margaret Cancer Centre (PMCC), gave an excellent talk regarding the clinical implications of finding intraductal prostate cancer (IPC) and cribriform pattern on prostate pathology (radical prostatectomy or prostate biopsy).

Published June 25, 2017
CUA 2017: Is Tumor Location in Upper Tract Urothelial Carcinoma an Important Prognostic Factor?
Toronto, Ontario (UroToday.com) Urothelial carcinoma (UC) is often treated as one entity. However, more and more evidence is demonstrating that upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BCa) may be two distinct entities. Within UTUC, there has often been debate regarding the impact of location on cancer-specific survival (CSS) – renal pelvis (RENPEL) vs ureteral (UL) UTUC may progress differently due to the environment surrounding their growth (ie depth of tissue, flow of urine, etc.).

Published June 26, 2017
CUA 2017: Liquid Biopsy in Personalizing CRPC Therapy.
Toronto, Ontario (UroToday.com) Dr. Kim Chi started the 5^th Annual CUA-Canadian Urologic Oncology Group (CUOG) Multidisciplinary meeting by reviewing the latest updates regarding liquid biopsy in castration resistant prostate cancer (CRPC) therapy. Dr. Chi notes that the treatment spectrum in the CRPC setting has rapidly developed over the last decade, subsequently increasing the prevalence of men with CRPC as these treatments prolong overall survival.

Published June 24, 2017
CUA 2017: Long-Term Incidence of Venous Thromboembolic Events Following cystectomy: A Population-Based Analysis
Toronto, Ontario (UroToday.com) Cancer and immobility both contribute to the development of venous thromboembolic events (VTE), including pulmonary embolism and deep vein thrombosis. As such, patients undergoing radical cystectomy for bladder cancer are at elevated risk. Dr. Diane Magee presented a study assessing the long-term incidence of VTE among all patients undergoing radical cystectomy in the province of Ontario.

Published June 27, 2017
CUA 2017: Magnetic Resonance Imaging-Targeted vs. Systematic Biopsies in Men on Active Surveillance: Results of a Prospective, Randomized Canadian Urology Research Consortium Trial.
Toronto, Ontario (UroToday.com) Dr. Laurence Klotz presented the first report of a multicentre, prospective, randomized phase 3 trial (ASIST) attempting to determine if multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy can improve selection of patients eligible for active surveillance. The question of the study was to see whether mpMRI and targeted biopsy improved detection of clinically significant cancer compared to systematic biopsy. The primary outcome was the proportion of subjects whose biopsy was upgraded at their confirmatory biopsy to Gleason score 7 (3 + 4) or higher.

Published June 25, 2017
CUA 2017: Medication Use and Kidney Cancer Risk: A Population-Based Study
Toronto, Ontario (UroToday.com) Exposure to commonly prescribed medications may be associated with reduced cancer risk; however, there is limited data in kidney cancer. Furthermore, methods of classifying cumulative medication exposure in previous studies may be prone to bias.

Published June 26, 2017
CUA 2017: Optimizing Active Surveillance for Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Stacy Loeb gave an excellent talk on the challenges and optimization of active surveillance (AS) in prostate cancer. Historically the vast majority of low risk patients received radical treatment, leading to unnecessary side effects. This has started to change, but even nowadays, in academic centers in the USA AS is utilized in 17% of cases, compared to 8% in community centers.

Published June 25, 2017
CUA 2017: Outcomes of an Aggressive Biopsy Strategy in Young Men with Prostate-Specific Antigen Between 0.5 and 2.5
Toronto, Ontario (UroToday.com) At the prostate cancer podium session at the 2017 CUA annual meeting, Dr. Hanan Goldberg and colleagues presented their work assessing outcomes of an aggressive prostate biopsy strategy among young men with a PSA between 0.5 and 2.5 ng/mL. With widespread PSA screening, prostate cancer detection rates have increased, particularly among young men (<50 years of age).

Published June 25, 2017
CUA 2017: Outcomes of Urothelial Bladder Cancer Patients who had Previous Upper Tract Urothelial Disease
Toronto, Ontario (UroToday.com) Urothelial carcinoma (UC) is often treated as one entity. However, more and more evidence is demonstrating that upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BCa) may be two distinct entities. As such, primary BCa and secondary BCa (following UTUC) may behave differently from one another. Studies show that secondary BCa or urothelial bladder carcinoma recurrence (UBCR) occurs in 22–47% of de novo UTUC (dNUTUC) patients.

Published June 25, 2017
CUA 2017: Perioperative Chemotherapy does not Improve Disease-Free Survival in Upper Tract Urothelial Carcinoma: A Population-Based Analysis.
Toronto, Ontario (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare disease, accounting for less than 5% of all urothelial cancers and with a peak incidence in the 8^th and 9^th decade. The role of perioperative chemotherapy remains poorly defined. Current practice in UTUC is derived from evidence related to muscle-invasive bladder cancer, where it has been shown to have a positive effect on cancer specific survival (CSS).

Published June 26, 2017
CUA 2017: Phase II Trial of Atezolizumab in Bacillus Calmette-Guérin-Unresponsive Non-Muscle-Invasive Bladder Cancer
Toronto, Ontario (UroToday.com) Immune checkpoint inhibitors (ICI) are a novel class of agents with promising results in multiple solid organ malignancies, typically in the advanced state. There are now 5 ICI’s approved for metastatic / advanced urothelial cancer (UC). However, while the promise of these therapies has been high, each has been shown to demonstrate an approximately 20% objective response rate (ORR), indicating the importance of patient selection.

Published June 26, 2017
CUA 2017: Population-Based Analysis of Treatment Toxicity Among Men with Castration-Resistant Prostate Cancer (mCRPC).
Toronto, Ontario (UroToday.com) At the GU oncology poster session at the 2017 CUA annual meeting, Dr. Christopher Wallis and colleagues from Toronto presented their population-based findings analyzing treatment toxicity among men with metastatic castration-resistant prostate cancer (mCRPC). Indeed, the toxicity and effectiveness of contemporary mCRPC treatments have not been assessed at a population level.

Published June 26, 2017
CUA 2017: Potential Role of a Novel Urinary Biomarker-Based Risk Score to Select Patients for Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection
Toronto, Ontario (UroToday.com) Introduction of multiparametric MRI (mpMRI) has drastically changed the landscape of prostate cancer (PCa) diagnostics. However, as with any diagnostic tool, learning to better select patients for appropriate use, especially in a cost-effective manner, is critically important. While originally touted to be an excellent discriminator between clinically significant prostate cancer and indolent disease, more recent results have been sobering; false negatives still persist in the range of 10-20%.

Published June 26, 2017
CUA 2017: Predictors of Early Disease-Specific Mortality Among Patients with Prostate Adenocarcinoma and Bone Metastasis at Diagnosis
Toronto, Ontario (UroToday.com) Patients who present with metastatic prostate cancer represent an incurable subset of patients with prostate cancer. While management has traditionally been immediate initiation of androgen-deprivation therapy (ADT) alone, more recent studies have demonstrated evidence of concurrent administration of chemotherapy or androgen axis inhibitors (abiraterone).^1,2,3,4

Published June 25, 2017
CUA 2017: Prostate-Specific Antigen Levels in Men Aged 60-70 and Development of Lethal Prostate Cancer Over 30 Years: Implications for Risk-Stratified Screening
Toronto, Ontario (UroToday.com) Dr. Mark Preston from Brigham and Women’s Hospital presented their group’s results of PSA levels in men 60-70 years of age and 30-year risk of developing lethal prostate cancer at the prostate cancer podium session at the 2017 CUA annual meeting. With a push over the past five years towards less detection and treatment of low grade prostate cancer, studies assessing unique screening algorithms to limit untoward screening are important.

Published June 25, 2017
CUA 2017: PSMA-Targeted Radionuclide Therapies in Treatment of Prostate Cancer.
Toronto, Ontario (UroToday.com) Dr. Neil Fleshner gave a talk on PSMA targeted radionuclide therapies in prostate cancer (PC). Medical isotopes have historically been used to both image and treat cancer. Short lived radioisotopes are attached to molecules that specifically bind PSMA, and can detect PC using PET or SPECT. By attaching radioisotopes such Lutetium or Actinium, radioactivity is targeted to the PSMA-expressing cells.

Published June 25, 2017
CUA 2017: Radical Cystectomy After Prior Partial Cystectomy for Urothelial Carcinoma: Perioperative and Oncological Outcomes
Toronto, Ontario (UroToday.com) Up to 50% of patients treated with partial cystectomy (PC) have been reported to require radical cystectomy (RC) due to local disease recurrence. The outcomes for these patients have not been well-described to date. Dr. Mason Ross presented a study evaluating outcomes of patients undergoing RC after PC for urothelial carcinoma (UC).

Published June 27, 2017
CUA 2017: Role of Androgen Deprivation in Salvage Radiotherapy
Toronto, Ontairo (UroToday.com) Dr. Tamim Niazi, from McGill University provided an excellent summary of the literature on the role for androgen-deprivation therapy (ADT) in patients undergoing salvage radiotherapy (RT).

Published June 25, 2017
CUA 2017: Role of MRI in Diagnosing Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Sangeet Ghai, a uro-radiologist at Princess Margaret Cancer Centre (PMCC), provided an overview of the role of MRI in the diagnosis of prostate cancer, focusing on patients with a prior negative biopsy and men on AS, but foraying into the biopsy-naïve segment as well.

Published June 25, 2017
CUA 2017: Safety of Minimizing Intensity of Followup on Active Surveillance for Clinical Stage I Testicular Germ Cell Tumors
Toronto, Ontario (UroToday.com) Active surveillance of stage 1 testicular germ cell tumors remains a standard of care, but the AS regimen continues to be modified and improved with experience. The Princess Margaret Cancer Centre (PMCC) experience with active surveillance has a long history, and began recommending a non-risk adapted active surveillance protocol for all clinical stage I (CSI) testicular germ cell tumors (TGCT) in 1981.

Published June 27, 2017
CUA 2017: State of the Art Immunotherapy for Urologic Cancers.
Toronto, Ontario (UroToday.com) Dr. Kim Chi from the BC Cancer Agency delivered a high-level overview of the current landscape of urologic oncology immunotherapy at the State-of-the-Art Lecture at the 2017 CUA annual meeting. Since the interferon trials for metastatic kidney cancer in the 1990’s, we have been waiting for subsequent immunotherapy breakthroughs. Over the past several years, we have certainly seen this with the targeting of immune checkpoints, first in melanoma and non-small cell lung cancer, followed by renal cell carcinoma (RCC).

Published June 25, 2017
CUA 2017: Statin Use and Time to Prostate Cancer Progression in Men Undergoing Active Surveillance
Toronto, Ontario (UroToday.com) At the prostate cancer poster session at the CUA 2017 annual meeting, Dr. Viranda Jayalath and colleagues presented their experience with statin use among men undergoing active surveillance (AS) for low-risk prostate cancer. Certainly, uptake rates of AS for appropriate men with low-risk prostate cancer are improving. Preclinical data support a protective effect of statins among patients with prostate cancer, however to date there is limited clinical data in the AS setting. The objective of this study was to provide a single center experience with statin use for men with prostate cancer on AS.

Published June 26, 2017
CUA 2017: The Prevalence and Biopsychosocial Predictors of Suicidality in Men with Prostate Cancer
Toronto, Ontario (UroToday.com) Dr. Dean Tripp and colleagues presented their study assessing prevalence and biopsychosocial predictors of suicidality in men with prostate cancer at the poster session on GU oncology at the CUA 2017 annual meeting. Prostate cancer is associated with higher depression levels than the general population, with upwards of 20% of men having clinical depression¹.

Published June 26, 2017
CUA 2017: The Role of Delayed Orchiectomy Following Chemotherapy in Metastatic Germ Cell Tumors, The Princess Margaret Cancer Centre Experience
Toronto, Ontario (UroToday.com) Rarely, testicular germ cell tumors (TGCT) present with high-burden metastases and chemotherapy is initiated prior to removal of the clinically diagnosed testicular primary. The standard of care has been orchiectomy post-chemotherapy, as the testicle is considered a sanctuary site at risk for residual disease. However, several small studies have observed complete response in the testicle.

Published June 26, 2017
CUA 2017: The Role of Testosterone Nadir Levels in Androgen Deprivation Therapy
Toronto, Ontario (UroToday.com) At the 5^th Annual CUA-CUOG Multidisciplinary session at the 2017 CUA annual meeting, Dr. Robert Siemens from Queen’s University and Dr. Abdenour Nabid from Centre Hospitalier de Universitaire de Sherbrooke debated the role of testosterone nadir levels among men undergoing androgen deprivation therapy (ADT).

Published June 25, 2017
CUA 2017: Update on Bladder Preservation in Muscle Invasive Disease
Toronto, Ontario (UroToday.com) Dr. Jason Efstathiou gave a talk on trimodal therapy (TMT) and bladder preservation in patients with muscle invasive bladder cancer (MIBC).

Published June 25, 2017
CUA 2017: What’s New in Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer?
Toronto, Ontario (UroToday.com) Dr. David Penson, the Paul V. Hamilton, M.D. and Virginia E. Howd Chair in Urologic Oncology and Professor of Urologic Surgery and Medicine at Vanderbilt University Medical Center, gave an excellent talk highlighting the status of patient-reported outcomes (PROs) following treatment for localized prostate cancer (PCa).

Published June 27, 2017

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Canadian Urological Association 2017

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