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Alberto Bossi, MD, of Institut Gustave Roussy, discusses phase III findings showing that combining prostate radiotherapy with systemic treatment did not improve overall survival in men with de novo metastatic castration-sensitive prostate cancer and low metastatic burden. However, best outcomes (radiographic progression–free-survival and overall survival) were observed in men receiving the standard of care plus abiraterone acetate plus prednisone with radiotherapy (Abstract LBA5000).
On May 31, the U.S. Food and Drug Administration (FDA) approved olaparib (Lynparza) in combination with abiraterone and prednisone (or prednisolone) for adult patients with deleterious or suspected deleterious BRCA-mutated metastatic castration-resistant prostate cancer, as determined by an...
On May 30, the U.S. Food and Drug Administration (FDA) approved the optimized, high-affinity radiohybrid prostate-specific membrane antigen (PSMA)-targeted positron-emission tomography (PET) imaging agent flotufolastat fluorine-18 (Posluma). Flotufolastat F-18 is indicated for PET imaging of...
In a systematic review and meta-analysis reported in JAMA Oncology, Baboudjian et al found no significant association between the use of 5α-reductase inhibitors (5-ARIs) and the risk of prostate cancer mortality. As stated by the investigators, “Recently, several large, high-quality analyses have...
In a modeling study reported in The Lancet Oncology, Huntley et al found that the extension of UK cancer screening programs for breast, prostate, and colorectal cancers to a polygenic risk score (PRS)-defined high-risk group of patients with cancer may improve cancer case detection and avoidance of ...
In an analysis of the phase III NRG Oncology/RTOG 0815 study reported in the Journal of Clinical Oncology, Benjamin Movsas, MD, and colleagues found few differences in patient-reported outcomes among patients with intermediate-risk prostate cancer receiving short-term total androgen suppression...
As reported in the Journal of Clinical Oncology by Daniel J. Krauss, MD, and colleagues, the phase III NRG Oncology/RTOG 0815 study showed no significant improvement in overall survival with the addition of short-term androgen-deprivation therapy (ADT) to dose-escalated radiotherapy in patients...
In an analysis of the final results of two STAMPEDE platform phase III trials reported in The Lancet Oncology, Gerhardt Attard, PhD, and colleagues found that the addition of enzalutamide to abiraterone plus prednisolone did not appear to improve survival outcomes and was associated with worse...
In a single-institution Dutch phase IIa feasibility trial reported in The Lancet Oncology, Stibbe et al evaluated the pharmacokinetics and safety of the prostate-specific membrane antigen (PSMA)-targeted fluorescent tracer OTL78 in patients undergoing robot-assisted radical prostatectomy for...
Researchers have estimated that about 14 of every 10,000 transgender women may be at risk of developing prostate cancer, according to a new study published by Nik-Ahd et al in JAMA. Background Transgender women keep their prostates even after gender-affirming surgery, but the extent to which they...
In a survey study reported in JAMA Network Open, Kalavacherla et al found a high prevalence of prostate-specific antigen (PSA) screening for prostate cancer among older patients than recommended for such screening in U.S. Preventive Services Task Force guidelines. The investigators stated: “The...
Investigators have found that vitamin D deficiencies may contribute to more aggressive prostate cancer in Black patients at a younger age compared with White patients, according to a new study published by Siddappa et al in Cancer Research Communications. The new findings could pave the way for...
This is Part 3 of Novel Hormonal Therapies for Prostate Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Alicia K. Morgans, Neeraj Agarwal, and David VanderWeele discuss the management of locally advanced high-risk prostate cancer. The patient is a 57-year-old man who presents to his urology with increasing nocturia symptoms. His PSA is 12.4 ng/mL, and an MRI shows a PI-RADS 5 lesion in the right apex concerning for prostate cancer. Biopsy confirms Gleason 4+4 prostate adenocarcinoma, and several retroperitoneal lymph node metastases are revealed on PSMA PET scan. He is found to have a germline BRCA2 mutation, and his team is considering treatment with radiation plus androgen-deprivation therapy, abiraterone acetate, and prednisone per STAMPEDE. The faculty discuss the optimal treatment workup for patients with locally advanced high-risk prostate cancer, the importance of germline genetic testing, the benefits of intensified treatment with ADT plus abiraterone acetate, and the role of gonadotropin-releasing hormone antagonists in improving testosterone recovery and maintaining quality of life.
This is Part 2 of Novel Hormonal Therapies for Prostate Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Alicia K. Morgans, Neeraj Agarwal, and David VanderWeele discuss the management of de novo metastatic hormone-sensitive prostate cancer. The patient is a 74-year-old man who presents to his primary care physician due to worsening back pain. An x-ray reveals an area in T12 concerning for metastatic cancer, and his PSA is found to be 23 ng/mL. He completes staging workup, which demonstrates multifocal bone metastases and metastatic disease in the liver, and he is started on androgen-deprivation therapy (ADT) as initial treatment for his metastatic disease. The faculty discuss ways to reduce the risk of complications from ADT for patients with metastatic hormone-sensitive prostate cancer, the role of intensified treatment with couplet or triplet ADT combinations, and the importance of co-management with primary care or cardiology.
This is Part 1 of Novel Hormonal Therapies for Prostate Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Alicia K. Morgans, Neeraj Agarwal, and David VanderWeele discuss biochemical recurrence in prostate cancer. The patient is a 64-year-old man with a history of localized prostate cancer treated with radical prostatectomy, Gleason 4+4, and positive extracapsular extension and positive right apical margin. Due to high-risk features, he underwent adjuvant radiation therapy. Although his PSA was initially undetectable, it started to increase after 2 years, reaching 12.9 ng/mL. He was negative for evidence of recurrent disease on bone scan, and his testosterone level was normal. The faculty discuss the challenge of timing treatment in the setting of biochemical recurrence. They also highlight the crucial importance of addressing comorbidities, such as metabolic syndrome, through the management of reversible cardiovascular risk factors to better prepare patients starting androgen-deprivation therapy.
In a study reported in the Journal of Clinical Oncology, Susan Halabi, PhD, and colleagues validated an overall survival prognostic model for docetaxel-naive patients with metastatic castration-resistant prostate cancer. As noted by the investigators, “We have previously developed and externally...
As reported in JAMA Oncology by Tang et al, the phase II EXTEND (External Beam Radiation to Eliminate Nominal Metastatic Disease) trial has shown that the addition of metastasis-directed therapy to intermittent hormone therapy improved progression-free survival in patients with oligometastatic...
As reported in the Journal of Clinical Oncology by Michael J. Morris, MD, and colleagues, the phase III Alliance A031201 trial has shown no significant improvement in overall survival with the addition of abiraterone acetate and prednisone to enzalutamide as first-line treatment for metastatic...
The addition of the PARP (poly [ADP-ribose] polymerase) inhibitor olaparib to standard-of-care abiraterone in the first-line setting of metastatic castration-resistant prostate cancer achieved longer progression-free survival vs abiraterone alone, as demonstrated in the final results of the phase...
As reported in The Lancet Oncology by Christopher J. Sweeney, MBBS, and colleagues, the primary overall survival analysis of the phase III ENZAMET trial showed a significant benefit with enzalutamide plus testosterone suppression vs standard nonsteroidal antiandrogen treatment plus testosterone...
Since 2010, investigators have discovered that the number of patients with prostate cancer in the United States who are choosing active surveillance over surgery or radiation therapy may be rapidly increasing, according to a new study published by Al Awamlh et al in JAMA Internal Medicine....
As reported in the Journal of Clinical Oncology by Kim N. Chi, MD, and colleagues, the phase III MAGNITUDE trial showed that the addition of niraparib to abiraterone acetate and prednisone improved radiographic progression–free survival as first-line treatment in patients with metastatic...
In a systematic review and meta-analysis reported in JAMA Oncology, Riaz et al found that first-line triplet therapy in metastatic castration-sensitive prostate cancer did not appear to offer an overall survival advantage vs androgen pathway inhibitor doublet therapy. As stated by the...
As reported in The New England Journal of Medicine by Karim Fizazi, MD, PhD, of Gustave Roussy Institute, Paris-Saclay University, and colleagues, the phase III TRITON3 trial has shown significantly improved progression-free survival with rucaparib vs physician-selected single-agent therapy in the...
Formal discussant of the FORMULA-509 trial, Tyler Seibert, MD, PhD, of the University of California San Diego, commented: “The important take-away of these results is who benefited from the intensification arm. The overall cohort with a PSA [prostate-specific antigen] level up to 0.5 ng/mL did not, ...
The addition of abiraterone acetate and apalutamide to standard of care gonadotropin-releasing hormone (GnRH) agonist for 6 months and radiation therapy failed to improve progression-free survival and metastasis-free survival after prostatectomy compared to bicalutamide plus a GnRH agonist and...
The formal discussant of the TALAPRO-2 trial, Elena Castro, MD, PhD, took issue with the conclusion of Dr. Neeraj Agarwal and colleagues that these results support the use of talazoparib plus enzalutamide as a first-line treatment of patients with metastatic castration-resistant prostate cancer,...
The addition of the poly (ADP ribose) polymerase (PARP) inhibitor talazoparib to the androgen receptor signaling inhibitor enzalutamide achieved a statistically significant and clinically meaningful improvement in radiographic progression–free survival compared with placebo plus enzalutamide as...
Alex K. Bryant, MD, of the University of Michigan, examined Veterans Administration (VA) facilities in which lower prostate-specific antigen (PSA) screening rates were associated with a subsequent increased incidence of metastatic prostate cancer, particularly among men aged 70 and older. From 2008 to 2019, PSA screening rates have declined in the national VA system, data that may be used to inform shared decision-making about the potential benefits of screening for those who wish to reduce their risk of advanced prostate cancer. (Abstract 298).
Rahul Aggarwal, MD, of the University of California, San Francisco, discusses recent data from the PRESTO study, which showed that apalutamide plus androgen-deprivation therapy (ADT) for 12 months significantly prolonged PSA progression-free survival compared with ADT alone in patients with biochemically recurrent prostate cancer. These results provide support for the intensification of ADT in this setting. (Abstract LBA63).
The addition of the androgen receptor inhibitor darolutamide to androgen-deprivation therapy and docetaxel reduced the risk of death by 30% compared with androgen-deprivation therapy plus docetaxel in patients with metastatic hormone-sensitive prostate cancer, according to a post hoc analysis of...
As reported in The New England Journal of Medicine by Freddie C. Hamdy, FRCS(Urol), FMedSci, and colleagues, 15-year follow-up of the UK phase III ProtecT trial has shown no significant difference in prostate cancer mortality with active monitoring, surgery, or radiotherapy for patients with...
Racial minorities in the United States may be less likely to receive treatment for prostate cancer and, overall, have worse survival outcomes compared with individuals who are White, according to a new study published by Nguyen et al in Urologic Oncology. Typically, patient-level and...
Researchers have revealed how the lack of genomic research for individuals with African ancestry—particularly those from the Sub-Saharan region—may be hampering efforts to reduce disparities for patients with prostate cancer, according to a new study published by Gheybi et al in JNCCN–Journal of...
Patients with prostate cancer who undergo active monitoring may experience the same 15-year survival rates as those who undergo radiotherapy or surgery, according to new findings published by Hamdy et al in The New England Journal of Medicine and simultaneously presented at the 2023 European...
Researchers have found that a novel technique used during prostate cancer surgery may reduce the risk of postoperative lymphocele by 50%, according to new findings presented by Neuberger et al at the 2023 European Association of Urology Annual Congress (Abstract A0656). The technique—involving the...
A common method of detecting prostate cancer may not be accurate enough to serve as a reliable screening tool by itself, researchers have warned. The digital rectal exam (DRE), in which health-care providers check the prostate gland with a finger for unusual swelling or lumps in the rectum, is...
A trial conducted at the University Hospital Bonn, Germany, has been testing the benefit of PSMA-PET/CT (prostate-specific membrane antigen–positron-emission tomography/computed tomography) to help target where to take biopsy samples, potentially improving the diagnosis of prostate cancer by giving ...
In an analysis reported in JAMA Network Open, Cooperberg et al found that the use of active surveillance (AS) for low-risk prostate cancer in U.S. patients has more than doubled in recent years but remains suboptimal and exhibits wide variations at the urology practice and individual practitioner...
“There are misconceptions about prostate cancer screening,” Karen Knudsen, MBA, PhD, said in an interview with The ASCO Post about newly published cancer statistics, including an increased incidence of prostate cancer, particularly advanced-stage disease. Dr. Knudsen is Chief Executive Officer of...
Overall cancer mortality rates have decreased 33% since 1991, and cervical cancer incidence decreased 65% from 2012 through 2019, according to the latest statistics reported by the American Cancer Society (ACS).1 Amid this good news, however, was a troubling 3% annual increase in prostate cancer...
The poly (ADP-ribose) polymerase (PARP) inhibitor rucaparib prolonged imaging-based progression-free survival vs physician’s choice of therapy in patients with metastatic castration-resistant prostate cancer whose tumors harbored BRCA or ATM alterations. These results of the phase III TRITON3 study ...
In a study reported in the Journal of Clinical Oncology, Derya Tilki, MD, and colleagues identified a prostate-specific antigen (PSA) level cutpoint, above which initiation of salvage radiation therapy after radical prostatectomy was associated with an increased risk of all-cause mortality in...
Researchers have identified nine new genetic variants that may increase the risk of developing prostate cancer in Black patients, according to a novel study published by Chen et al in European Urology. The investigators also found that genetic differences may help determine which patients are most...
Sumanta K. Pal, MD, introduces his City of Hope colleagues, Hedyeh Ebrahimi, MD, MPH, who discusses the prevalence of dietary modification and supplement use in patients with metastatic renal cell carcinoma, and Daniela Castro, MSc, who discusses expanding eligibility criteria in kidney, prostate, and urothelial cancer trials to more accurately reflect the real-world population and reducing exclusion criteria. (Abstract 662, 612, 34, 453)
In an analysis from the phase III ARASENS trial reported in the Journal of Clinical Oncology, Maha Hussain, MD, FACP, FASCO, and colleagues found that the addition of darolutamide to androgen-deprivation therapy (ADT) and docetaxel significantly improved overall survival in subgroups of patients...
Scott T. Tagawa, MD, of Weill Cornell Medicine, NewYork-Presbyterian Hospital, discusses study results showing that, the anti-PSMA (prostate-specific membrane antigen) monoclonal antibody J591 with ketoconazole and hydrocortisone, when radiolabeled with lutetium-177, leads to improved 18-month metastasis-free survival vs radiolabeling with indium-111 in patients with nonmetastatic (M0) castration-resistant prostate cancer. This supports the development of anti-PSMA radioimmunotherapy, although the optimal radionuclide and targeting agent are unknown. (Abstract LBA21).
Alan H. Bryce, MD, of the Mayo Clinic, discusses the final results of the primary endpoint of rPFS and interim results on overall survival among patients with chemotherapy-naive metastatic castration-resistant prostate cancer. The data showed that rucaparib improved radiographic progression-free survival compared with either docetaxel or abiraterone and enzalutamide in disease with BRCA1/2 alterations. (Abstract 18).
Daniel P. Petrylak, MD, of the Yale Cancer Center, discusses phase III findings from the KEYNOTE-921 study, which was designed to assess the combination of pembrolizumab and docetaxel in the treatment of patients with metastatic castration-resistant prostate cancer. They had not received chemotherapy, but their disease progressed on the next-generation hormonal agent, or they could not tolerate the agent. (Abstract 19).
Paul L. Nguyen, MD, of Dana-Farber Cancer Institute and Harvard Medical School, discusses results from the FORMULA-509 study, which compared postoperative salvage radiotherapy and 6 months of GnRH agonist with or without abiraterone acetate/prednisone (AAP) and apalutamide, after radical prostatectomy. The study suggested that adding AAP and apalutamide to salvage radiotherapy, plus 6 months of androgen-deprivation therapy, may improve outcomes, particularly in the subgroup of patients with a prostate-specific antigen level higher than 0.5 ng/mL. (Abstract 303).