Sumanta K. Pal, MD, of City of Hope, discusses the ways in which the composition of the gut microbiome may impact the outcome of immune therapy. Methods such as fecal microbiome transplant hold promise as a means of augmenting the effect of treatment and, according to Dr. Pal, potentially resensitizing patients to therapies.
Stephen J. Freedland, MD, of Cedars-Sinai Medical Center, discusses the incidence of prostate cancer in transgender women. Although the rates of disease appear lower than in cisgender men, Dr. Freedland notes the risk is not as limited as case reports may suggest. He also discusses interpreting PSA values and rises in PSA for patients on gender-affirming hormone therapies.
Rana R. McKay, MD, of the University of California, San Diego, discusses phase II findings from the Neptune study of neoadjuvant olaparib plus androgen-deprivation therapy followed by radical prostatectomy in patients with intermediate-risk or high-risk prostate cancer marked by germline or somatic BRCA1/2 gene alterations. This population generally has inferior outcomes, and PARP inhibition has shown efficacy in these patients.
Bishoy M. Faltas, MD, of Weill Cornell Medicine, discusses the biology of upper tract urothelial carcinoma and how it affects treatment, noting that most of these tumors are luminal papillary with a T-cell–depleted immune contexture driven by FGFR3 activation. Phase III trials have confirmed the predicted differential effects of FGFR3 inhibitors in this type of tumor compared with bladder cancer based on biological differences.
Samson W. Fine, MD, of Memorial Sloan Kettering Cancer Center, discusses the evolving spectrum of atypical intraductal proliferations in the prostate, from high-grade prostatic intraepithelial neoplasia to intraductal carcinoma. He describes several clinical challenges, including: assessment and terminology of cribriform architecture; pathologic reporting in various biopsy scenarios; and association with genetic findings.
William J. Catalona, MD, of Northwestern University Feinberg School of Medicine, reviews the genetic landscape in prostate cancer, including BRCA2 and ATM, two important mutations for aggressive disease; the clinical implications of germline testing such as guiding screening and disease management, as well as identifying patients at high risk for aggressive prostate cancer; and the role of somatic testing, especially in advanced disease.
