AUA: Prostate Cancer

“I think the real driving factor in all of this is that collecting smoking status and tobacco use is hard. It's difficult to get this information out. It requires a lot of time; it requires energy; it requires infrastructure in the data and the electronic medical record,” says Richard Matulewicz, MD, MS.

“We [found] that patients' overall [total] bowel symptoms scores were improved for those of the patients who received the active therapeutic treatment of [darolutamide] versus placebo,” says Neal D. Shore, MD, FACS.

Among the key findings was that CDK inhibition may overcome PARP resistance.

The latest findings for the PARP inhibitor in prostate cancer come from an analysis of the pivotal phase 3 PROfound trial presented during the 2021 AUA Annual Meeting.

“These studies highlight important research in better predicting the behavior and outcomes of prostate cancer in African American men compared to men of other racial and ethnic groups,” says Brian T. McNeil, MD, MBA, FACS.

In this interview, Shore discusses findings of a study of darolutamide (Nubeqa) presented at the 2021 AUA annual meeting and their significance for patients with nonmetastatic castration-resistant prostate cancer.

“This device is unique in that because it's done during real-time MRI imaging while the patient is in the MRI machine, [we] can monitor the temperatures achieved by our treatment in real time and make adjustments in real time. What that means is that we're able to determine areas that will be sensitive to the treatment, both cancer and areas from a quality-of-life perspective,” says Behfar Ehdaie, MD.

Magnetic resonance–guided focused ultrasound (MRgFUS) may be an effective alternative to radical therapy that improves outcomes for sexual function and urinary incontinence in men with intermediate-risk prostate cancer.

Patients with prostate cancer have a 20% to 30% incidence of depression and anxiety; however, practicing yoga could improve their quality of life.

The PET agent targeting prostate specific membrane antigen (PSMA) 18F-DCFPyL effectively detected recurrent lesions in prostate cancer patients with biochemical recurrence.

In comparison to the cohort of highly trained dogs, the eNose instrument was found to have sensitivity of 85.2% and specificity of 79.1%.

Adding the investigational agent masitinib to standard frontline docetaxel significantly reduced the risk of disease progression or death in men with metastatic castration-resistant prostate cancer and baseline alkaline phosphatase levels (ALP) of 250 IU/mL or less.

“This study highlights a deficiency in urologic oncology [randomized, controlled trials’] to assess smoking status and participants. Given smoking’s effects on treatments, survival, and quality of life, we believe this is an important area that deserves more attention,” said Calvin C. Zhao, MD

The combination is now being explored in a phase 3 trial.

The results come from a posthoc analysis of the pivotal phase 3 ARCHES trial.

“Darolutamide was associated with a reduction in locally invasive procedures and delayed time to deterioration in patient health-related quality of life with respect to urinary and bowel symptoms,” says Neal D. Shore, MD, FACS.

The prognostic factor analysis included patients who received either 177Lu-PSMA-617 or 177Lu-J591.

Men whose tumors are microsatellite instability–high or mismatch repair–deficient may have a greater response to immune checkpoint blockade compared with patients with high tumor mutational burden.

“In a real-world clinical setting, providers representing a broad range of practice styles, settings, education, and experience readily adopted IsoPSA to help risk stratify and generated about a 50% reduction in the number of prostate biopsies recommended,” said Eric A. Klein, MD.

A secondary analysis of the phase 3 HERO trial showed that relugolix failed to significantly improve castration resistance–free survival versus standard leuprolide n patients with advanced prostate cancer.

Now that pivotal trials have demonstrated a survival benefit with PSMA-targeted therapy in metastatic prostate cancer, researchers are hoping to deliver the exciting new approach earlier in the disease course.

The researchers did identify several other factors that were independent predictors of cancer-specific mortality in this patient population.

“Our real-world study showed that PSA response to apalutamide and continuous androgen deprivation therapy was robust and consistent with that in the SPARTAN study,” said Benjamin H. Lowentritt, MD.

An analysis of three phase 3 trials highlighted the "obesity paradox" in prostate cancer.