Best of AUA 2013: Prostate Cancer

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Presented by Jay D. Raman, MD

Penn State Milton S. Hershey Medical Center, Hershey, PA

• Studies of active surveillance show persistent underutilization in the U.S. over the past 10 years (<10%), whereas in a Swedish cohort, more than 50% of patients with low-risk prostate cancer were successfully managed on an active surveillance regimen.

• An analysis of long-term (10-year median) outcomes of active surveillance regimens found a 54% rate of disease progression and a prostate cancer mortality risk of <1%.

• A large cohort study found metabolic syndrome was associated with increased risks of finding prostate cancer (1.44-fold) and high-grade prostate cancer (1.58-fold) at needle biopsy.

• Analysis of data from almost 13 years of follow-up for about 42,000 men in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer found that PSA screening significantly reduced the risk of mortality by 32% in men aged 55-69 years, but had no such benefit for older men.

• Evidence from several studies indicates the U.S. Preventive Services Task Force grade D recommendation on PSA screening has already contributed to a decline in screened patients.

• Two groups reported an increased rate of infectious complications following repeat prostate needle biopsy, with the risk increasing 15% to 30% per biopsy.

• In a prospective study, International Index of Erectile Function scores were depressed for 3 months after prostate needle biopsy.

• Magnetic resonance imaging/transrectal ultrasonography of the prostate fusion technology may improve the diagnostic accuracy of prostate needle biopsy for detecting cancer and high-grade cancers.

• Several groups found genomic classifiers to be accurate for risk-stratifying patients with adverse pathology at radical prostatectomy.

• A combination of epigenetic field defect DNA methylation markers (EVXl and FGF1) showed promise for detecting prostate cancer in patients with a histologically negative biopsy.

• Research from several groups support the utility of preoperative MRI as a surgical planning aid for radical prostatectomy. A nomogram combining MRI and biopsy data was created to predict extraprostatic extension.

• Substaging of pT3a prostate cancer (focal vs. established disease) has prognostic significance based on analysis of 10-year biochemical recurrence-free survival rates.

• In a prospective study including 5,500 patients, laparoscopic radical prostatectomy was associated with a higher rate of complications than a robot-assisted procedure (24% vs. 15%), as well as a higher rate of Clavien III/IV complications.

• A study including almost 10,000 patients found that minimally invasive radical prostatectomy was associated with an increased risk of hernia compared with open surgery; the risk of incisional hernias was especially increased (3.2-fold).

• A multicenter study of more than 7,300 men with clinically localized prostate cancer who underwent radical prostatectomy and pelvic lymph node dissection (LND) found higher LN yield did not impact the risk of biochemical recurrence in men negative for LN metastasis.

• In a study of men with intermediate- and high-risk prostate cancer, robotic extended LND was associated with a greater LN yield and higher detection of LN metastases than standard LND, but there was no difference between groups in 3-year biochemical recurrence-free survival.

• Abiraterone acetate (ZYTIGA) delayed time to disease progression in a study of 1,088 patients with metastatic castrate-resistant prostate cancer who were chemotherapy naïve.

• Radium Ra 223 dichloride (Xofigo) treatment in men with castrate-resistant prostate cancer (CRPC) and bony metastases reduced pain and opioid use and improved quality of life.

• Analyses using a SEER-Medicare database found utilization of chemotherapy for patients with metastatic CRPC increased from 12% in 1992 to 31% in 2007; over 50% of patients required hospital readmission due to therapy-related morbidity.

• Adjuvant hormone therapy in men with pT3N+M0 prostate cancer who underwent prostatectomy improved recurrence-free survival versus radiation alone or observation, but did not impact cancer-specific or overall survival.

• Men with a pre-salvage radiotherapy (SRT) PSA level ≤1.0 ng/mL had a lower salvage radiotherapy failure rate than their counterparts with a higher pre-SRT PSA, but further substratification of PSA levels below 1.0 ng/mL had no prognostic significance.

• Men undergoing prostatectomy after consuming a low-fat fish oil diet for 4 to 6 weeks had significant reductions in serum proinflammatory eicosanoid levels and prostate cancer tissue cell cycle progression score.

• Studies in prostate cancer mouse models provide insight on the possible molecular mechanism by which a high-fat diet induces prostate cancer progression and show that a fish oil diet is particularly beneficial for slowing tumor growth and improving animal survival.UT

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