Prostate Cancer: Studies suggest strategies for marker, mpMRI use

Kirsten Lynn Greene, MD, MSFindings from the ProtecT trial, the European Randomized study of Screening for Prostate Cancer, and PIVOT were among the other noteworthy studies in prostate cancer presented at the AUA annual meeting. The take-home messages were presented by Kirsten Lynn Greene, MD, MS, of the University of California, San Francisco.

Studies of blood and urine markers and multiparametric magnetic resonance imaging (mpMRI) for risk stratification are suggesting strategies for sequencing these tools and using their results to guide biopsy decisions.

Prostate Prognostic Grade Groups are predictive of oncologic endpoints after radical prostatectomy.

Studies investigating the impact of U.S. Preventive Services Task Force prostate cancer screening recommendations show an increased risk in high-grade disease, a decrease in diagnosis of low-risk disease, and about a 3% increase in metastasis at presentation.

Results from large trials investigating MRI fusion biopsy show no difference between visual estimation (cognitive fusion) and fusion software-based technology; mpMRI fusion performs better at overall detection versus transrectal ultrasound biopsy alone, but the two techniques are equal for detecting high-risk disease. PIRADS ≥3 is significantly associated with detection of cancer on biopsy.

Both transperineal and transrectal biopsy approaches can be done with mpMRI cognitive fusion or fusion software.

Continue to the next page for more take-home messages.

• Transperineal biopsy is associated with a lower infection rate than transrectal biopsy, but the transperineal technique requires anesthesia and affects costs.

• After 15 years of follow-up, the ProtecT trial found no differences in rates of metastases or prostate cancer-specific death among men with clinically localized prostate cancer randomly assigned to active surveillance, radical prostatectomy, or radiotherapy.

• The European Randomized study of Screening for Prostate Cancer showed no difference in overall survival after 15 years of follow-up when comparing low- and intermediate-risk prostate cancer patients receiving active treatment (surgery or radiotherapy) versus active monitoring.

• PIVOT found no decrease in prostate cancer-specific or all-cause mortality at 20 years comparing surgery and observation.

• The technique used for radical prostatectomy (open versus robotic) is not as important as surgeon experience and expertise.

• Crowdsourcing can identify surgeon expertise for performing robot-assisted radical prostatectomy.

Next: Open, robotic RP approaches compared

• Open and robotic approaches for radical prostatectomy were equivalent in outcomes and quality of life measures and appeared to be better than a pure laparoscopic approach.

• Fluorescent antibody labeling to detect cancer in lymph nodes and the Retzius-sparing approach are promising techniques.

• An 11-mm margin is ideal for focal therapy for prostate cancer.

• A study of men with prostate cancer found no association between exome sequence and race, but found significant inter-institutional variations that may explain racial disparities seen in other trials.

• Primary and metastatic prostate cancer are strongly associated with BRCA2 mutations.

• Patient-derived samples could be successfully cultured in vitro and may facilitate a precision-medicine approach to the management of men with biochemical recurrence of prostate cancer.

• Analyses of data from the AUA Quality Registry show that approximately 60% of men with low-risk prostate cancer are being treated.

• The AUA released new localized prostate cancer guidelines that use grade groups for risk stratification and for the first time include a recommendation to consider referral for genetic counseling for patients and their families with high-risk localized disease and a strong family history of specific cancers or with a BRCA2 mutation.

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