New Marker May Identify Men Who Require More Aggressive Prostate Cancer Treatment

Excerpt:

“A prostate-specific antigen (PSA) nadir (the lowest level a PSA drops following treatment) greater than 0.5 ng/mL following radiation and androgen deprivation therapy seems to identify men prior to PSA failure who are at high-risk for death, and would thus require more aggressive treatment for their prostate cancer, according to the results of a recent study in JAMA Oncology.

“The study looked at data from a randomized trial of 206 men treated with either radiation or radiation plus 6 months of hormonal therapy and compared early markers of prostate cancer death to identify men at risk of dying early.”

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Younger NSCLC Patients More Likely to Harbor Targetable Genomic Alterations

“Patients diagnosed with non–small-cell lung cancer (NSCLC) at a younger age are far more likely to harbor a targetable genomic alteration than older patients, according to a new study. Poor survival in these younger patients suggests more aggressive disease.

“Unlike with other malignancies such as breast or colon cancer, ‘NSCLC occurring in young patients is a poorly studied clinical entity,’ wrote study authors led by Geoffrey R. Oxnard, MD, of the Dana-Farber Cancer Institute in Boston. ‘The median age at diagnosis of NSCLC is 70 years and less than 5% of patients are younger than 50 years at diagnosis.’ The study authors hypothesized that young age at diagnosis might define a population with targetable genomic alterations.

“They analyzed genetic data and outcomes for a cohort of 2,237 patients with NSCLC who were genotyped at Dana-Farber between 2002 and 2014. Of these, 81 patients (4%) were under the age of 40 at diagnosis; 252 patients (11%) were between 40 and 49, 597 (27%) were aged 50 to 59 years, 697 (31%) were between 60 and 69, and 610 (27%) were 70 years or older. Results of the study were published online ahead of print in JAMA Oncology.”


Study Shows Abiraterone Acetate Is Useful Even in Most Aggressive Prostate Cancers

“In 1048 prostate cancer patients previously treated with docetaxel and 996 metastatic, castration-resistant patients, treatment with the androgen-lowering drug abiraterone acetate (Zytiga) led to longer overall disease control, even when a very high Gleason score indicated especially aggressive cancer.Results recently published in the Annals of Oncology show that for patients with Gleason score greater than 8, post-docetaxel treatment with abiraterone extended progression-free survival from 5.5 months to 6.4 months, and pre-chemotherapy abiraterone treatment extended progression-free survival from 8.2 months to 16.5 months.”


For Prostate Cancer Patients, Risk-Specific Therapies Now More the Norm

“After decades of overtreatment for low-risk prostate cancer and inadequate management of its more aggressive forms, patients are now more likely to receive medical care matched to level of risk, according to a study by researchers at UC San Francisco.

“In the first study to document updated treatment trends, researchers found that from 2010 to 2013, 40 percent of men with low-risk prostate cancer opted for active surveillance, in which the disease is monitored closely with blood tests, imaging studies and biopsies. Treatment is deferred unless these tests show evidence of progression.

“In contrast, less than 10 percent overall of low-risk prostate cancer patients pursued active surveillance in the years from 1990 through 2009. Rates for radiation therapy for this low-risk group have also slipped since 1995, the authors noted in the study published in JAMA earlier this month.”


Genomic Fingerprint May Predict Aggressive Prostate Cancer in African Americans

“African American men are more likely to develop prostate cancer than European American men, and are also more than twice as likely to die from it. Although there are many reasons that contribute to this health disparity, new research shows that African American men may have a distinctly different type of prostate cancer than European American men, according to new genomic fingerprinting results.

“ ‘This study, this line of research, is about finding better and more appropriate therapies for African American men,’ says corresponding author of the study, Kosj Yamoah, M.D., Ph.D., Chief Resident in the Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University. ‘The first step is to figure out how prostate cancer is different and more aggressive at the genomic level.’ In research published in the Journal of Clinical Oncology on July 20th, Dr. Yamoah and colleagues identify a subset of genes known as biomarkers that define a genomic subtype of prostate cancer that is more common in African American men, and which signals a more aggressive disease.”


Researcher Discovers Metabolite of Prostate Cancer Drug More Effective at Treating Aggressive Tumors

“Cleveland Clinic researchers have discovered for the first time that a metabolite of an FDA-approved drug for metastatic prostate cancer, abiraterone (Abi), has more anti-cancer properties than its precursor. The research will be published online June 1st in Nature.

“Cleveland Clinic researcher Nima Sharifi, M.D., found that abiraterone, a steroid inhibitor, is converted into the more physiologically active D4A (Δ4-abiraterone) in both patients and animal models with prostate cancer who take the drug. Furthermore, they found that D4A is more effective than abiraterone at killing aggressive prostate cancer cells, suggesting that some patients may benefit from direct treatment with D4A.

“Prostate cancer cells are fueled by androgens (male hormones). When prostate cancer spreads, androgen deprivation therapy (‘medical castration’) is used to cut off the tumor’s energy supply. However, aggressive, metastatic tumors can become resistant to this type of therapy. In a landmark 2013 publication in Cell, Dr. Sharifi described a genetic mutation that enables prostate cancer cells to produce their own hormones for fuel, making them resistant to traditional hormone deprivation therapies.”


Prostate Cancer: Biopsy Strategies Assessed (CME/CE)

“Biopsy guided by a fusion of magnetic resonance imaging (MRI) and ultrasound (US) improves detection of aggressive prostate cancer compared with mapping or targeting alone and systematic 12-core biopsy.

“Among the first 1,000 men to undergo MRI-fusion biopsy of the prostate at the University of California Los Angeles (UCLA), the presence of a grade 5 region of interest on fusion biopsy was the strongest predictor of high-grade prostate cancer. ‘Patients who had a grade 5 lesion compared to those who had no suspicious lesions had 23 times the odds of having Gleason ≥7 cancer,’ said Christopher Filson, MD, at UCLA.

“In a separate series of men presenting for prostate biopsy at New York University (NYU), MRI-targeted biopsy increased the detection of Gleason ≥7 prostate cancer by 23% compared with systematic biopsy while decreasing the detection of Gleason 6 disease by 26%.

“These data were presented during a press briefing at the annual meeting of the American Urological Association.


New Screening Method for Prostate Cancer Recurrence

“The American Cancer Society estimated that 220,800 new cases of prostate cancer will be diagnosed in the United States in 2015. Approximately 27,540 men will die of the disease, accounting for 5 percent of all cancer deaths.

“A common treatment for prostate cancer is a , in which all or part of the is removed. Recent studies have shown that this procedure is often over-prescribed. As early as 2010, the New England Journal of Medicine reported that such a procedure extended the lives of just 1 patient in 48. Side effects from the surgery, including urinary incontinence and impotence, can affect the quality of life of the patient.

” ‘For every 20 surgery procedures to take out the prostate, it is estimated that only one life is saved,’ said Gabriel Popescu, director of the Quantitative Light Imaging Laboratory (QLI) and senior author on the study. ‘For the other 19 people, they would be better left alone, because with removing the prostate, the quality of life goes down dramatically. So if you had a tool that could tell which patient will actually be more likely to have a bad outcome, then you could more aggressively treat that case.’ ”


Study Confirms 4Kscore Accurately Predicts High-Grade Prostate Cancer

“A blood test called the 4Kscore results in accurate detection of high-grade prostate cancer. In a prospective study of 1,012 men, this test more accurately predicted the presence of high-grade disease compared with a commonly used risk calculator in men with elevated prostate-specific antigen (PSA) levels.

“The results from this study (Abstract 1) were presented by Sanoj Punnen, MD, a urologic oncologist at the University of Miami in Florida at the 2015 Genitourinary Cancers Symposium.

“In this study, men scheduled for a prostate biopsy were enrolled, regardless of their PSA level or clinical findings, at 26 centers across the United States between October 2013 and April 2014. A total of 231 (23%) high-grade prostate cancers were detected. The 4Kscore showed a higher net benefit in comparison with the PCPTRC at all threshold possibilities for high-grade disease used in clinical practice.

“The test is able to detect aggressive prostate cancer with high accuracy, Punnen told Cancer Network. ‘The area under the curve is better than any other biomarker in this area. There was a significant reduction in biopsies that could be attained if we used this test,’ he said.

“The goal of the 4Kscore is to reduce unnecessary biopsies, as the vast majority of biopsies show either no cancer or a low-grade tumor. These biopsies result in high medical costs, as well as morbidities for the patient.”