ADT Plus Chemo Ideal for Oligometastatic Prostate Cancer

“Oligometastatic prostate cancer is optimally treated with the combination of docetaxel and androgen deprivation therapy (ADT), according to a presentation at the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC).

“ ‘Oligometastatic disease is a transit state of prostate cancer and is an imaging technique-dependent definition,’ Bertrand Tombal MD, PhD, Chairman of the Division of Urology, Universite Catholique de Louvain, Brussels, Belgium, explained at the conference. ‘Nevertheless, it is unlikely that metastases targeted treatment will be enough to control the disease.’ “


Androgen Deprivation Therapy Associated with Increased Risk for Fatal Heart Attack

“Long term follow up indicates that men with comorbidity, predominately a prior heart attack, who received androgen deprivation therapy (ADT) died earlier, due to a fatal heart attack.

“Androgen deprivation therapy (ADT) and radiation therapy (RT) is known to prolong survival in men with unfavorable-risk prostate cancer and is considered a standard of care. However, in 2008, the FDA implemented a black box warning about ADT use for prostate cancer due to evidence that suggested an increased risk in non-fatal cardiovascular events. The association of ADT use and fatal heart attacks has remained uncertain until now. Specifically, long term follow up of a randomized clinical trial that compared ADT and radiation therapy (RT) to RT alone finds that men with significant comorbidity; most commonly prior heart attack, who received ADT died earlier, due to a fatal heart attack, compared to men who did not receive ADT.”


Men with AR-V7 Variant May Benefit from Taxanes for Advanced Prostate Cancer

“Men with advanced prostate cancer who have the androgen receptor splice variant-7 respond to chemotherapy equally as well as those who do not have the variant, according to findings from a small clinical trial.

“Further, taxane chemotherapy may be more effective than hormone therapy for men with the androgen receptor splice variant-7 (AR-V7).

” ‘The key finding from this study is that men with detectable AR-V7 in their circulating tumor cells may respond more favorably to chemotherapy (docetaxel or cabazitaxel [Jevtana, Sanofi]) compared to novel hormonal therapies (abiraterone and enzalutamide),’ Emmanuel S. Antonarakis, MBBCh, assistant professor of oncology and assistant professor of urology at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, told HemOnc Today. ‘This finding was quite a relief because AR-V7–positive prostate cancer can be very lethal, and now we have at least one class of drugs that may work for these patients.’ ”


Super Patient: John Wagontall Gets a Third Opinion and Survives Prostate Cancer


Update:  We are deeply saddened to report that John passed away on December 18, 2016. It is a privilege to continue to share his story and keep his memory alive.

In the summer of 2004, John Wagontall looked like the picture of health. The 46-year-old Canadian had been a firefighter for 20 years, was an avid cyclist, and also worked out alongside his wife as she trained for a bodybuilding competition. The only sign that something was wrong was a bit of blood in his urine.

His doctor told John he had a bladder infection, prescribed antibiotics, and sent him home. And all appeared to be well until a few months later, when his urine was bloody again. This time, his doctor sent him to a urologist to learn the underlying cause of his recurring bladder infection. Continue reading…


Statins at Start of Androgen Deprivation Therapy Increase Treatment Efficacy

“Statin use has been associated with improved outcome in prostate cancer. In a study reported in JAMA Oncology, Harshman et al found that statin use at the time of initiation of androgen-deprivation therapy was associated with prolonged time to progression during androgen-deprivation therapy in men with hormone-sensitive prostate cancer. The potential mechanism of this effect may be statin competitive inhibition of dehydroepiandrosterone sulfate (DHEAS) uptake.

“Androgen-deprivation therapy for biochemical or metastatic recurrence or new metastatic disease between January 1996 and November 2013 showed that 283 men (31%) were taking statins at the start of androgen-deprivation therapy. After a median follow-up of 5.8 years, 644 patients (70%) had disease progression while receiving androgen-deprivation therapy, with a median time to progression during androgen-deprivation therapy of 20.3 months. Median time to progression was 27.5 months (95% confidence interval [CI] = 21.1–37.7 months) in statin users vs 17.4 months (95% CI = 14.9–21.1 months) in nonusers (P < .001).”


ASCO 2015: Notable Reports on Prostate Cancer Treatment


This year’s American Society of Clinical Oncology (ASCO) annual meeting was short on any truly exciting developments in prostate cancer treatment. In stark contrast to other cancers, such as lung, breast, kidney, and melanoma, there were no reports of note on targeted and immunotherapies in prostate cancer. The two presentations summarized here offered new strategies in chemotherapy. Continue reading…


Addition of Chemotherapy Drugs to Androgen Suppression Improves Relapse-Free Survival in High-Risk Localized Prostate Cancer

“In a French phase III trial (GETUG 12) reported in The Lancet Oncology, Fizazi et al found that the addition of docetaxel and estramustine (Emcyt) to androgen-deprivation therapy (ADT) improved relapse-free survival among patients with high-risk localized prostate cancer…

“In the open-label trial, 413 patients with treatment-naive disease and at least one risk factor (stage T3-T4, Gleason score ≥ 8, prostate-specific antigen [PSA] concentration > 20 ng/mL, or pathologic node-positive disease) underwent staging pelvic lymph node dissection and were randomized to ADT (goserelin 10.8 mg every 3 months for 3 years) plus four cycles of docetaxel 70 mg/m2 on day 2 and estramustine 10 mg/kg/d on days 1 to 5 every 3 weeks (n = 207) or ADT alone (n = 206). Local treatment was administered at 3 months. The primary endpoint was relapse-free survival in the intention-to-treat population. Follow-up for other endpoints is ongoing.

“The chemotherapy and ADT alone groups were balanced for age (median 62 and 62 years), Gleason score (42% and 43% ≥ 8), pathologic node-positive status (29% in both), and serum PSA level (> 20 ng/mL in 59% in both).”


Adding ADT to RT Improved PFS After Radical Prostatectomy

“Assigning men in biological relapse after radical prostatectomy to combined salvage treatment with hormone therapy and radiation therapy significantly delayed disease progression compared with radiation therapy alone, according to the results of the GETUG-AFU 16 phase III trial (abstract 5006).

“ ‘Salvage radiotherapy combined with limited androgen deprivation therapy improves the 5-year progression-free survival rate compared to radiotherapy alone,’ said study presenter Christian Carrie, MD, of the department of radiation oncology at the University of Lyon-Centre Leon Berard. ‘There is no significant difference in overall survival, but the follow-up is still too short.’

“Between October 2006 and March 2010, 743 patients were enrolled in GETUG-AFU 16 and randomly assigned to radiation therapy alone (n = 374) or radiation plus hormone therapy with goserelin 10.8 mg for 6 months (n = 369). The primary endpoint of the trial was progression-free survival.”


Metabolic Syndrome up with ADT in Prostate Cancer

“For patients with prostate cancer treated with androgen deprivation therapy there are increases in components of metabolic syndrome and in the prevalence of full metabolic syndrome, according to a study published in the June issue of The Journal of Urology.

“Juan Morote, M.D., from Hospital Vall d’Hebron and Universitat Autónoma de Barcelona in Spain, and colleagues conducted an observational prospective study involving 539 prostate cancer patients scheduled to receive three-month depot luteinizing hormone-releasing hormone analogs for longer than 12 months. The authors examined the prevalence of full metabolic syndrome, assessed according to different definitions, and its components…

” ‘Counseling patients on the prevention, early detection, and treatment of specific metabolic alterations is recommended,’ the authors write.”