Active Surveillance of Prostate Cancer Associated with Favorable Outcomes in Younger Men

Excerpt:

“Younger age was associated with lower risks for disease progression and biopsy-based Gleason score upgrades during active surveillance of low- or intermediate-risk prostate cancer, according to a study published in Journal of Clinical Oncology.

” ‘The results of this study indicate that younger patients with low-risk prostate cancer experienced favorable outcomes when managed with active surveillance at nearly 5-year median follow-up,’ Michael Leapman, MD, assistant professor in the department of urology at Yale University School of Medicine, told HemOnc Today. ‘Younger patients have conventionally been counseled to receive definitive treatment, even in the setting of low-risk disease. This study is impactful as it may expand the use of surveillance, potentially limiting the harms of overtreatment for patients with screening-detected low-grade tumors.’ ”

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No Benefit Observed From Combined Irradiation in Intermediate-Risk Prostate Cancer

Excerpt:

“The addition of external-beam radiotherapy (EBRT) to interstitial brachytherapy failed to reduce prostate cancer progression compared to brachytherapy alone in men with intermediate-risk disease, interim data from a randomized trial showed.

“The 5-year freedom from progression was 84.5% with combined-modality radiotherapy and 85.6% with prostate brachytherapy alone. The odds ratio (OR) for brachytherapy versus combined radiotherapy was 1.09 after a median follow-up of 7.7 years, a difference that did not achieve statistical significance for efficacy or meet the prespecified statistical value to stop the trial for futility.”

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Intermediate Risk Prostate Cancer May Be Well Controlled with Brachytherapy Alone

Excerpt:

“For men with intermediate risk prostate cancer, radiation treatment with brachytherapy alone can result in similar cancer control with fewer long-term side effects, when compared to more aggressive treatment that combines brachytherapy with external beam therapy (EBT), according to research presented today at the 58th Annual Meeting the American Society for Radiation Oncology (ASTRO).”

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SBRT Offers Prostate Cancer Patients High Cancer Control and Low Toxicity in Fewer Treatments

Excerpt:

“High dose stereotactic body radiotherapy (SBRT) for men newly-diagnosed with low- or intermediate-risk prostate cancer results in shorter treatment times, low severe toxicity and excellent cancer control rates, according to research presented today at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO). The study is the first large, multi-institutional study of SBRT in prostate cancer with long-term follow-up.”

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HIFU Study Makes Case for Role in Prostate Cancer Subgroup

Excerpt:

“Treatment with unilateral high-intensity focused ultrasound (HIFU) led to eradication of all clinically significant cancer in the treated lobe for 94% of patients with early prostate cancer, according to findings presented at the 2016 American Urological Association meeting.

“HIFU resulted in complete ablation of all cancer in the treated lobe for 87 of 101 cases (86%) and absence of any cancer in the whole prostate (including untreated areas) in 68 cases (67%). After 2 years of follow-up, 89% of the patients remained alive without radical therapy (95% CI, 81.0-93.8). Almost 100% of patients had resolution of urinary incontinence at 12 months, and almost 80% of the men had preserved erectile function.”

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'Very Big Deal': NCCN Okays Watching More Prostate Cancer

“In a groundbreaking recommendation, the National Comprehensive Cancer Network (NCCN) has broadened the scope of prostate cancers that qualify for active surveillance in the United States to include men with ‘favorable’ intermediate-risk disease.

” ‘I think this is a very big deal,’ said James Mohler, MD, a urologist from Roswell Park Cancer Institute in Buffalo, New York, who is chair of the NCCN prostate cancer guideline panel.

“The recommendations of the NCCN are often followed by clinicians, insurers, and institutions, and the NCCN is the first major organization in the United States to make this recommendation.”


Increased Risk of Aggressive Prostate Cancer in Testicular Cancer Survivors

“Men with a history of testicular cancer had a nearly fivefold higher risk for later  developing prostate cancer than did men without a history of testicular cancer, including an increased risk for developing intermediate- and high-risk disease, according to the results of a case control study.

“ ‘Based on these findings, men with a history of testicular cancer should consider a discussion regarding the risks and benefits of prostate cancer screening with their physicians,’ said Mohummad Minhaj Siddiqui, MD, an assistant professor of surgery at the University of Maryland School of Medicine and director of urologic robotic surgery at the University of Maryland Marlene and Stewart Greenebaum Cancer Center.

“Siddiqui presented the results of the study (Abstract 177) at a press conference held in advance of the 2015 ASCO Genitourinary Cancers Symposium.

“Previous research has demonstrated that there is an increased rate of prostate cancer in men with a history of testicular cancer. Siddiqui and colleagues sought to determine if men with a history of testicular cancer also had an increased risk for intermediate- to high-risk prostate cancers.”


Study Provides Evidence for New Approaches to Prostate Cancer

“Monitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 years. According to the results of a new study conducted at Brigham and Women’s Hospital (BWH), there is evidence to also support AS as an initial approach for men with favorable intermediate-risk of PC (men with no evidence of the cancer spreading beyond the prostate, a Gleason score of 3+4 or less and PSA, prostate-specific antigen, under 20). These findings are published online by JAMA Oncology.

” ‘We found that men with favorable intermediate-risk prostate cancer did not have significantly increased risks of death compared to men with low-risk prostate cancer,’ said Ann Caroline Raldow, MD, first author of the study and resident physician at BWH and the Harvard Radiation Oncology Program. ‘The clinical significance of our findings is that men with favorable intermediate-risk prostate cancer may also be able to avoid, or at least defer the side effects of, prostate cancer treatment, and enter an active surveillance program as an initial approach.’ “


ADT Before or After Surgery Gives Similar Survival Rates in Prostate Cancer

The gist: Recent research found that prostate cancer patients have similar survival rates whether they have androgen deprivation therapy (ADT) before or after tumor-removal surgery. The study focused on men with intermediate- or high-risk prostate cancer who were treated between 1995 and 2002.

“Patients with intermediate- or high-risk prostate cancer demonstrated similar biochemical relapse-free survival, distant metastasis-free survival and OS regardless of whether they received androgen deprivation in the neoadjuvant or adjuvant settings, according to study results.

“Patients with localized prostate cancer typically undergo androgen deprivation therapy (ADT) in the neoadjuvant setting, concurrent with radiation therapy.

“Michael A. Weller, MD,of Cleveland Clinic, and colleagues assessed whether patients who underwent ADT in the adjuvant setting experienced different outcomes.

“The analysis included 515 patients treated with radiation therapy and ADT from 1995 to 2002. Of these patients, 311 underwent ADT in the neoadjuvant setting, beginning 2 to 3 months before the start of radiation therapy. The other 204 patients underwent ADT in the adjuvant setting, immediately after the completion of radiation therapy.”