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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Phase III Results Support Novel Focal Therapy for Low-Risk Prostate Cancer

Excerpt:

“Padeliporfin vascular-targeted photodynamic therapy, a novel tissue-preserving treatment, may offer men with low-risk prostate cancer a safe and effective alternative to either active surveillance or radical therapy, according to the results of a phase III trial published in The Lancet Oncology.

“Among treatment-naïve patients with low-risk, localized prostate cancer, disease progression at 24 months was 28% among patients receiving padeliporfin vascular-targeted photodynamic therapy versus 58% in those receiving active surveillance (HR, 0.34; 95% CI, 0.24-0.46; P <.0001). The median time to progression was 28.3 months (95% CI, 26.0-30.6) versus 14.1 months (95% CI, 12.9-23.8; P <.0001), respectively.”

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Photodynamic Therapy Can Preserve Tissue in Low-Risk Prostate Cancer

Excerpt:

“Vascular-targeted photodynamic therapy with padeliporfin was significantly better than active surveillance over a 2-year period in men with low-risk localized prostate cancer, according to a new study. The treatment could allow men to avoid more radical therapy.

” ‘Focal therapy and active surveillance are both tissue-preserving strategies,’ wrote study authors led by Mark Emberton, MD, of University College London in the United Kingdom. ‘However, focal therapy differs from active surveillance in that it treats disease—by the process of selective tissue ablation—above a certain risk threshold and monitors disease below that threshold, because the latter is deemed to be clinically significant.’ ”

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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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Patients with Low Risk Prostate Cancer on Active Surveillance Experience Good Quality of Life

Excerpt:

“Active surveillance (AS) has become an increasingly important alternative to surgery, chemotherapy, or radiation treatment for men diagnosed with low risk prostate cancer. However, what is the impact of AS on health related quality of life (HRQoL) in patients selected or opting for this conservative form of disease management? New research published in The Journal of Urology found that patients on AS who were tracked for three years experienced similar HRQoL as men without prostate cancer, both clinically and psychologically.

“The majority of men diagnosed with prostate cancer have low risk disease and face a difficult decision between having the disease managed conservatively through AS or undergoing definitive therapy. These results can help guide physicians and patients through this decision-making process.”

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A Treatment Vaccine for Low-Risk Prostate Cancer

Excerpt:

“A Louisiana-based biopharmaceutical company is betting that its experimental immunotherapeutic vaccine can keep previously untreated prostate cancer in check.

“The company, OncBioMune Pharnaceuticals, Inc, in Baton Rouge, is planning to test the vaccine, dubbed ProscaVax, in a phase 2 trial for patients with previously untreated prostate cancer and in a second trial for patients with recurrent or hormone-refractory disease.

“The trial of a treatment vaccine in untreated, low-risk prostate cancer patients is novel.”

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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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Active Surveillance for Prostate Cancer Can Give Men Good Quality of Life

“Choosing ongoing monitoring instead of immediate curative treatment (surgery or radiotherapy) leads to a better overall quality of life for men with low-risk prostate cancer. In fact, the Quality of life (QoL) is about the same as for men who do not have cancer. These are the findings of a new long-term study comparing Active Surveillance, immediate curative treatment, and a reference group of men without cancer, presented at the European Association of Urology Congress in Munich.

“Prostate cancer is the most common male cancer, with around 400,000 new cases every year in Europe. Most  are treated quickly by  -radical prostatectomy (RP) – or radiotherapy (RT), but both treatments can show significant and distressing side effects, most commonly incontinence, or erectile dysfunction. One alternative which is increasingly considered for patients with less-aggressive cancers is to delay or avoid initial treatment, but instead keeping the patient under Active Surveillance (AS), meaning that the cancer is regularly monitored, with the option of switching to curative treatment if the condition of the tumour changes. Now a new study has examined whether AS actually helps prostate cancer patients to live a better quality of life in the long term.”


Hypofractionation Is Ready for Prime Time in Prostate Cancer, but Will It Be Adopted?

“Separate phase III trials presented at the 2016 Genitourinary Cancers Symposium demonstrated that modest hypofractionated radiotherapy is noninferior to conventional radiotherapy for men with intermediate- and low-risk prostate cancer and should be considered a new standard of care.1,2 However, it is not clear how widely adopted hypofractionation schedules will be.

“NRG Oncology RTOG 0415 was a randomized, phase III, noninferiority study comparing two fractionation schedules in men with low-risk prostate cancer: conventional radiotherapy (73 Gy in 41 fractions over 8.3 weeks) vs hypofractionation (70 Gy in 28 fractions over 5.6 weeks).1

“The study enrolled 1,115 patients with low-risk prostate cancer. No androgen suppression was given. Patients were stratified according to Gleason score 2–4 and Gleason score 5–6.”