Active Surveillance Preserves Quality of Life for Prostate Cancer Patients

Excerpt:

“Faced with the negative quality-of-life effects from surgery and radiation treatments for prostate cancer, low risk patients may instead want to consider active surveillance with their physician, according to a study released Tuesday by the Journal of the American Medical Association (JAMA).

“The Vanderbilt University Medical Center study led by Daniel Barocas, M.D., MPH, associate professor of Urologic Surgery, compared the side effects and outcomes of contemporary treatments for localized with in order to guide men with prostate cancer in choosing the best treatment for them.

“Surgery is considered by some to be the most definitive treatment, and there is evidence from other studies that it has better long-term cancer outcomes than radiation for higher-risk cancers, but it has more sexual and urinary side effects than radiation.”

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Popular Prostate Cancer Therapy Is Short, Intense and Unproven

Excerpt:

“After learning he had early stage prostate cancer, Paul Kolnik knew he wanted that cancer destroyed immediately and with as little disruption as possible to his busy life as the New York City Ballet’s photographer.

“So Mr. Kolnik, 65, chose a type of radiation treatment that is raising some eyebrows in the prostate cancer field. It is more intense than standard radiation and takes much less time — five sessions over two weeks instead of 40 sessions over about two months or 28 sessions over five to six weeks.

“The newer therapy is surging in popularity, but no one knows whether it is as effective in curing prostate cancer, or how its side effects compare.”

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Petrylak Discusses Significance of Genetic Testing in Prostate Cancer

Excerpt:

“The 2017 Philadelphia Prostate Cancer International Consensus was recently held at the Sidney Kimmel Cancer Center of Thomas Jefferson University. The theme of this year’s meeting was The Role Of Genetic Testing For Inherited Prostate Cancer Risk.

” ‘Genetics is the way of the future for patients with prostate cancer,’ said steering committee co-chair Daniel Petrylak, MD.

“In an interview with OncLive at the meeting, Petrylak, professor of Medicine and Urology, co-director, Signal Transduction Research Program, Yale School of Medicine, discussed the significance of genetics in the future of prostate cancer care and highlighted emerging treatments and challenges in the field.”

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Expert Calls for Shorter Radiation Use in Prostate Cancer Treatment

Excerpt:

“Men with prostate cancer can receive shorter courses of radiation therapy than what is currently considered standard, according to Justin Bekelman, MD, an associate professor of Radiation Oncology, Medical Ethics, and Health Policy at the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center. In his call for practice change, Bekelman cites research showing the shorter radiation treatment — known as moderate hypofractionation — is just as effective at treating cancer, while costing less and easing the burden on patients. The commentary was published online by the International Journal of Radiation Oncology Biology and Physics and was co-authored by W. Robert Lee, MD, MEd, MS, a professor of Radiation Oncology at the Duke University School of Medicine.”

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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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Four New Studies of Oncotype DX® Genomic Prostate Score™ (GPS) Reconfirm Value of Test in Guiding Early-stage Prostate Cancer Risk Assessment and Treatment Selection

Excerpt:

“Genomic Health, Inc. (GHDX) announced today the presentation of results from four studies evaluating the clinical value and utility of its Oncotype DX® Genomic Prostate Score (GPS) in the management of early-stage prostate cancer. Collectively, these new data highlight the test’s ability to predict disease aggressiveness and refine risk stratification across National Comprehensive Cancer Network (NCCN) clinical risk groups.

” ‘We now have 22 clinical studies, involving more than 4,200 prostate cancer patients, that distinguish Oncotype DX as the only test developed specifically for men who are deciding between active surveillance or definitive treatment. The test is validated to provide individualized information about both the current state and future risk of patients’ prostate cancer,’ said Phil Febbo, M.D., chief medical officer, Genomic Health. ‘Together with the recently published economic analysis demonstrating substantial cost savings of more than $2,200 per patient tested, the data presented will support increased adoption and reimbursement of Oncotype DX as physicians aim to bring precision medicine to their prostate cancer patients.’ “

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Immunotherapy Needs a New Math

Excerpt:

“A group of doctors and other healthcare industry professionals have set out to develop a more efficient tool for assessing the true value of immuno-oncology (I/O) drugs. They note that these drugs often come with high prices that may distract from their advantages over other types of therapy. For example, Kroger Pharmacy is selling the checkpoint inhibitor ipilimumab (Yervoy) for $140 per mg. At the recommended dose of 3 mg/kg for melanoma patients, the total expense can be high. However, ipilimumab is one of the class of I/O drugs that have improved expectations on supportive care costs and survival benefit. The old measures of value may not apply. Therefore, how does one determine whether $140/mg is a fair price for the drug?”

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Blood Test Instead of Biopsy for Metastatic Prostate Cancer

Excerpt:

“There has been a lot of buzz recently about the use of ‘liquid biopsies’ and how these blood tests that show cancer may be able to replace the need for tissue biopsies.

“The latest study shows that such a test could be useful in metastatic prostate cancer, where the biopsy sample would need to be taken from bone, which is painful, risky, and expensive, says an expert.

“This study used the Guardant360 test and found that cell-free, circulating tumor DNA (ctDNA) was detected in most patients (94%) with metastatic castration-resistant prostate cancer (mCRPC).”

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Adding Antiandrogen Therapy to Radiation Improves Survival in Recurrent Prostate Cancer

Excerpt:

“The addition of hormonal therapy to radiation treatment following surgery significantly improved survival in patients with recurrent prostate cancer, according to the results of a study published in The New England Journal of Medicine.

“In the multicenter trial—which initially enrolled 760 men with biochemical recurrence after radical prostatectomy—patients were randomly assigned to treatment with bicalutamide or placebo for 2 years, along with 6.5 weeks of radiation therapy.”

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