Prostate Cancer

Key clinical point: A 3-tiered prostate cancer screening and risk stratification using a combination of prostate-specific antigen (PSA), 4-kallikrein panel, and magnetic resonance imaging (MRI) is feasible.

Major finding: The participation rate is 40%. PSA of 3 ng/mL or more was reported in 7% of men, 6% had a positive kallikrein panel, and 3% had suspicious MRI findings. Clinically significant cancer (Gleason score of ≥7) was detected in 5 men. The number needed to screen for clinically significant cancer was 32. Kallikrein panel and MRI after PSA reduced biopsy rate by 56%.

Study details: Study of 399 men invited for screening with 3 stepwise tests (PSA, kallikrein panel, and MRI).

Disclosures: This study was supported by Academy of Finland, Finnish Cancer Organisations, Jane and Aatos Erkko Foundation, and others. The authors received advisory/lecture fees, congress support, and royalties and held stocks outside this work.

Source: Rannikko A et al. BJU Int. 2021 Dec 27. doi: 10.1111/bju.15683.

Key clinical point: A 3-tiered prostate cancer screening and risk stratification using a combination of prostate-specific antigen (PSA), 4-kallikrein panel, and magnetic resonance imaging (MRI) is feasible.

Major finding: The participation rate is 40%. PSA of 3 ng/mL or more was reported in 7% of men, 6% had a positive kallikrein panel, and 3% had suspicious MRI findings. Clinically significant cancer (Gleason score of ≥7) was detected in 5 men. The number needed to screen for clinically significant cancer was 32. Kallikrein panel and MRI after PSA reduced biopsy rate by 56%.

Study details: Study of 399 men invited for screening with 3 stepwise tests (PSA, kallikrein panel, and MRI).

Disclosures: This study was supported by Academy of Finland, Finnish Cancer Organisations, Jane and Aatos Erkko Foundation, and others. The authors received advisory/lecture fees, congress support, and royalties and held stocks outside this work.

Source: Rannikko A et al. BJU Int. 2021 Dec 27. doi: 10.1111/bju.15683.

Key clinical point: A 3-tiered prostate cancer screening and risk stratification using a combination of prostate-specific antigen (PSA), 4-kallikrein panel, and magnetic resonance imaging (MRI) is feasible.

Major finding: The participation rate is 40%. PSA of 3 ng/mL or more was reported in 7% of men, 6% had a positive kallikrein panel, and 3% had suspicious MRI findings. Clinically significant cancer (Gleason score of ≥7) was detected in 5 men. The number needed to screen for clinically significant cancer was 32. Kallikrein panel and MRI after PSA reduced biopsy rate by 56%.

Study details: Study of 399 men invited for screening with 3 stepwise tests (PSA, kallikrein panel, and MRI).

Disclosures: This study was supported by Academy of Finland, Finnish Cancer Organisations, Jane and Aatos Erkko Foundation, and others. The authors received advisory/lecture fees, congress support, and royalties and held stocks outside this work.

Source: Rannikko A et al. BJU Int. 2021 Dec 27. doi: 10.1111/bju.15683.

Key clinical point: Docetaxel transiently decreased health-related quality of life (HRQoL) during chemotherapy in patients with intermediate-/high-risk localized prostate cancer, but the decline is temporary and recovers at 1 year. The decline was clinically meaningful in functional and physical domains.

Major finding: At the end of treatment (24 weeks), the HRQoL significantly declined in the docetaxel vs surveillance group (mean difference [MD], ─7.1 points; P < .0001). At 1 year, the HRQoL was similar between the 2 groups (P = .344). A clinically significant decline in HRQoL scores during treatment with docetaxel was reported in functional (MD, –2.43 points; P < .0001) and physical domains (MD, –2.89 points; P < .0001).

Study details: Post hoc analysis of a randomized, phase 3 SPCG-13 study including 376 patients with intermediate-/high-risk localized prostate cancer following radiotherapy were randomly assigned to docetaxel or surveillance.

Disclosures: This work was supported by Tampere University Hospital. The authors received advisory/speaker fees from various sources.

Source: Lehtonen M et al. Anticancer Res. 2021 Dec 29. doi: 10.21873/anticanres.15460.

Key clinical point: Docetaxel transiently decreased health-related quality of life (HRQoL) during chemotherapy in patients with intermediate-/high-risk localized prostate cancer, but the decline is temporary and recovers at 1 year. The decline was clinically meaningful in functional and physical domains.

Major finding: At the end of treatment (24 weeks), the HRQoL significantly declined in the docetaxel vs surveillance group (mean difference [MD], ─7.1 points; P < .0001). At 1 year, the HRQoL was similar between the 2 groups (P = .344). A clinically significant decline in HRQoL scores during treatment with docetaxel was reported in functional (MD, –2.43 points; P < .0001) and physical domains (MD, –2.89 points; P < .0001).

Study details: Post hoc analysis of a randomized, phase 3 SPCG-13 study including 376 patients with intermediate-/high-risk localized prostate cancer following radiotherapy were randomly assigned to docetaxel or surveillance.

Disclosures: This work was supported by Tampere University Hospital. The authors received advisory/speaker fees from various sources.

Source: Lehtonen M et al. Anticancer Res. 2021 Dec 29. doi: 10.21873/anticanres.15460.

Key clinical point: Docetaxel transiently decreased health-related quality of life (HRQoL) during chemotherapy in patients with intermediate-/high-risk localized prostate cancer, but the decline is temporary and recovers at 1 year. The decline was clinically meaningful in functional and physical domains.

Major finding: At the end of treatment (24 weeks), the HRQoL significantly declined in the docetaxel vs surveillance group (mean difference [MD], ─7.1 points; P < .0001). At 1 year, the HRQoL was similar between the 2 groups (P = .344). A clinically significant decline in HRQoL scores during treatment with docetaxel was reported in functional (MD, –2.43 points; P < .0001) and physical domains (MD, –2.89 points; P < .0001).

Study details: Post hoc analysis of a randomized, phase 3 SPCG-13 study including 376 patients with intermediate-/high-risk localized prostate cancer following radiotherapy were randomly assigned to docetaxel or surveillance.

Disclosures: This work was supported by Tampere University Hospital. The authors received advisory/speaker fees from various sources.

Source: Lehtonen M et al. Anticancer Res. 2021 Dec 29. doi: 10.21873/anticanres.15460.

Key clinical point: Apalutamide plus androgen deprivation therapy (ADT) leads to higher PSA responses by 6 months in patients with nonmetastatic castration-resistant prostate cancer (CRPC).

Major finding: At 6 months, a higher proportion of patients in the apalutamide vs placebo group reported a PSA reduction of ≥50% (90% vs 1.5%) and ≥90% (57% vs 0%). Deep PSA responses (PSA reduction of ≥50% or PSA levels of ≤0.2 ng/mL) at 6 months after apalutamide treatment were associated with a significant improvement in metastasis-free survival (P < .001) and overall survival (P < .001).

Study details: A post hoc analysis of phase 3 randomized SPARTAN trial of 1,207 patients with nonmetastatic CRPC randomly assigned to receive apalutamide (n=806) or placebo (n=401) plus ADT.

Disclosures: This study was sponsored by Janssen Research & Development. The authors reported employment, research funding, advisory/consulting roles, travel compensation, honoraria, stock ownership, royalties, or patents outside this work.

Source: Saad F et al. Eur Urol. 2021 Dec 13. doi: 10.1016/j.eururo.2021.11.020.

Key clinical point: Apalutamide plus androgen deprivation therapy (ADT) leads to higher PSA responses by 6 months in patients with nonmetastatic castration-resistant prostate cancer (CRPC).

Major finding: At 6 months, a higher proportion of patients in the apalutamide vs placebo group reported a PSA reduction of ≥50% (90% vs 1.5%) and ≥90% (57% vs 0%). Deep PSA responses (PSA reduction of ≥50% or PSA levels of ≤0.2 ng/mL) at 6 months after apalutamide treatment were associated with a significant improvement in metastasis-free survival (P < .001) and overall survival (P < .001).

Study details: A post hoc analysis of phase 3 randomized SPARTAN trial of 1,207 patients with nonmetastatic CRPC randomly assigned to receive apalutamide (n=806) or placebo (n=401) plus ADT.

Disclosures: This study was sponsored by Janssen Research & Development. The authors reported employment, research funding, advisory/consulting roles, travel compensation, honoraria, stock ownership, royalties, or patents outside this work.

Source: Saad F et al. Eur Urol. 2021 Dec 13. doi: 10.1016/j.eururo.2021.11.020.

Key clinical point: Apalutamide plus androgen deprivation therapy (ADT) leads to higher PSA responses by 6 months in patients with nonmetastatic castration-resistant prostate cancer (CRPC).

Major finding: At 6 months, a higher proportion of patients in the apalutamide vs placebo group reported a PSA reduction of ≥50% (90% vs 1.5%) and ≥90% (57% vs 0%). Deep PSA responses (PSA reduction of ≥50% or PSA levels of ≤0.2 ng/mL) at 6 months after apalutamide treatment were associated with a significant improvement in metastasis-free survival (P < .001) and overall survival (P < .001).

Study details: A post hoc analysis of phase 3 randomized SPARTAN trial of 1,207 patients with nonmetastatic CRPC randomly assigned to receive apalutamide (n=806) or placebo (n=401) plus ADT.

Disclosures: This study was sponsored by Janssen Research & Development. The authors reported employment, research funding, advisory/consulting roles, travel compensation, honoraria, stock ownership, royalties, or patents outside this work.

Source: Saad F et al. Eur Urol. 2021 Dec 13. doi: 10.1016/j.eururo.2021.11.020.

Key clinical point: Enzalutamide was associated with worsening of self-reported fatigue, cognitive function, and physical function, but not overall health and quality of life (OHQL) in newly diagnosed patients with metastatic hormone-sensitive prostate cancer (HSPC).

Major finding: Conventional nonsteroidal antiandrogen vs enzalutamide was associated with less worsening of fatigue (mean difference [MD], 5.2; P < .001), cognitive function (MD, 4.0; P < .001), and physical function (MD, 2.6; P < .001), but not OHQL (MD, 1.2; P = .1).

Study details: An open-label, international, randomized, phase 3, cooperative group ENZAMET trial of newly diagnosed patients with metastatic prostate cancer who were randomly assigned to enzalutamide or a conventional nonsteroidal antiandrogen.

Disclosures: This study was funded by Astellas. The authors received speakers/advisory/consulting fees, honoraria, research funding, royalties, and travel/accommodation expenses; were employed by; held stocks/other ownership interests; and had leadership roles outside this work.

Source: Stockler MR et al. J Clin Oncol. 2021 Dec 20. doi: 10.1200/JCO.21.00941.

Key clinical point: Enzalutamide was associated with worsening of self-reported fatigue, cognitive function, and physical function, but not overall health and quality of life (OHQL) in newly diagnosed patients with metastatic hormone-sensitive prostate cancer (HSPC).

Major finding: Conventional nonsteroidal antiandrogen vs enzalutamide was associated with less worsening of fatigue (mean difference [MD], 5.2; P < .001), cognitive function (MD, 4.0; P < .001), and physical function (MD, 2.6; P < .001), but not OHQL (MD, 1.2; P = .1).

Study details: An open-label, international, randomized, phase 3, cooperative group ENZAMET trial of newly diagnosed patients with metastatic prostate cancer who were randomly assigned to enzalutamide or a conventional nonsteroidal antiandrogen.

Disclosures: This study was funded by Astellas. The authors received speakers/advisory/consulting fees, honoraria, research funding, royalties, and travel/accommodation expenses; were employed by; held stocks/other ownership interests; and had leadership roles outside this work.

Source: Stockler MR et al. J Clin Oncol. 2021 Dec 20. doi: 10.1200/JCO.21.00941.

Key clinical point: Enzalutamide was associated with worsening of self-reported fatigue, cognitive function, and physical function, but not overall health and quality of life (OHQL) in newly diagnosed patients with metastatic hormone-sensitive prostate cancer (HSPC).

Major finding: Conventional nonsteroidal antiandrogen vs enzalutamide was associated with less worsening of fatigue (mean difference [MD], 5.2; P < .001), cognitive function (MD, 4.0; P < .001), and physical function (MD, 2.6; P < .001), but not OHQL (MD, 1.2; P = .1).

Study details: An open-label, international, randomized, phase 3, cooperative group ENZAMET trial of newly diagnosed patients with metastatic prostate cancer who were randomly assigned to enzalutamide or a conventional nonsteroidal antiandrogen.

Disclosures: This study was funded by Astellas. The authors received speakers/advisory/consulting fees, honoraria, research funding, royalties, and travel/accommodation expenses; were employed by; held stocks/other ownership interests; and had leadership roles outside this work.

Source: Stockler MR et al. J Clin Oncol. 2021 Dec 20. doi: 10.1200/JCO.21.00941.

Key clinical point: In patients with metastatic castration-resistant prostate cancer (mCRPC), enzalutamide improves outcomes independent of concurrent corticosteroid use (CCU).

Major finding: In patients with baseline CCU, enzalutamide vs placebo improved overall survival (OS; hazard ratio [HR], 0.70; P = .012), radiographic progression-free survival (rPFS; HR, 0.59; P < .001), and time to prostate-specific antigen progression (TTPP; HR, 0.36; P < .001). Enzalutamide improved OS (HR, 0.59; P < .001), rPFS (HR, 0.33; P < .001) and TTPP (HR, 0.22; P < .001) in patients with no CCU.

Study details: A post hoc analysis of phase 3, randomized AFFIRM trial of 1,199 patients with mCRPC who were randomly assigned to enzalutamide 160 mg/day or placebo.

Disclosures: This work was supported by Pfizer Inc. and Astellas Pharma, Inc. The authors received honoraria, advisory/consulting fees, nonfinancial support, and/or research funding outside this work. Some authors reported being employed, held patents, and/or were inventors or investigators.

Source: Zhao JL et al. Clin Cancer Res. 2021 Dec 29. doi: 10.1158/1078-0432.CCR-21-1090.

Key clinical point: In patients with metastatic castration-resistant prostate cancer (mCRPC), enzalutamide improves outcomes independent of concurrent corticosteroid use (CCU).

Major finding: In patients with baseline CCU, enzalutamide vs placebo improved overall survival (OS; hazard ratio [HR], 0.70; P = .012), radiographic progression-free survival (rPFS; HR, 0.59; P < .001), and time to prostate-specific antigen progression (TTPP; HR, 0.36; P < .001). Enzalutamide improved OS (HR, 0.59; P < .001), rPFS (HR, 0.33; P < .001) and TTPP (HR, 0.22; P < .001) in patients with no CCU.

Study details: A post hoc analysis of phase 3, randomized AFFIRM trial of 1,199 patients with mCRPC who were randomly assigned to enzalutamide 160 mg/day or placebo.

Disclosures: This work was supported by Pfizer Inc. and Astellas Pharma, Inc. The authors received honoraria, advisory/consulting fees, nonfinancial support, and/or research funding outside this work. Some authors reported being employed, held patents, and/or were inventors or investigators.

Source: Zhao JL et al. Clin Cancer Res. 2021 Dec 29. doi: 10.1158/1078-0432.CCR-21-1090.

Key clinical point: In patients with metastatic castration-resistant prostate cancer (mCRPC), enzalutamide improves outcomes independent of concurrent corticosteroid use (CCU).

Major finding: In patients with baseline CCU, enzalutamide vs placebo improved overall survival (OS; hazard ratio [HR], 0.70; P = .012), radiographic progression-free survival (rPFS; HR, 0.59; P < .001), and time to prostate-specific antigen progression (TTPP; HR, 0.36; P < .001). Enzalutamide improved OS (HR, 0.59; P < .001), rPFS (HR, 0.33; P < .001) and TTPP (HR, 0.22; P < .001) in patients with no CCU.

Study details: A post hoc analysis of phase 3, randomized AFFIRM trial of 1,199 patients with mCRPC who were randomly assigned to enzalutamide 160 mg/day or placebo.

Disclosures: This work was supported by Pfizer Inc. and Astellas Pharma, Inc. The authors received honoraria, advisory/consulting fees, nonfinancial support, and/or research funding outside this work. Some authors reported being employed, held patents, and/or were inventors or investigators.

Source: Zhao JL et al. Clin Cancer Res. 2021 Dec 29. doi: 10.1158/1078-0432.CCR-21-1090.

Key clinical point: Adding abiraterone acetate plus prednisone (AA+P) to androgen deprivation therapy (ADT) extends survival in patients with newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC) and visceral disease.

Major finding: AA+P vs placebo significantly improved overall survival (median, 55.4 months vs 33.0 months; hazard ratio [HR], 0.582; P = .0029) and radiographic progression-free survival (median, 30.7 months vs 18.3 months; HR, 0.527; P = .0005) in patients with vs without visceral metastases.

Study details: A post hoc analysis of LATITUDE study including 1,199 newly diagnosed patients with mCSPC who were randomly assigned to AA+P and ADT or placebo plus ADT.

Disclosures: This work was funded by Janssen Research & Development. The authors reported employment/stock ownership; received personal/advisory fees, funding, honorarium, and travel and accommodation expense outside this work; were employees of Janssen Research & Development; and/or held company stock.

Source: Baciarello G et al. Eur J Cancer. 2021 Dec 22. doi: 10.1016/j.ejca.2021.11.026.

Key clinical point: Adding abiraterone acetate plus prednisone (AA+P) to androgen deprivation therapy (ADT) extends survival in patients with newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC) and visceral disease.

Major finding: AA+P vs placebo significantly improved overall survival (median, 55.4 months vs 33.0 months; hazard ratio [HR], 0.582; P = .0029) and radiographic progression-free survival (median, 30.7 months vs 18.3 months; HR, 0.527; P = .0005) in patients with vs without visceral metastases.

Study details: A post hoc analysis of LATITUDE study including 1,199 newly diagnosed patients with mCSPC who were randomly assigned to AA+P and ADT or placebo plus ADT.

Disclosures: This work was funded by Janssen Research & Development. The authors reported employment/stock ownership; received personal/advisory fees, funding, honorarium, and travel and accommodation expense outside this work; were employees of Janssen Research & Development; and/or held company stock.

Source: Baciarello G et al. Eur J Cancer. 2021 Dec 22. doi: 10.1016/j.ejca.2021.11.026.

Key clinical point: Adding abiraterone acetate plus prednisone (AA+P) to androgen deprivation therapy (ADT) extends survival in patients with newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC) and visceral disease.

Major finding: AA+P vs placebo significantly improved overall survival (median, 55.4 months vs 33.0 months; hazard ratio [HR], 0.582; P = .0029) and radiographic progression-free survival (median, 30.7 months vs 18.3 months; HR, 0.527; P = .0005) in patients with vs without visceral metastases.

Study details: A post hoc analysis of LATITUDE study including 1,199 newly diagnosed patients with mCSPC who were randomly assigned to AA+P and ADT or placebo plus ADT.

Disclosures: This work was funded by Janssen Research & Development. The authors reported employment/stock ownership; received personal/advisory fees, funding, honorarium, and travel and accommodation expense outside this work; were employees of Janssen Research & Development; and/or held company stock.

Source: Baciarello G et al. Eur J Cancer. 2021 Dec 22. doi: 10.1016/j.ejca.2021.11.026.

Key clinical point: A focal boost to external beam radiotherapy (EBRT) improves local failure-free survival (LFS) and regional/distant metastasis-free survival (rdMFS) in patients with localized high-risk prostate cancer.

Major finding: At a median follow-up of 72 months, focal boost improved LFS (adjusted hazard ratio [aHR], 0.33; P = .01) and rdMFS (aHR, 0.56; P = .02). A higher dose to the tumor resulted in lower LFS and rdMFS rates.

Study details: A phase 3, multicenter, randomized controlled FLAME trial of 571 patients with intermediate- or high-risk localized prostate cancer who were randomly assigned to receive EBRT with or without an additional boost of up to 95 Gy to the macroscopic tumor.

Disclosures: This study was supported by the Dutch Cancer Society. The authors reported no conflict of interests.

Source: Groen VH et al. Eur Urol. 2021 Dec 22. doi: 10.1016/j.eururo.2021.12.012.

Key clinical point: A focal boost to external beam radiotherapy (EBRT) improves local failure-free survival (LFS) and regional/distant metastasis-free survival (rdMFS) in patients with localized high-risk prostate cancer.

Major finding: At a median follow-up of 72 months, focal boost improved LFS (adjusted hazard ratio [aHR], 0.33; P = .01) and rdMFS (aHR, 0.56; P = .02). A higher dose to the tumor resulted in lower LFS and rdMFS rates.

Study details: A phase 3, multicenter, randomized controlled FLAME trial of 571 patients with intermediate- or high-risk localized prostate cancer who were randomly assigned to receive EBRT with or without an additional boost of up to 95 Gy to the macroscopic tumor.

Disclosures: This study was supported by the Dutch Cancer Society. The authors reported no conflict of interests.

Source: Groen VH et al. Eur Urol. 2021 Dec 22. doi: 10.1016/j.eururo.2021.12.012.

Key clinical point: A focal boost to external beam radiotherapy (EBRT) improves local failure-free survival (LFS) and regional/distant metastasis-free survival (rdMFS) in patients with localized high-risk prostate cancer.

Major finding: At a median follow-up of 72 months, focal boost improved LFS (adjusted hazard ratio [aHR], 0.33; P = .01) and rdMFS (aHR, 0.56; P = .02). A higher dose to the tumor resulted in lower LFS and rdMFS rates.

Study details: A phase 3, multicenter, randomized controlled FLAME trial of 571 patients with intermediate- or high-risk localized prostate cancer who were randomly assigned to receive EBRT with or without an additional boost of up to 95 Gy to the macroscopic tumor.

Disclosures: This study was supported by the Dutch Cancer Society. The authors reported no conflict of interests.

Source: Groen VH et al. Eur Urol. 2021 Dec 22. doi: 10.1016/j.eururo.2021.12.012.

Key clinical point: In patients with high-risk nonmetastatic prostate cancer, adding abiraterone acetate and prednisolone to androgen deprivation therapy (ADT) prolongs survival vs ADT alone.

Major finding: Add-on abiraterone acetate plus prednisolone to ADT vs ADT alone significantly improved metastasis-free survival (MFS; hazard ratio [HR], 0.53; P < .0001) and overall survival (HR, 0.60; P < .0001). There was no difference in MFS when enzalutamide and abiraterone acetate were administered concurrently vs abiraterone acetate alone (interaction HR, 1.02; P = .91).

Study details: A meta-analysis of 2 phase 3 STAMPEDE trials including 1,974 patients with high-risk nonmetastatic prostate cancer randomly assigned to ADT alone or ADT plus abiraterone acetate and prednisolone with or without enzalutamide.

Disclosures: This work was supported by Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, and others. The authors received personal fees, honoraria, grants, travel support, royalty, nonfinancial support, and payments or held patents outside this work.

Source: Attard G et al. Lancet. 2021 Dec 23. doi: 10.1016/S0140-6736(21)02437-5.

Key clinical point: In patients with high-risk nonmetastatic prostate cancer, adding abiraterone acetate and prednisolone to androgen deprivation therapy (ADT) prolongs survival vs ADT alone.

Major finding: Add-on abiraterone acetate plus prednisolone to ADT vs ADT alone significantly improved metastasis-free survival (MFS; hazard ratio [HR], 0.53; P < .0001) and overall survival (HR, 0.60; P < .0001). There was no difference in MFS when enzalutamide and abiraterone acetate were administered concurrently vs abiraterone acetate alone (interaction HR, 1.02; P = .91).

Study details: A meta-analysis of 2 phase 3 STAMPEDE trials including 1,974 patients with high-risk nonmetastatic prostate cancer randomly assigned to ADT alone or ADT plus abiraterone acetate and prednisolone with or without enzalutamide.

Disclosures: This work was supported by Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, and others. The authors received personal fees, honoraria, grants, travel support, royalty, nonfinancial support, and payments or held patents outside this work.

Source: Attard G et al. Lancet. 2021 Dec 23. doi: 10.1016/S0140-6736(21)02437-5.

Key clinical point: In patients with high-risk nonmetastatic prostate cancer, adding abiraterone acetate and prednisolone to androgen deprivation therapy (ADT) prolongs survival vs ADT alone.

Major finding: Add-on abiraterone acetate plus prednisolone to ADT vs ADT alone significantly improved metastasis-free survival (MFS; hazard ratio [HR], 0.53; P < .0001) and overall survival (HR, 0.60; P < .0001). There was no difference in MFS when enzalutamide and abiraterone acetate were administered concurrently vs abiraterone acetate alone (interaction HR, 1.02; P = .91).

Study details: A meta-analysis of 2 phase 3 STAMPEDE trials including 1,974 patients with high-risk nonmetastatic prostate cancer randomly assigned to ADT alone or ADT plus abiraterone acetate and prednisolone with or without enzalutamide.

Disclosures: This work was supported by Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, and others. The authors received personal fees, honoraria, grants, travel support, royalty, nonfinancial support, and payments or held patents outside this work.

Source: Attard G et al. Lancet. 2021 Dec 23. doi: 10.1016/S0140-6736(21)02437-5.

Extensive efforts have been put forth to evaluate which patients may safely delay, or completely avoid, treatment for prostate cancer. However, identifying who can safely avoid treatment is challenging. Arcot et al. utilized the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men to determine whether those with prostate cancer grade group 1 with delayed treatment had increased need for secondary treatments, such as androgen deprivation or radiation therapy, compared with those with upfront surgery. There was a small decrease in the probability of being free from secondary treatment 24 months after diagnosis (96% vs. 93%), suggesting that such an approach is quite reasonable.

These two studies exemplify one of the ongoing points of discussion in treatment of early stage prostate cancer: whether upfront treatments are of net benefit for patients. The study by Wallis et al. further evaluated this point by conducting a prospective cohort study to evaluate the extent of regret of choice of treatment strategy amongst patients with prostate cancer. Out of this cohort of 2,072 men, 16% who underwent surgery, 11% who received radiation, and 7% who chose active surveillance reported regret regarding the treatment choice. However, when controlled for functional outcomes, the differences amongst treatment modalities were not statistically significant. However, perceived treatment efficacy and adverse effects were associated with regret when compared with patient expectations prior to treatment. This suggest that research and focus on shared decision-making in the clinic may be highly beneficial.

Extensive efforts have been put forth to evaluate which patients may safely delay, or completely avoid, treatment for prostate cancer. However, identifying who can safely avoid treatment is challenging. Arcot et al. utilized the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men to determine whether those with prostate cancer grade group 1 with delayed treatment had increased need for secondary treatments, such as androgen deprivation or radiation therapy, compared with those with upfront surgery. There was a small decrease in the probability of being free from secondary treatment 24 months after diagnosis (96% vs. 93%), suggesting that such an approach is quite reasonable.

These two studies exemplify one of the ongoing points of discussion in treatment of early stage prostate cancer: whether upfront treatments are of net benefit for patients. The study by Wallis et al. further evaluated this point by conducting a prospective cohort study to evaluate the extent of regret of choice of treatment strategy amongst patients with prostate cancer. Out of this cohort of 2,072 men, 16% who underwent surgery, 11% who received radiation, and 7% who chose active surveillance reported regret regarding the treatment choice. However, when controlled for functional outcomes, the differences amongst treatment modalities were not statistically significant. However, perceived treatment efficacy and adverse effects were associated with regret when compared with patient expectations prior to treatment. This suggest that research and focus on shared decision-making in the clinic may be highly beneficial.

Extensive efforts have been put forth to evaluate which patients may safely delay, or completely avoid, treatment for prostate cancer. However, identifying who can safely avoid treatment is challenging. Arcot et al. utilized the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men to determine whether those with prostate cancer grade group 1 with delayed treatment had increased need for secondary treatments, such as androgen deprivation or radiation therapy, compared with those with upfront surgery. There was a small decrease in the probability of being free from secondary treatment 24 months after diagnosis (96% vs. 93%), suggesting that such an approach is quite reasonable.

These two studies exemplify one of the ongoing points of discussion in treatment of early stage prostate cancer: whether upfront treatments are of net benefit for patients. The study by Wallis et al. further evaluated this point by conducting a prospective cohort study to evaluate the extent of regret of choice of treatment strategy amongst patients with prostate cancer. Out of this cohort of 2,072 men, 16% who underwent surgery, 11% who received radiation, and 7% who chose active surveillance reported regret regarding the treatment choice. However, when controlled for functional outcomes, the differences amongst treatment modalities were not statistically significant. However, perceived treatment efficacy and adverse effects were associated with regret when compared with patient expectations prior to treatment. This suggest that research and focus on shared decision-making in the clinic may be highly beneficial.