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Urine test for prostate cancer signals amount of aggressive tumor
according to a recent report.
In a study of biopsy and prostatectomy samples, researchers found that the multigene Prostate Urine Risk-4 (PUR-4) signature was strongly associated with the presence and amount of Gleason pattern 4 tumors, but not tumors of less aggressive histology.
Given that increased Gleason pattern 4 tumor burden is associated with disease progression in men at intermediate risk, the results suggest that “PUR can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance,” said senior author Jeremy Clark, PhD, of the University of East Anglia, Norwich, England. “PUR will also be useful for monitoring disease in men that do not currently require treatment and flag up the emergence and expansion of aggressive disease.”
The study by Dr. Clark and colleagues was published online on Nov. 3, 2021, in Life.
Tests using the traditional blood-based biomarker for prostate cancer – prostate-specific antigen (PSA) – have limited sensitivity and specificity, leading to unnecessary biopsies and overtreatment.
The PUR biomarker, one of several emerging alternatives to PSA, is a four-group classifier based on 36 genes, Dr. Clark and colleagues explained. Its categories correspond to the probabilities of the presence of normal tissue (PUR-1), and D’Amico low-risk (PUR-2), intermediate-risk (PUR-3), and high-risk (PUR-4) prostate cancer.
Dr. Clark’s team found in earlier research that the PUR-4 signature was able to predict disease progression in men on active surveillance for prostate cancer up to 5 years after a single urine sample. For their latest study, they sought to understand the relationship between PUR-4 and the amount and grade of tumor.
On the basis of biopsy samples from 215 men with prostate cancer, the researchers found that PUR-4 signature values correlated significantly with increasing Gleason grade.
There was no significant difference in PSA level by tumor volume for Gleason grade 1, 2, or 3. The same was true for PUR-4 and Gleason grade 1 tumors, which only contain less clinically significant Gleason pattern 3 cancer. However, PUR-4 values in men with Gleason grade 2 tumors larger than the median were significantly greater than for smaller tumors. PUR-4 values for large Gleason grade 3 tumors were also greater than for smaller ones, although the difference did not reach statistical significance.
“Since [Gleason grade] 2 and [Gleason grade] 3 contain both Gleason pattern 3 and 4 cancer these observations suggest that Gleason Pattern 4 cancer may be contributing to PUR-4 status,” the authors wrote.
The researchers also examined radical-prostatectomy specimens from nine men – three with Gleason grade 1, four with Gleason grade 2, and two with Gleason grade 3 tumors, as determined on the basis of presurgical biopsy.
There was no significant correlation between PUR-4 and PSA levels, nor were PUR-4 values linked to total tumor area or Gleason pattern 3 tumor area. But the amount of Gleason pattern 4 tumors showed a strong correlation with PUR-4 values, which did not change after adjusting for total prostate size.
“Our study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy,” Dr. Clark said in an interview. “It could therefore be a very useful tool indeed for assessing a man’s risk of dying from prostate cancer.”
Jack Schalken, PhD, a professor of experimental urology at Radboud University Medical Center in Nijmegen, the Netherlands, called PUR “another test” for prostate cancer the performance of which is in the same range as that of existing products.
“In fact, several tests are commercially available, but the clinical use is surprisingly low,” he told this news organization. Dr. Schalken, who was not involved in the new study, has reviewed several biomarkers for prostate cancer.
The PUR test is now undergoing validation in an international study that is expected to last another 2 years, Dr. Clark said. If successful, the test would stand out for several reasons.
First, it is based on many genes, so it is able to spot malignancies that other tests, which rely on just a few genes, may not pick up. In addition, although it is sensitive to the amount of Gleason pattern 4 tumor, it does not seem to detect the clinically less significant Gleason pattern 3 cancers.
“We have an at-home collection kit – the men do not have to come to a hospital to provide a urine sample,” Dr. Clark said.
The study did not receive commercial funding. Dr. Clark and two coauthors have filed a patent application related to their research.
A version of this article first appeared on Medscape.com.
according to a recent report.
In a study of biopsy and prostatectomy samples, researchers found that the multigene Prostate Urine Risk-4 (PUR-4) signature was strongly associated with the presence and amount of Gleason pattern 4 tumors, but not tumors of less aggressive histology.
Given that increased Gleason pattern 4 tumor burden is associated with disease progression in men at intermediate risk, the results suggest that “PUR can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance,” said senior author Jeremy Clark, PhD, of the University of East Anglia, Norwich, England. “PUR will also be useful for monitoring disease in men that do not currently require treatment and flag up the emergence and expansion of aggressive disease.”
The study by Dr. Clark and colleagues was published online on Nov. 3, 2021, in Life.
Tests using the traditional blood-based biomarker for prostate cancer – prostate-specific antigen (PSA) – have limited sensitivity and specificity, leading to unnecessary biopsies and overtreatment.
The PUR biomarker, one of several emerging alternatives to PSA, is a four-group classifier based on 36 genes, Dr. Clark and colleagues explained. Its categories correspond to the probabilities of the presence of normal tissue (PUR-1), and D’Amico low-risk (PUR-2), intermediate-risk (PUR-3), and high-risk (PUR-4) prostate cancer.
Dr. Clark’s team found in earlier research that the PUR-4 signature was able to predict disease progression in men on active surveillance for prostate cancer up to 5 years after a single urine sample. For their latest study, they sought to understand the relationship between PUR-4 and the amount and grade of tumor.
On the basis of biopsy samples from 215 men with prostate cancer, the researchers found that PUR-4 signature values correlated significantly with increasing Gleason grade.
There was no significant difference in PSA level by tumor volume for Gleason grade 1, 2, or 3. The same was true for PUR-4 and Gleason grade 1 tumors, which only contain less clinically significant Gleason pattern 3 cancer. However, PUR-4 values in men with Gleason grade 2 tumors larger than the median were significantly greater than for smaller tumors. PUR-4 values for large Gleason grade 3 tumors were also greater than for smaller ones, although the difference did not reach statistical significance.
“Since [Gleason grade] 2 and [Gleason grade] 3 contain both Gleason pattern 3 and 4 cancer these observations suggest that Gleason Pattern 4 cancer may be contributing to PUR-4 status,” the authors wrote.
The researchers also examined radical-prostatectomy specimens from nine men – three with Gleason grade 1, four with Gleason grade 2, and two with Gleason grade 3 tumors, as determined on the basis of presurgical biopsy.
There was no significant correlation between PUR-4 and PSA levels, nor were PUR-4 values linked to total tumor area or Gleason pattern 3 tumor area. But the amount of Gleason pattern 4 tumors showed a strong correlation with PUR-4 values, which did not change after adjusting for total prostate size.
“Our study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy,” Dr. Clark said in an interview. “It could therefore be a very useful tool indeed for assessing a man’s risk of dying from prostate cancer.”
Jack Schalken, PhD, a professor of experimental urology at Radboud University Medical Center in Nijmegen, the Netherlands, called PUR “another test” for prostate cancer the performance of which is in the same range as that of existing products.
“In fact, several tests are commercially available, but the clinical use is surprisingly low,” he told this news organization. Dr. Schalken, who was not involved in the new study, has reviewed several biomarkers for prostate cancer.
The PUR test is now undergoing validation in an international study that is expected to last another 2 years, Dr. Clark said. If successful, the test would stand out for several reasons.
First, it is based on many genes, so it is able to spot malignancies that other tests, which rely on just a few genes, may not pick up. In addition, although it is sensitive to the amount of Gleason pattern 4 tumor, it does not seem to detect the clinically less significant Gleason pattern 3 cancers.
“We have an at-home collection kit – the men do not have to come to a hospital to provide a urine sample,” Dr. Clark said.
The study did not receive commercial funding. Dr. Clark and two coauthors have filed a patent application related to their research.
A version of this article first appeared on Medscape.com.
according to a recent report.
In a study of biopsy and prostatectomy samples, researchers found that the multigene Prostate Urine Risk-4 (PUR-4) signature was strongly associated with the presence and amount of Gleason pattern 4 tumors, but not tumors of less aggressive histology.
Given that increased Gleason pattern 4 tumor burden is associated with disease progression in men at intermediate risk, the results suggest that “PUR can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance,” said senior author Jeremy Clark, PhD, of the University of East Anglia, Norwich, England. “PUR will also be useful for monitoring disease in men that do not currently require treatment and flag up the emergence and expansion of aggressive disease.”
The study by Dr. Clark and colleagues was published online on Nov. 3, 2021, in Life.
Tests using the traditional blood-based biomarker for prostate cancer – prostate-specific antigen (PSA) – have limited sensitivity and specificity, leading to unnecessary biopsies and overtreatment.
The PUR biomarker, one of several emerging alternatives to PSA, is a four-group classifier based on 36 genes, Dr. Clark and colleagues explained. Its categories correspond to the probabilities of the presence of normal tissue (PUR-1), and D’Amico low-risk (PUR-2), intermediate-risk (PUR-3), and high-risk (PUR-4) prostate cancer.
Dr. Clark’s team found in earlier research that the PUR-4 signature was able to predict disease progression in men on active surveillance for prostate cancer up to 5 years after a single urine sample. For their latest study, they sought to understand the relationship between PUR-4 and the amount and grade of tumor.
On the basis of biopsy samples from 215 men with prostate cancer, the researchers found that PUR-4 signature values correlated significantly with increasing Gleason grade.
There was no significant difference in PSA level by tumor volume for Gleason grade 1, 2, or 3. The same was true for PUR-4 and Gleason grade 1 tumors, which only contain less clinically significant Gleason pattern 3 cancer. However, PUR-4 values in men with Gleason grade 2 tumors larger than the median were significantly greater than for smaller tumors. PUR-4 values for large Gleason grade 3 tumors were also greater than for smaller ones, although the difference did not reach statistical significance.
“Since [Gleason grade] 2 and [Gleason grade] 3 contain both Gleason pattern 3 and 4 cancer these observations suggest that Gleason Pattern 4 cancer may be contributing to PUR-4 status,” the authors wrote.
The researchers also examined radical-prostatectomy specimens from nine men – three with Gleason grade 1, four with Gleason grade 2, and two with Gleason grade 3 tumors, as determined on the basis of presurgical biopsy.
There was no significant correlation between PUR-4 and PSA levels, nor were PUR-4 values linked to total tumor area or Gleason pattern 3 tumor area. But the amount of Gleason pattern 4 tumors showed a strong correlation with PUR-4 values, which did not change after adjusting for total prostate size.
“Our study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy,” Dr. Clark said in an interview. “It could therefore be a very useful tool indeed for assessing a man’s risk of dying from prostate cancer.”
Jack Schalken, PhD, a professor of experimental urology at Radboud University Medical Center in Nijmegen, the Netherlands, called PUR “another test” for prostate cancer the performance of which is in the same range as that of existing products.
“In fact, several tests are commercially available, but the clinical use is surprisingly low,” he told this news organization. Dr. Schalken, who was not involved in the new study, has reviewed several biomarkers for prostate cancer.
The PUR test is now undergoing validation in an international study that is expected to last another 2 years, Dr. Clark said. If successful, the test would stand out for several reasons.
First, it is based on many genes, so it is able to spot malignancies that other tests, which rely on just a few genes, may not pick up. In addition, although it is sensitive to the amount of Gleason pattern 4 tumor, it does not seem to detect the clinically less significant Gleason pattern 3 cancers.
“We have an at-home collection kit – the men do not have to come to a hospital to provide a urine sample,” Dr. Clark said.
The study did not receive commercial funding. Dr. Clark and two coauthors have filed a patent application related to their research.
A version of this article first appeared on Medscape.com.
FROM LIFE
Clinical Edge Journal Scan Commentary: Prostate Cancer November 2021
In the study by Aggarwal et al., the investigators evaluated whether molecular subtypes as identified from biopsies of metastatic tumors in patients with metastatic castrate resistant prostate cancer (mCRPC) could result in improved prediction of response to therapies. In this retrospective study of 4 distinct cohorts, 45% of tumors were classified as luminal and 55% were classified as basal. Luminal tumors exhibited increased expression of androgen receptor pathway genes, and patients with luminal tumors had better survival after treatment with ASI compared with those with basal tumors. Genomic analyses of mCRPC metastases are challenging due to processing issues that can arise if bone decalcification needs to be done; therefore, this study provides an important next step to aid in the design appropriate clinical trials to investigate whether such genomic subtyping results in improved patient outcomes.
In the study by Saad et al, the investigators evaluated whether the addition of the androgen receptor inhibitor apalutamide added to abiraterone would result in a higher radiographic progression free survival (rPFS) compared with abiraterone alone in patients with mCRPC. The combination resulted in an improvement in rPFS (24 versus 16.6 months); however, there was no improvement in overall survival. These results are similar to the Alliance A0321201 study, where enzalutamide was added to abiraterone, and no overall survival was observed. Further study is needed to determine if this combination strategy can work.
Supportive care aside from ASIs or chemotherapy directed against prostate cancer is also of critical importance to patients with metastatic prostate cancer. Previous studies have demonstrated that BMAs, such as denosumab or zoledronic acid, result in the prevention of skeletal-related events (SREs) in patients with mCRPC. However, this same benefit has not been demonstrated in metastatic castrate sensitive prostate cancer (mCSPC); therefore, BMAs are not recommended in this population unless they are at high risk for osteoporotic fracture. Mitchell et al. evaluated a retrospective cohort identified from Surveillance, Epidemiology, and End Results (SEER)-Medicare data to determine the number of patients with likely mCSPC treated with a BMA (defined as prescribed a BMA within 180 or 90 days after initial diagnosis of metastatic disease). A significant number of patients with likely mCSPC were prescribed BMAs within 180 days of diagnosis (23.6% of the cohort) and within 90 days (18.4% of the cohort). It is likely that most of these patients inappropriately received BMAs and were potentially subject to unnecessary costs and toxicity. Further study of strategies to reduce inappropriate BMA use could lead to less toxicity and lower costs.
In the study by Aggarwal et al., the investigators evaluated whether molecular subtypes as identified from biopsies of metastatic tumors in patients with metastatic castrate resistant prostate cancer (mCRPC) could result in improved prediction of response to therapies. In this retrospective study of 4 distinct cohorts, 45% of tumors were classified as luminal and 55% were classified as basal. Luminal tumors exhibited increased expression of androgen receptor pathway genes, and patients with luminal tumors had better survival after treatment with ASI compared with those with basal tumors. Genomic analyses of mCRPC metastases are challenging due to processing issues that can arise if bone decalcification needs to be done; therefore, this study provides an important next step to aid in the design appropriate clinical trials to investigate whether such genomic subtyping results in improved patient outcomes.
In the study by Saad et al, the investigators evaluated whether the addition of the androgen receptor inhibitor apalutamide added to abiraterone would result in a higher radiographic progression free survival (rPFS) compared with abiraterone alone in patients with mCRPC. The combination resulted in an improvement in rPFS (24 versus 16.6 months); however, there was no improvement in overall survival. These results are similar to the Alliance A0321201 study, where enzalutamide was added to abiraterone, and no overall survival was observed. Further study is needed to determine if this combination strategy can work.
Supportive care aside from ASIs or chemotherapy directed against prostate cancer is also of critical importance to patients with metastatic prostate cancer. Previous studies have demonstrated that BMAs, such as denosumab or zoledronic acid, result in the prevention of skeletal-related events (SREs) in patients with mCRPC. However, this same benefit has not been demonstrated in metastatic castrate sensitive prostate cancer (mCSPC); therefore, BMAs are not recommended in this population unless they are at high risk for osteoporotic fracture. Mitchell et al. evaluated a retrospective cohort identified from Surveillance, Epidemiology, and End Results (SEER)-Medicare data to determine the number of patients with likely mCSPC treated with a BMA (defined as prescribed a BMA within 180 or 90 days after initial diagnosis of metastatic disease). A significant number of patients with likely mCSPC were prescribed BMAs within 180 days of diagnosis (23.6% of the cohort) and within 90 days (18.4% of the cohort). It is likely that most of these patients inappropriately received BMAs and were potentially subject to unnecessary costs and toxicity. Further study of strategies to reduce inappropriate BMA use could lead to less toxicity and lower costs.
In the study by Aggarwal et al., the investigators evaluated whether molecular subtypes as identified from biopsies of metastatic tumors in patients with metastatic castrate resistant prostate cancer (mCRPC) could result in improved prediction of response to therapies. In this retrospective study of 4 distinct cohorts, 45% of tumors were classified as luminal and 55% were classified as basal. Luminal tumors exhibited increased expression of androgen receptor pathway genes, and patients with luminal tumors had better survival after treatment with ASI compared with those with basal tumors. Genomic analyses of mCRPC metastases are challenging due to processing issues that can arise if bone decalcification needs to be done; therefore, this study provides an important next step to aid in the design appropriate clinical trials to investigate whether such genomic subtyping results in improved patient outcomes.
In the study by Saad et al, the investigators evaluated whether the addition of the androgen receptor inhibitor apalutamide added to abiraterone would result in a higher radiographic progression free survival (rPFS) compared with abiraterone alone in patients with mCRPC. The combination resulted in an improvement in rPFS (24 versus 16.6 months); however, there was no improvement in overall survival. These results are similar to the Alliance A0321201 study, where enzalutamide was added to abiraterone, and no overall survival was observed. Further study is needed to determine if this combination strategy can work.
Supportive care aside from ASIs or chemotherapy directed against prostate cancer is also of critical importance to patients with metastatic prostate cancer. Previous studies have demonstrated that BMAs, such as denosumab or zoledronic acid, result in the prevention of skeletal-related events (SREs) in patients with mCRPC. However, this same benefit has not been demonstrated in metastatic castrate sensitive prostate cancer (mCSPC); therefore, BMAs are not recommended in this population unless they are at high risk for osteoporotic fracture. Mitchell et al. evaluated a retrospective cohort identified from Surveillance, Epidemiology, and End Results (SEER)-Medicare data to determine the number of patients with likely mCSPC treated with a BMA (defined as prescribed a BMA within 180 or 90 days after initial diagnosis of metastatic disease). A significant number of patients with likely mCSPC were prescribed BMAs within 180 days of diagnosis (23.6% of the cohort) and within 90 days (18.4% of the cohort). It is likely that most of these patients inappropriately received BMAs and were potentially subject to unnecessary costs and toxicity. Further study of strategies to reduce inappropriate BMA use could lead to less toxicity and lower costs.
Prostate cancer: SBRT safe in older patients with baseline anticoagulant use
Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.
Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.
Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.
Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.
Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.
Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.
Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.
Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.
Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.
Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.
Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.
Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.
Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.
Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.
Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.
Prostate cancer: HDR brachytherapy boost linked to lower early toxicity rates
Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.
Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.
Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.
Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.
Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.
Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.
Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.
Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.
Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.
Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.
Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.
Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.
Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.
Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.
Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.
Metastatic prostate cancer: Chemotherapy use and survival have increased in recent years
Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.
Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).
Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).
Disclosures: No funding source was identified for this work. The authors had no competing interests.
Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.
Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.
Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).
Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).
Disclosures: No funding source was identified for this work. The authors had no competing interests.
Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.
Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.
Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).
Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).
Disclosures: No funding source was identified for this work. The authors had no competing interests.
Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.
High real-world use of bone-modifying agents in mCSPC
Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).
Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.
Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.
Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.
Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.
Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).
Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.
Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.
Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.
Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.
Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).
Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.
Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.
Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.
Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.
Androgen-signaling inhibitors extend survival in luminal mCRPC subtype
Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.
Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).
Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.
Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.
Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.
Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.
Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).
Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.
Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.
Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.
Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.
Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).
Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.
Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.
Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.
Metastatic prostate cancer: EBRT has no survival benefit in newly diagnosed elderly
Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.
Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).
Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.
Disclosures: No study source was identified for this work. The authors declared no conflict of interests.
Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.
Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.
Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).
Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.
Disclosures: No study source was identified for this work. The authors declared no conflict of interests.
Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.
Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.
Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).
Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.
Disclosures: No study source was identified for this work. The authors declared no conflict of interests.
Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.
Localized prostate cancer: Robot-assisted laparoscopic prostatectomy safe in long term
Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.
Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).
Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.
Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.
Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.
Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.
Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).
Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.
Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.
Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.
Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.
Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).
Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.
Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.
Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.
Recurrent prostate cancer: Adding abiraterone-prednisone delays PSA progression
Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).
Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).
Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.
Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.
Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.
Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).
Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).
Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.
Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.
Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.
Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).
Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).
Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.
Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.
Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.