AUA 2018: Panel Discusses New Research on Prostate Cancer Management Protocols and Treatments

Key Points

  • When compared to the da Vinci robotic surgical system, the Revo-i had similar intra- and perioperative findings, but had a longer console time.
  • Results showed with a mean follow-up of approximately 4 years, in men also treated with testosterone therapy, biochemical recurrence was observed in six men after radical prostatectomy (6.5%), in two men after radiotherapy (2.0%) and in two men after high-intensity focused ultrasound.
  • A substantial proportion of men with low-risk prostate cancer can safely follow a deintensified active surveillance protocol, which would improve the tolerability, safety, and cost-effectiveness of this treatment option.

Researchers presented new findings on a Korean Food and Drug Administration (KFDA)-approved robotic system, safety of testosterone therapy after prostate cancer, and active surveillance protocol for low-risk prostate cancer patients at the 113th Annual Meeting of the American Urological Association (AUA).

Revo-i Surgical Robotic System

This is the first study on the Revo-i robotic surgical system for radical prostatectomy in humans (Abstract MP16-08). Doctors performed surgery on 17 men with a mean age of 69 years using the August 2017 KFDA-approved surgical robotic system.

When compared to the da Vinci robotic surgical system, the Revo-i had similar intra- and perioperative findings, but had a longer console time (106.9±29.3 min vs 77.3±15.5 min, P < .001).

Results from the study showed no serious complications. One patient received blood during surgery and two required a blood transfusion postsurgery. The average hospital stay was 5 days.

Recurrence Rates Following Testosterone Therapy in Prostate Cancer

Limited evidence regarding the safety of testosterone therapy in men with a history of prostate cancer prompted researchers to explore recurrence rates in men who were either diagnosed or underwent prostate cancer treatment followed by testosterone therapy (Abstract MP17-03).

Researchers identified nearly 200 men with a mean age of 68 years who received testosterone therapy via transdermal gels/liquids, short- and long-acting injections, and/or pellets. Prostate cancer treatments included radical prostatectomy, radiotherapy, high-intensity focused ultrasound, and active surveillance.

Biochemical recurrence (BCR) was defined as PSA 0.3 ng/ml or higher after radical prostatectomy, and PSA nadir plus 2 ng/ml after radiotherapy. For men on active surveillance, progression was defined as any biopsy showing a higher Gleason score than initial diagnosis.

Results showed with a mean follow-up of approximately 4 years, biochemical recurrence was observed in six men after radical prostatectomy (6.5%), in two men after radiotherapy (2.0%) and in two after high-intensity focused ultrasound. Progression was noted in two men on active surveillance (3.5%). Recurrence rates from this study were consistent with published recurrence/progression rates for the various forms of prostate cancer management.

When Can Active Surveillance be Less Active?

Active surveillance is increasingly becoming the preferred management strategy for men with low-risk prostate cancer. However, nearly all active surveillance protocols entail PSA testing every 3 to 6 months and prostate biopsies every 1 to 2 years. For many men with small volume and slow-growing prostate cancer, this regimen can be overly intense and may expose them to the discomfort, risks, and costs associated with repeat biopsies.  Researchers set out to determine if some men can be safely selected for a less intense active surveillance regimen by predicting the probability of nonreclassification over the next 4 years of active surveillance (Abstract PD20-01).

Using data collected from the multicenter Canary Prostate Active Surveillance Study, researchers developed a risk prediction model assessed at a measurement time of 1 year postdiagnosis to calculate the risk of reclassification (defined as an increase in their Gleason score) at 4 years following diagnosis.

Results showed:

  • Men at the lowest risk of cancer progression faced a 6% (95% confidence interval [CI] = 0%–12%) risk of reclassification within 4 years, and men at the highest risk faced a 73% (95% CI = 55%–84%) risk of reclassification within 4 years.
  • A substantial proportion of men with low-risk prostate cancer can safely follow a deintensified active surveillance protocol, which would improve the tolerability, safety, and cost-effectiveness of this treatment option.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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