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Prostate Cancer
Issues in Oncology

A Gleason 6 Tumor: Is It Cancer, and Should It Be Treated?

The diagnosis and treatment of prostate cancer have long been a source of controversy among the oncology community, the political sector, and patient advocacy groups. Most notably, the decision to biopsy a man’s prostate gland rests largely on his prostate-specific antigen (PSA) test numbers, the...

Prostate Cancer

Long-Term Effects of Finasteride in Patients From the Prostate Cancer Prevention Trial

In the Prostate Cancer Prevention Trial finasteride was found to reduce the risk of low-grade prostate cancer but to have no effect on overall survival. Results of the trial, in which 18,880 men were randomized to receive finasteride or placebo for 7 years, were reported in 2003. In a recent study...

Issues in Oncology
Lung Cancer
Gastrointestinal Cancer
Prostate Cancer
Colorectal Cancer

At ESMO 2016, Many Phase III Trials Fail to Meet Primary Endpoints

The 2016 European Society for Medical Oncology (ESMO) Congress revealed many important positive findings from key trials in a number of tumor types, but many highly anticipated phase III trials in advanced disease failed to meet their primary endpoints. The ASCO Post has summarized several of these ...

prostate cancer
sarcoma

Link Between Molecular Mechanisms in Prostate Cancer and Ewing Sarcoma Found

Medical researchers at Indiana University (IU) Bloomington have found evidence for a link between prostate cancer, which affects millions of men aged 50 and older, and Ewing's sarcoma, a rare form of cancer that affects children and young adults. The results of the study, reported by Kedage et al...

Prostate Cancer

Similar Functional Outcomes With Robot-Assisted Laparoscopic and Open Radical Retropubic Prostatectomy

Robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy yielded similar domain-specific quality-of-life or pathologic outcomes at 12 weeks in men with newly diagnosed, clinically localized prostate cancer, according to the results of a randomized phase III trial reported ...

Prostate Cancer

Prognostic and Predictive Molecular Subtypes of Prostate Cancer Identified

Members of the oncology community have long complained that prostate cancer lags behind breast cancer regarding biomarkers for prognosis and treatment, but the good news is that this gap is narrowing. In the largest study of its kind to date, presented at the 58th Annual Meeting of the American...

Prostate Cancer

Safety of Extreme Hypofractionation Reassuring in Intermediate-Risk Prostate Cancer

Giving patients larger fractions of radiation over shorter periods (ie, hypofractionation) is gaining ground in several types of cancers. This approach is attractive for patients’ convenience, shortening treatment and travel times, and also for resource utilization. Several studies have shown that ...

prostate cancer

Christopher J. Sweeney, MBBS, on Prostate Cancer: CHAARTED Trial Follow-up

Christopher J. Sweeney, MBBS, of the Dana-Farber Cancer Institute, discusses how long-term study results showed no survival benefit in men with ogliometastatic prostate cancer. (Abstract 720PD)

prostate cancer

Christopher J. Sweeney, MBBS, on Localized Prostate Cancer: Metastasis-Free Survival as a Surrogate for Overall Survival

Christopher J. Sweeney, MBBS, of the Dana-Farber Cancer Institute, discusses how this early clinical endpoint will accelerate the development of new therapies for localized intermediate and high-risk prostate cancer. (Abstract 717O)

Prostate Cancer

Surgery and Radiation ProtecT Against Progression/Metastasis vs Active Monitoring in Prostate Cancer, but at What Cost?

The ProtecT trial showing similar 10-year survival with active monitoring, surgery, or radiotherapy for prostate-specific antigen (PSA)-detected localized prostate cancer but a greater risk of disease progression/metastasis with monitoring was recently reported by Hamdy and colleagues and is...

Prostate Cancer

Risk of Metastasis With Active Monitoring in PSA-Detected Localized Prostate Cancer: The ProtectT Trial

The ProtecT study findings1 are provocative. Despite having a control arm of active monitoring with serial prostate-specific antigen (PSA) testing, as compared with watchful waiting in the prior randomized trials (ie, SPCG-42 and PIVOT3), and also enrolling men with more favorable-risk disease...

Prostate Cancer

Similar 10-Year Survival With Active Monitoring, Surgery, or Radiotherapy for PSA-Detected Clinically Localized Prostate Cancer

In the UK ProtecT trial reported in The New England Journal of Medicine, Freddie C. Hamdy, FRCS, FMedSci, of the University of Oxford, and colleagues found no significant differences in prostate cancer–specific or overall mortality among men with clinically localized prostate cancer detected by...

prostate cancer
issues in oncology

Study Reports No Association Between Vasectomy and Prostate Cancer Incidence or Mortality

In an analysis of the Cancer Prevention Study II (CPS-II) study cohort reported in the Journal of Clinical Oncology, Jacobs et al found no significant association between vasectomy and overall prostate cancer incidence or mortality. A recent prospective study had shown an association of vasectomy...

prostate cancer

Paul L. Nguyen, MD, on Prostate Cancer: High-Risk Disease, Brachytherapy, And Hormones

Paul L. Nguyen, MD, of the Dana-Farber Cancer Institute, summarizes a session he moderated, which included talks on local recurrence following brachytherapy, long-term PSA stability after the procedure, and androgen deprivation and high-dose radiotherapy. (Scientific Session 41)

prostate cancer

Bradley R. Prestidge, MD, on Prostate Cancer: Initial Findings of NRG Oncology/RTOG 0232

Bradley R. Prestidge, MD, of Bon Secours VA Health System, summarizes his plenary lecture on this phase III trial comparing combined external beam radiation and transperineal interstitial permanent brachytherapy with brachytherapy alone for selected patients with intermediate-risk prostate cancer. (Plenary Lecture 1, Presentation 7)

prostate cancer

Alan Pollack, MD, PhD, on Prostate Cancer: Postprostatectomy Radiotherapy

Alan Pollack, MD, PhD, of the University of Miami Health System, summarizes a session that included discussion of outcomes, dose response, oligometastatic disease, and gene predictor of response. (Presentations 228-235)

prostate cancer

Anders Widmark, MD, PhD, on Intermediate-Risk Prostate Cancer: Results From the HYPO-RT-PC Trial

Anders Widmark, MD, PhD, of the Umea University Hospital Oncology, discusses the early toxicity results from the phase III Scandinavian study on extreme hypofractionation vs conventionally fractionated radiotherapy for intermediate-risk prostate cancer. (Abstract LBA-5)

prostate cancer

Daniel Hamstra, MD, PhD, on Prostate Cancer: Decreasing Rectal Toxicity

Daniel A. Hamstra, MD, PhD, of Texas Oncology, discusses phase III findings on the use of an absorbable hydrogel spacer designed to decrease rectal toxicity and improve bowel quality of life for patients with prostate cancer. (Abstract LBA-6)

Prostate Cancer

Large Study Finds No Link Between Vasectomy and Prostate Cancer Risk

In a new study, men who underwent vasectomy did not have an increased risk of prostate cancer, nor were they more likely to die from prostate cancer than men who did not receive this procedure. According to the researchers, this is the largest prospective study of vasectomy and fatal prostate...

Prostate Cancer

Testosterone-Related Genetic Mutation Associated With Poorer Survival in Prostate Cancer

A collaborative Cleveland Clinic–Mayo Clinic team of researchers has shown for the first time that patients with advanced prostate cancer are more likely to die earlier of their disease if they carry a specific testosterone-related genetic abnormality. The findings, published by Hearn et al in The...

Prostate Cancer

Continuation of Docetaxel May Improve Survival in Metastatic Castration-Resistant Prostate Cancer

The number of docetaxel cycles completed was associated with improved overall survival among men with metastatic castration-resistant prostate cancer receiving docetaxel, prednisone, and lenalidomide (Revlimid) or docetaxel/prednisone, in the phase III Mainsail trial. de Morrée et al reported this ...

Bladder Cancer
Kidney Cancer
Prostate Cancer

Multitude of Mentors Help Shape an Illustrious Career in Oncology

Sumanta K. Pal, MD, has had a longer career in oncology than many other colleagues his age. Perhaps the reason for that may center on his starting college at the age 13 and medical school at the age of 17. Today this internationally recognized leader in genitourinary cancers is Assistant Professor ...

Prostate Cancer

Hypofractionated Radiotherapy for Localized Prostate Cancer: A New Standard of Care?

For at least the past quarter of a century, radiobiologists and radiation oncologists have debated the role of hypofractionation (fewer total fractions with a higher dose per fraction) for prostate cancer. The debate stems from the unique radiobiology of prostate cancer and the best means to...

Prostate Cancer

European Studies Compare Conventional vs Hypofractionated Radiotherapy for Localized Prostate Cancer

Two recent European phase III trials with different study designs focused on hypofractionated vs conventional radiotherapy in localized prostate cancer. Investigators in the CHHiP trial1 showed that the hypofractionated approach is noninferior to standard fractionation, with no increase in side...

Prostate Cancer

Hypofractionated Radiotherapy: Balancing Benefits vs Risks in Men With Localized Prostate Cancer

Radiation for prostate cancer typically requires 40 to 45 daily treatments, given over 8 to 9 weeks. Long fractionation schemes are chosen for most cancers, because they allow for tumor killing while reducing the potential for injury to normal tissue. However, the radiobiology of prostate cancer...

Prostate Cancer

Hypofractionated Radiotherapy Not Inferior to Conventional Radiotherapy in Low-Risk Prostate Cancer

In a phase III noninferiority trial (NRG Oncology RTOG 0415) reported in the Journal of Clinical Oncology, W. Robert Lee, MD, MS, Med, of Duke University Medical Center, and colleagues found that hypofractionated radiotherapy was not inferior to conventional radiotherapy in disease-free survival...

Prostate Cancer

Hypofractionation May Be Poised to Become New Standard of Care for Prostate Cancer

There has been an ongoing debate about which type of radiation therapy is preferable in the treatment of localized prostate cancer: hypofractionation (larger fractions given over 4–5 weeks) or conventional radiotherapy (given over 8–9 weeks). A new study presented at the 2016 ASCO Annual Meeting...

solid tumors
prostate cancer

No Survival Benefit for Cabozantinib Reported in Previously Treated Metastatic Castration-Resistant Prostate Cancer

Smith et al found no improvement in overall survival with cabozantinib (Cometriq) vs prednisone in patients with previously treated metastatic castration-resistant prostate cancer, in the phase III COMET-1 trial reported in the Journal of Clinical Oncology. Cabozantinib, which inhibits MET, VEGF...

Prostate Cancer

Novel Approach to PET/CT Imaging May Predict Location and Extent of Primary Prostate Cancer

With surgical removal at the front line of defense against prostate cancer, oncologists are considering prostate-specific molecular imaging at the point of initial biopsy and preoperative planning to root out the full extent of disease, researchers showed at the 2016 Annual Meeting of the Society...

Prostate Cancer

FDA Approves New Diagnostic Imaging Agent to Detect Recurrent Prostate Cancer

On May 27, the U.S. Food and Drug Administration (FDA) approved fluciclovine F-18 (Axumin), a radioactive diagnostic agent for injection. Fluciclovine F-18 is indicated for positron-emission tomography (PET) imaging in men with suspected prostate cancer recurrence based on elevated...

Prostate Cancer

Increased Survival and Toxicity With Docetaxel, No Benefit of Zoledronic Acid, When Added to First-Line Hormone Therapy in Prostate Cancer

As reported in The Lancet by Nicholas D. James, BSc, MBBS, PhD, of the University of Warwick, and colleagues, survival results of the STAMPEDE trial, which used a multiarm, multistage seamless phase II/III design, provide little evidence of benefit of zoledronic acid and showed increased survival ...

Prostate Cancer

Prostate Cancer: Opinions Vary on Gleason Scores and Surgery

Diagnosis and treatment of prostate cancer have been the source of heated debate for decades, most of which has centered on the clinical value of the prostate-specific antigen (PSA) test. In 2012, the U.S Preventive Services Task Force (USPSTF) gave the PSA test a D grade, which discourages many...

prostate cancer

Toni K. Choueiri, MD, and Paul L. Nguyen, MD, on Prostate Cancer: Expert Perspectives on Four Studies

Toni K. Choueiri, MD, and Paul L. Nguyen, MD, both of the Dana-Farber Cancer Institute, discuss four key studies on high- and intermediate-risk prostate cancer, as well as localized disease (Abstracts 5001, 5003, 5023, and 5021).

Prostate Cancer

Chemotherapy After Radical Prostatectomy May Benefit African Americans and High-Risk Patients

A new U.S. Department of Veterans Affairs (VA) study suggests that African American men and men with a higher tumor stage may benefit from adjuvant chemotherapy following radical prostatectomy.1 According to prespecified analysis of these two “high–risk” subgroups, patients with ≥ T3b disease had a ...

prostate cancer

Celestia S. Higano, MD, and Chris Parker, MD, on the PROMIS Study of Elevated PSA

Celestia S. Higano, MD, of the University of Washington, and Chris Parker, MD, of the Royal Marsden Hospital, discuss findings from this confirmatory study evaluating the accuracy of MRI and TRUS biopsy in men with an elevated PSA (Abstract 5000).

prostate cancer

A. Oliver Sartor, MD, and Celestia S. Higano, MD, on Findings of the FIRSTANA Trial in Prostate Cancer

A. Oliver Sartor, MD, of Tulane University, and Celestia S. Higano, MD, of the University of Washington, discuss findings from this phase III study on cabazitaxel vs docetaxel in chemotherapy-naive patients with metastatic castration-resistant prostate cancer (Abstract 5006).

Prostate Cancer
Geriatric Oncology

Significant Increased Risk of Noncancer Hospitalization Following Diagnosis of Prostate Cancer in the Elderly

Elderly men had a significant increase in the risk of noncancer hospitalizations following the diagnosis of prostate cancer, according to a population-based retrospective cohort study conducted by Amit D. Raval, PhD, and colleagues at West Virginia University, Morgantown. Results were published in...

Breast Cancer
Prostate Cancer
Hematologic Malignancies

Highlights From the 2016 AACR Annual Meeting

This year’s Annual Meeting of the American Association for Cancer Research (AACR) featured outstanding research in the field of cancer, as well as an inspiring talk by Vice President Joe Biden (see the May 10 issue of The ASCO Post). Here are some summaries of studies that warrant attention; they...

Gynecologic Cancers
Multiple Myeloma
Skin Cancer
Pancreatic Cancer
Lung Cancer
Prostate Cancer
Breast Cancer
Survivorship

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): 2016 Guidelines

In 1996, the National Comprehensive Cancer Network (NCCN®) published its first set of Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), covering eight tumor types. The NCCN Guidelines® are now published for more than 60 tumor types and topics. Some of the key updates for 2016 were...

Prostate Cancer

Moving Forward in Castration-Resistant Prostate Cancer: The TERRAIN and STRIVE Studies

It was over 2 decades ago that my colleagues and I reported in The New England Journal of Medicine that a first-generation oral antiandrogen, flutamide, when added to a luteinizing hormone–releasing hormone (LHRH) agonist, improved survival by nearly 6 months compared to an LHRH agonist alone in...

Prostate Cancer

Enzalutamide Produces Large Progression-Free Survival Benefit vs Bicalutamide in Two Trials in Castration-Resistant Prostate Cancer

In the randomized phase II TERRAIN trial reported in The Lancet Oncology, Neal D. Shore, MD, of Carolina Urologic Research Center, Myrtle Beach, and colleagues found that use of the androgen receptor inhibitor enzalutamide (Xtandi) more than doubled median progression-free survival vs bicalutamide...

Prostate Cancer

Severe Adverse Event Clusters Identified Using NCI Common Terminology Criteria

Using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE), researchers from Columbia University, New York, and Fred Hutchinson Cancer Research Center, Seattle, identified six severe adverse event clusters in patients with advanced prostate cancer. The clusters...

Prostate Cancer

Choline Kinase Alpha as Androgen Receptor Chaperone and Prostate Cancer Target

As reported in the Journal of the National Cancer Institute, Asim and colleagues found that choline kinase alpha (CHKA) acts as a chaperone for the androgen receptor (AR) and may serve as a therapeutic target in prostate cancer. CHKA expression was found to be androgen regulated in cell lines,...

Prostate Cancer

Active Surveillance Has Become Standard Care for Men With Low-Risk Localized Prostate Cancer

Active surveillance has been increasingly adopted as a standard approach for men with Gleason score ≤ 6 localized prostate cancer, with major guidelines and consensus statements encouraging this approach,1 including a recently published guideline from Cancer Care Ontario (CCO),2 and endorsement of...

Prostate Cancer

ASCO Endorses Cancer Care Ontario Guideline on Active Surveillance for Management of Localized Prostate Cancer

As reported by Ronald C. Chen, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues in the Journal of Clinical Oncology, ASCO has endorsed, with qualifications, the 2015 Cancer Care Ontario (CCO) guideline on active surveillance for management of localized prostate cancer....

Prostate Cancer

Decreased PSA Screening and Decreased Diagnosis of Early-Stage Prostate Cancer

Recent data indicate that the rate of prostate-specific antigen (PSA) screening and the rate of diagnosis of early-stage prostate cancer have decreased since a 2012 U.S. Preventive Services Task Force (USPSTF) statement (released in October 2011) gave a grade D recommendation against PSA...

Prostate Cancer

Throwing Out the Baby With the Bathwater: A Critical Appraisal of the USPSTF Recommendation Against Screening for Prostate Cancer

In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against routine screening for prostate cancer.1,2 The grade D recommendation was considered controversial at the time, and remains so now, because many stakeholders have weighed the same body of evidence and come to...

solid tumors
prostate cancer

Survival Differs With Metastatic Site in Castration-Resistant Prostate Cancer

Overall survival differed according to the site of metastases in men with castration-resistant prostate cancer, according to a meta-analysis reported in the Journal of Clinical Oncology by Halabi et al. Study Details The study involved data from 8,820 men who received docetaxel chemotherapy in...

Prostate Cancer

New High-Intensity Focused Ultrasound Advances Treatment for Prostate Cancer

For the estimated 220,000 men who will be diagnosed with prostate cancer this year, deciding on a method of treatment can be a challenge. Some with early-stage cancer pursue active surveillance, while others with more severe cancer immediately pursue surgery, including prostatectomy. Others fall...

Prostate Cancer

Biomarkers in Prostate Cancer: PARP Inhibitors and Defects in DNA Repair

New data on molecular biomarkers in advanced prostate cancer are accumulating at a fast pace. The studies in this area can now be broadly grouped in two distinct areas—those that broadly relate to androgen signaling and those that relate to DNA-repair pathways. The Androgen-Signaling Pathway With...

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