Mayo Clinic Archives

Novel Targeted Treatments for Metastatic Disease

Posted by Alan H. Bryce, MD | Nov 2023

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, discusses the limitations of traditional treatments for metastatic prostate cancer, such as androgen deprivation therapy (ADT) and chemotherapy, which, while effective initially, often lead to resistance and progression. He emphasizes the need for innovative approaches that target specific molecular pathways involved in prostate cancer growth and metastasis.
He highlights several promising targeted therapies currently under investigation. One is the use of PARP inhibitors, such as olaparib and rucaparib, which target cancer cells with defective DNA repair mechanisms, particularly those with BRCA1/2 mutations. Dr. Bryce also discusses the role of androgen receptor (AR) pathway inhibitors, including novel agents like enzalutamide and enzalutamide, which provide more potent and selective inhibition of AR signaling than traditional ADT.
Dr. Bryce switches focuses to radiopharmaceuticals, such as lutetium-177 (Lu-177) PSMA-617, which deliver targeted radiation to prostate-specific membrane antigen (PSMA)-expressing cells. Clinical trials indicate that this approach can effectively reduce tumor burden and improve clinical outcomes in patients with advanced prostate cancer. Additionally, he explores the potential of immunotherapies, including immune checkpoint inhibitors and vaccines, in treating metastatic prostate cancer.

Management of mHSPC-Singlets and Doublets and Triplets

Posted by Alan H. Bryce, MD | Nov 2023

Alan H. Bryce, MD, discusses metastatic hormone-sensitive prostate cancer (mHSPC) and the importance of early and effective treatment to improve patient outcomes. While singlet therapy, which typically involves androgen deprivation therapy (ADT) alone, has been the traditional approach, newer evidence supports the use of combination therapies.
Data on doublet therapy, combining ADT with either chemotherapy or a novel hormonal agent such as abiraterone, enzalutamide, or apalutamide, have demonstrated significant improvements in overall survival and progression-free survival compared to ADT alone. Key studies, including the LATITUDE and CHAARTED trials, have established the efficacy of these doublet regimens.
Dr. Bryce also explores adding a second novel agent or chemotherapy to the ADT and initial novel agent combination (triplet therapy). He notes that while triplet therapy may offer further survival advantages, it also carries an increased risk of side effects and requires careful patient selection and management.

Updates in Advanced Prostate Cancer

Posted by Alan H. Bryce, MD | Oct 2023

Alan H. Bryce, MD, reviews the current landscape of advanced prostate cancer treatment. Dr. Bryce begins by addressing the dwindling access to second-line treatment options as patients progress through therapy lines.

He then reviews findings from the STAMPEDE study, which explored the use of combination therapy involving ADT and abiraterone for high-risk prostate cancer patients. Dr. Bryce endorses this kind of combination therapy, highlighting its effect on overall survival rates.

Finally, Dr. Bryce touches on treatment intensification for patients with MHSC-9 positivity. Using a data-driven approach, he recommends combination therapy and the potential role of triplet regimens.

Point-Counterpoint: Holmium vs. Thulium Laser – Thulium

Posted by Karen L. Stern, MD | Oct 2023

Karen L. Stern, MD, discusses the advantages of the thulium fiber laser (TFL) compared to the holmium laser. She highlights the increased irrigation, visibility, and flexibility of the technology, emphasizing its ablation capabilities and citing studies from the American Urological Association and the European Association of Urology.

Dr. Stern addresses TFL concerns and notes the increased convenience, hearing safety, and cost-effectiveness of TFL. She also encourages utilizing thulium fiber laser enucleation of the prostate (ThuFLEP) rather than holmium laser enucleation of the prostate (HoLEP), noting ThuFLEP’s increased water absorption ability and hemostatic approach.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Holmium vs. Thulium Laser – Holmium.”

Point-Counterpoint: Mini-PCNL vs. Standard PCNL– Mini-PCNL

Posted by Karen L. Stern, MD | Sep 2023

Karen L. Stern, MD, explores the improved postoperative outcomes and increased cost-effectiveness of mini percutaneous nephrolithotomy (PCNL) compared to standard PCNL. Dr. Stern continues by pinpointing the specific advantages of mini PCNL, citing that blood loss, blood transfusion, and hospitalization rates all favor mini PCNL according to recent 2022 studies.

Dr. Stern notes that, while stone-free rates and fever rates are equivalent between mini and standard PCNL, meta-analyses comparing the outcomes of mini and standard PCNL tend to favor mini PCNL, even with larger kidney stones. Dr. Stern closes by exploring the capabilities of plastic vacuum sheaths and lower lithotripsy times of mini PCNL, emphasizing efficient stone removal and lower fever rates over that of standard.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Mini PCNL vs. Standard PCNL – Standard PCNL.”