Roswell Park Comprehensive Cancer Center Archives

A Better Abiraterone: The Backdoor Pathway for Intracrine Androgen Metabolism

Posted by James L. Mohler, MD | Jul 2020

James L. Mohler, MD, Associate Director and Senior Vice President for Translational Research and Professor of Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, New York, discusses the cause of and potential solutions to androgen receptor expression in castration-recurrent prostate cancer. He explains that prostate cancer tissue in a patient with castration-recurrent disease actually has greater levels of testosterone than benign prostate tissue and that castration-resistant prostate cancer relies on a backdoor pathway of manufacturing testosterone by which dihydrotestosterone (DHT) is made from androstanediol. Abiraterone is intended to inhibit CYP17A1 and therefore prevent the manufacture of DHT, but Dr. Mohler suggests that abiraterone inhibits CYP17A1 that is too far from DHT synthesis to achieve long term response by inhibition. He then discusses current research about a promising drug that targets the catalytic domain shared by the five 3α-oxidoreductases associated with DHT production.

Biochemical Recurrence After Local Therapy: Assessment and Management

Posted by Peter R. Carroll, MD, MPH | Feb 2020

Peter R. Carroll, MD, MPH, Taube Family Distinguished Professor in Urology, Department of Urology at the University of California, San Francisco, outlines detection and treatment options for biochemical recurrence following a prostatectomy or radiation therapy. He details how recurrence can be detected with PSMA PET imaging, as the majority of cases have PSMA-avid lesions present. Dr. Carroll further notes typical and atypical regional and local areas of recurrence. He also describes a new disease management algorithm for deciding between further radiation therapy or monitoring & localized treatment.

Treating a Patient Denied Coverage Based on Not Conforming to NCCN Guidelines

Posted by James L. Mohler, MD | Feb 2020

James L. Mohler, MD, Chair of the National Comprehensive Cancer Network (NCCN) Prostate Panel, discusses approaches for urologists dealing with insurance coverage denial for patients who do not fit within NCCN guidelines for prostate cancer. He outlines the iterative, bias-free process of creating the guidelines, which allows for a quick response to the latest research. Dr. Mohler further details how the guidelines value efficacy, quantity/quality of evidence, consistency of evidence, and safety above affordability, and how this can lead to denial of coverage. He then outlines talking points for overcoming guideline-based reasons for rejection from insurance providers.

Current NCCN Recommendations for Prostate Cancer Genetic Testing

Posted by James L. Mohler, MD | Jan 2020

James L. Mohler, MD, discusses the rationale and development of the 2019 NCCN guideline recommendations on genetic testing for prostate cancer. He details the workflow for developing these guidelines and changes for 2019, outlines a new decision-making algorithm for how and when men should be tested, and lays out the panel’s goals and challenges for improving genetic testing.