David Utz

David Utz

Disclosures:

Talks by David Utz

Industry Perspective: ConfirmMDx and Improving the Identification of Men at Risk for Clinically Significant Prostate Cancer

Wim Van Criekinge, PhD, Professor of Computational Genomics and Bioinformatics at Ghent University in Ghent, Belgium, and Chief Scientific Officer for MDxHealth in Ghent, discusses ConfirmMDx, a test for prostate cancer from MDxHealth which uses tissue from a negative biopsy. He explains that prostate biopsies have a false negative rate of 25% since they only sample a very small percentage of the prostate and can miss the cancer entirely. ConfirmMDx, Dr. Van Criekinge notes, leverages the fact that cancer originates from changes in DNA which create a halo or field effect around the actual tumor. He details the specific ConfirmMDx genes, all of which were previously cited in a prognostic context, and explains that negative cores that are proximal to cancer will show up positive on ConfirmMDx. Dr. Van Criekinge highlights that ConfirmMDx, which has a negative predictive value of 96%, outperforms traditional methods like age, PSA, atypia, and the PCPT Risk Calculator 2.0 in identifying men harboring aggressive cancer. He also emphasizes the test’s accessibility and low cost, noting that the vast majority of patients are responsible for paying $250 or less. Dr. Van Criekinge concludes by detailing the clinical information required for the ConfirmMDx test, including PSA and DRE result, PSA and DRE date, and the pathology report, adding the caveat that tissue more than 30 months old may be rejected.

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Industry Perspective: The Role of URO17 ™ in the Diagnosis and Management of Bladder Cancer

John Cucci, an executive at Acupath Laboratories, Inc., introduces the URO17TM antibody, a promising adjunct to cytology for bladder cancer diagnosis. Mr. Cucci explains that while cytology is the standard technique used in diagnosing bladder cancer and has a high positive predictive value, its sensitivity is low. URO17TM detects the expression of keratin-17, a protein strongly associated with bladder cancer, and has greater than 95% sensitivity and specificity. Mr. Cucci goes over the promising early results for URO17TM, as discussed in several papers, and notes that it has been given an expedited clinical trial process by the FDA. He also looks at its potential clinical utilization, both as a screening tool for hematuria patients and as a long-term monitoring tool for bladder cancer patients after they complete therapy. He emphasizes that URO17TM can cheaply and effectively provide additional and reliable information for the pathologist and urologist to more appropriately rule in or out additional diagnostic work-up in patients. Mr. Cucci concludes by presenting a graphic of the URO17TM diagnosis categories and risk meter.

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Focal Therapy Compared to Radical Prostatectomy

Steven N. Gange, MD, FACS, Director of Research and Education at Granger Medical Clinic/Summit Urology Group, reviews a propensity score-matched study comparing focal therapy (FT) for localized prostate cancer to radical prostatectomy (RP). Dr. Gange explains that, until now, this information has never been reported, as randomized controlled trials (RCTs) comparing RP to FT methods such as high-intensity focused ultrasound (HIFU), brachytherapy, or cryotherapy have historically failed to enroll and could be considered unethical given the disparity of risk. By using propensity score matching, the researchers for this study roughly simulated an RCT by selecting patients with matching entry criteria from a diverse dataset, ultimately testing 246 patients on each respective side. The primary outcome was failure-free survival, and Dr. Gange notes that at 3, 5, and 8 years the results were similar for both cohorts. Each cohort also had similar biochemical and histopathological outcomes. Dr. Gange concludes that this appears to be a reasonable comparison between RP and FT, but observes that there are some limitations to the study, including an inability to account for confounding variables and to adjust for baseline urinary and sexual function, as well as a lack of long-term outcomes.

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Men with High-Risk Prostate Cancer Should Not Undergo Neoadjuvant Therapy Prior to Surgery

J. Kellogg Parsons MD, MHS, FACS, Professor of Urology at the University of California, San Diego, explains why neoadjuvant therapy prior to surgery may not be the best option for prostate cancer patients. He reviews findings from definitive randomized clinical trials that show ADT does not improve survival, and addresses common side effects, such as cognitive impairment and loss of testosterone function. Dr. Parsons then explains AUA Clinical Guidelines published in alignment with SUO and ASTRO that strongly recommend against routine neoadjuvant therapy prior to surgery. Lastly, he gives examples of when physicians can consider the option despite such caveats.

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