Raoul S. Concepcion, MD, FACS

Raoul S. Concepcion, MD, FACS

U.S. Urology Partners

Nolensville, Tennessee

Raoul S. Concepcion, MD, FACS, is the Chief Science Officer of U.S. Urology Partners in Nolensville, Tennessee. He was a resident in General Surgery and Urology at Vanderbilt University from 1984-1990, and later served as a Clinical Associate Professor of Urology there. Dr. Concepcion’s clinical interests revolve around advanced prostate and bladder cancer management. He is a past President of LUGPA. Along with two other urologists, he founded CUSP, a urologic research consortium in the United States. Additionally, he is an advisor and/or speaker for many companies, including Dendreon, Pfizer, Astellas, Amgen, Cellay, and Janssen, and has served as editor for Urologists in Cancer Care.


Speakers Bureau Member: Astellas, Amgen, Pfizer
Advisory Committee Member: Dendreon, Clovis
Consultant: Merck, Invitae, CUSP PharmaTech Consulting, Cellay, Sun Pharmaceutical Industries, Integra Connect
Honorarium Recipient: Dendreon, Clovis, Merck, Invitae, CUSP PharmaTech Consulting, Cellay, Sun Pharmaceutical Industries, Integra Connect

Talks by Raoul S. Concepcion, MD, FACS

Final Results from ACIS Trial of Apalutamide Plus Abiraterone/Prednisone in Patients with Chemo-Naive mCRPC

Raoul S. Concepcion, MD, FACS, Chief Science Officer of U.S. Urology Partners in Nolensville, Tennessee, presents the final results of the ACIS trial, a random double-blind phase III study examining concomitant treatment with apalutamide and abiraterone plus prednisone against abiraterone and androgen deprivation therapy (ADT) in patients with chemotherapy-naïve metastatic castrate-resistant prostate cancer (mCRPC). He provides background, describes the study design and baseline characteristics, and reviews the findings. Dr. Concepcion explains the role of activated androgen receptors and intratumoral androgens in mCRPC. He also describes the concept of androgen annihilation, essentially blocking androgen at both the production and receptor level. The ACIS trial met its primary endpoint, radiographic progression-free survival (rPFS), at a median of 25.7 months of follow up, representing a 31% reduction in risk of radiographic progression or death. The risk reduction was maintained at 30% in long term follow-up at 54.8 months. However, overall survival was similar between treatment arms. Likewise, the secondary endpoints, time to initiation of cytotoxic chemotherapy, time to pain progression, and time to chronic opioid use, were also similar. Lastly, Dr. Concepcion notes that no new safety signals were observed and patient quality of life was comparable between treatment arms.

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Genetic Testing and Prostate Cancer

Raoul S. Concepcion, MD, FACS, Chief Science Officer of U.S. Urology Partners in Nolensville, Tennessee, discusses genomics and DNA repair within the context of prostate cancer treatment to demonstrate the ability of next generation sequencing (NGS) to improve patient outcomes. He begins by giving basic definitions of genetics, genomics, and the genome before sharing data that supports an argument for performing genetic testing. Dr. Concepcion reviews studies on several related topics that all show higher rates of germline mutations in patients with metastatic and/or high-grade cancer. Dr. Concepcion explains that the link between germline mutations and higher rates of metastatic and higher-grade cancer shows that understanding DNA mutations and genomics can improve treatment. He then gives an overview of genomics, explaining how genetic code is formed and behaves and the different types of DNA mutations. He also gives an example of a pathogenic report expressing a nonsense mutation. Dr. Concepcion reviews the American College of Medical Genetics and Genomics (ACMG) classification system and how including testing as a part of treatment plans will improve that system. He then discusses the Knudson “two-hit” model hypothesis, presents data demonstrating that 60% of metastatic cancer patients do not undergo molecular testing, and explains that patients treated with targeted therapies based on genetic testing have 63% longer overall survival than other metastatic patients. Dr. Concepcion concludes by observing that an understanding of modern-day genomics and DNA repair is crucial to improving treatment.

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The Effect of Local Antibiogram-Based Augmented Antibiotic Prophylaxis on Infection-Related Complications Following Prostate Biopsy

Raoul S. Concepcion, MD, FACS, and E. David Crawford, MD, discuss a recent study Dr. Concepcion was involved with that looked at antibiotic-augmented prophylaxis based on local antibiograms as a method of reducing infections from prostate biopsies. They discuss the design and rationale of the study and methods for administering the prophylaxis, as well as the results, which showed a 53% reduction in infectious complications compared to historical data.

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New Considerations for Oligometastatic Prostate Cancer

Raoul S. Concepcion, MD, FACS, discusses the management of patients with oligometastatic prostate cancer. Currently, there is no standard definition of what defines oligometastatic.  Additionally, questions remain about the handling of the primary tumor in this setting, as well as whether therapy directed at the primary has a long term benefit in overall survival.

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