Los Angeles Archives

Neoadjuvant Trials in High Risk Prostate Cancer: A Must Do for the Field

Posted by Robert E. Reiter, MD, MBA | Apr 2021

Robert E. Reiter, MD, MBA, Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, and Principal Investigator of UCLA’s SPORE (Specialized Program in Research Excellence) program, argues for supporting neoadjuvant trials in high-risk prostate cancer as a key way to improve treatment results. He explains that ⅓ of high-risk patients die from their cancer, citing this as evidence that high-risk prostate cancer management must improve. Dr. Reiter then reviews several trials, beginning with CaLGB 90203, a neoadjuvant chemohormonal therapy study which found that over the course of ten years neoadjuvant patients experienced an 80% survival probability, while patients who were treated with only surgery experienced a 74% survival probability. He analyzes an assortment of phase II trials exploring whether more intensive androgen ablation can improve the short-term results of, for example, pathologic complete responses. These trials found that the complete response rates increased from 4% to 14% over the course of 12 weeks with no biochemical recurrences. Dr. Reiter continues by drawing attention to the current phase 3 PROTEUS trial, which should clarify whether or not pathologic complete response is a valid endpoint. He concludes with a discussion of the beneficial findings of pure translational neoadjuvant studies.

Image-Guided Minimally-Invasive Whole Gland Treatment

Posted by Steven S. Raman, MD | Mar 2021

Steven S. Raman, MD, Clinical Professor of Radiology and Director of Prostate MR Imaging and Interventions at the David Geffen School of Medicine of the University of California, Los Angeles, explains how magnetic resonance imaging (MRI) aids in prostate cancer staging, diagnosis, follow-up, treatment planning, and image-guided treatment. After reviewing relevant FDA guidelines, Dr. Raman outlines the MRI-guided transurethral ultrasound ablation (TULSA)-PRO® treatment planning and delivery process, noting the potential for real-time MR thermometry and feedback control. To further display benefits of the treatment, he reviews outcomes from the TACT trial. He then addresses potential next steps in prostate tissue ablation.

Germline Genetics and Prostate Cancer Evolution and Aggressivity

Posted by Paul Boutros, PhD, MBA | Feb 2021

Paul C. Boutros, PhD, MBA, Professor of Human Genetics and Urology at the University of California, Los Angeles, explains the relationship between the germline and cancer evolution, as well as the implications this relationship has for screening and care. Dr. Boutros begins by explaining why it makes sense to study the germline, noting that while cancer is a disease of somatic mutations, there are already many known germline risk factors and evidence suggests that 20% of prostate cancer biopsies could be avoided if patients received a polygenic risk score. Dr. Boutros then looks at the results of a study from his lab at UCLA which show that the germline drives somatic epigenomics and that some single nucleotide polymorphisms (SNPs) are prognostic. Another yet-to-be-published study by the same team suggests that the germline also drives somatic mutations, with multiple quantitative trait loci (QTLs) predicting somatic driver mutations. This means that mutations that occur early in tumor evolution and can increase the likelihood of aggressive cancer are more likely to occur in certain people based on genomic factors. This also appears to be the case with multiple cancer types. Dr. Boutros concludes by noting possible future directions for research in this area, including multi-ancestric studies and studies into germline influences on the transcriptome and proteome. He also observes that it is not yet clear how this research should be integrated with diagnostic and prognostic tests nor how it could influence decision-making.

HIFU Focal Therapy: Prostate Cancer – Emerging Data and Clinical Utility vs. Standard Care

Posted by Andre Abreu, MD | Jan 2021

Andre Abreu, MD, Urologist at the Keck Hospital of University of Southern California, describes how high-intensity focused ultrasound (HIFU) works, and the data that earned it FDA-approval for prostatic tissue ablation in November 2015. Following this, Dr. Abreu reviews the three main goals of focal therapy: selectively ablating known disease, preserving functions, and minimizing morbidity, all without compromising life expectancy. He then uses two systematic reviews, one from 2017 and one from 2019, to explain how focal therapy benefits continence and potency rates. Further presented data includes a 2020 review of evidence and reported outcomes from an October 2020 study of hemigland HIFU ablation as primary treatment for localized prostate cancer, both of which exhibit HIFU’s safety, excellent potency, and continence preservation, as well as adequate short-term prostate cancer control. Dr. Abreu also addresses comparisons to radiation and acknowledges that HIFU works well for intermediate-disease but is still controversial for low- or high-risk disease, showing a need for further study.

Hormonal Intervention for the Treatment of Veterans with COVID-19 Requiring Hospitalization (HITCH)

Posted by Matthew Rettig, MD | Dec 2020

Matthew Rettig, MD, Chief of Hematology-Oncology at the VA Medical Center in Greater Los Angeles and Professor of Medicine and Urology at the David Geffen School of Medicine at the University of California, Los Angeles, discusses the rationale and goals of a current study looking at whether androgen deprivation therapy (ADT) may benefit men with COVID-19. Dr. Rettig notes that men appear to be both slightly more susceptible than women to COVID-19 and to have significantly worse outcomes, possibly as a result of differences in behavior and comorbidities, but also potentially because androgens may exacerbate the effects of COVID-19, while estrogen may be protective against it. Small early studies were inconclusive as to whether patients with prostate cancer already being treated with ADT had a reduced incidence of COVID-19, but data from the VA system suggests that ADT has a modest protective effect against a diagnosis of COVID-19. Dr. Rettig explains that the currently-recruiting Hormonal Intervention for the Treatment of Veterans with COVID-19 Requiring Hospitalization (HITCH) study is designed to determine whether, in addition to its protective effects, ADT also reduces the severity of COVID-19 illness. To that end, the study investigators plan to see if treating men between the ages of 18 and 85 who have been hospitalized due to COVID-19 with degarelix improves clinical outcomes by reducing mortality, ongoing need for hospitalization, or requirement for mechanical ventilation.