Maryland Archives

Cardiovascular & Metabolic Risk Profiles of Hormonal Agents for Managing Advanced Prostate Cancer

Posted by Celestia S. Higano, MD | Mar 2021

Celestia S. Higano, MD, FACP, Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia and Medical Director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre, reviews her 2020 paper outlining the cardiovascular risks associated with ADT and new treatments for prostate cancer, highlighting its increasing relevance in the wake of recent approvals for drugs like relugolix. She explains that there is controversy in the literature regarding whether ADT increases cardiovascular risks, but suggests that patients who are already at risk of cardiovascular disease may see more adverse cardiovascular effects on ADT. Phase 3 trials combining ADT with drugs like enzalutamide, apalutamide, and abiraterone, as well as other second-generation antiandrogens, demonstrate greater cardiovascular risk to patients on a combination as opposed to on ADT alone. Dr. Higano emphasizes that urologists must discuss risk factors for cardiovascular disease with their patients before prescribing these treatments, and she recommends following the Vanderbilt Cardiooncology Group’s ABCDE checklist with them.

Castration Resistant Prostate Cancer – Developments and Challenges from 2020

Posted by Emmanuel S. Antonarakis, MD | Mar 2021

In this Platinum Lecture, Emmanuel S. Antonarakis, MD, Professor of Oncology and Urology as well as Director of Prostate Cancer Medical Oncology Research and the Co-Director of the Prostate Cancer Multidisciplinary Clinic at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, summarizes developments from 2020 in mutation-targeted treatments for metastatic castration-resistant prostate cancer (mCRPC). He considers the successes of PARP inhibitors, especially for patients with the BRCA2 mutation, and the limitations of PD1 inhibitors. Dr. Antonarakis concludes by looking at promising research into B7-H3 and PSMA.

In My Opinion: Biomarkers for the Diagnosis of Prostate Cancer

Posted by Michael A. Gorin, MD | Dec 2020

Michael A. Gorin, MD, discusses biomarkers for diagnosing prostate cancer, including PSA, mpMRI, and serum and urine tests. He gives an overview of the history of prostate specific antigen (PSA), emphasizing that PSA screening is beneficial even as he acknowledges that PSA’s high sensitivity and low specificity result in many unnecessary biopsies. There are now many serum and urine biomarker tests that can help provide more specificity, including 4KScore, Prostate Health Index, SelectMDx, and ExoDx Prostate IntelliScore (EPI), all of which are endorsed by the NCCN Guidelines. Dr. Gorin notes that, when price is considered, SelectMDx and EPI outperform the other tests. Dr. Gorin concludes the presentation by discussing how multiparametric MRI should be used in prostate cancer diagnosis, noting that while there is little official guidance on this yet, he uses it in his own practice if a patient has a PSA ≥3 and receives an abnormal result from a serum or urine biomarker test.

Biologics in Sexual Medicine – Controversy and Therapeutic Potential

Posted by Trinity J. Bivalacqua, MD, PhD | Aug 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology and R. Christian B. Evensen Associate Professor of Urology and Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine in Baltimore, Maryland, discusses studies on biologics and low-intensity extracorporeal shock wave therapy (Li-ESWT), as well as controversial misinformation surrounding their use in sexual medicine. He reviews the results of a Li-ESWT study which displayed the treatment’s ability to improve symptoms, exercise capacity, and myocardial perforation in patients with severe coronary artery disease without indication for percutaneous coronary intervention or coronary artery bypass graft surgery. He then argues that for-profit stem cell clinics who offer biologic treatment for sexual medicine promise results with no supporting efficacy data, and that the trials these clinics use for support are not well-designed. Dr. Bivalacqua concludes that there is a demonstrated therapeutic potential for biologics, but more research is needed to support their use in sexual medicine and to prove their therapeutic value.

The First Tissue Engineered Neo-Urinary Conduit (NUC) Clinical Trial for Complete Organ Replacement: Successes, Pitfalls, Challenges

Posted by Trinity J. Bivalacqua, MD, PhD | Jul 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses the first tissue-engineered neo-urinary conduit (NUC) clinical trial for complete organ replacement in patients with bladder cancer. He explains that the standard methods of using the genitourinary (GI) tract for cystectomy in patients with bladder cancer often cause sustained and significant complications associated with exposing the GI tissue to urine, and therefore the development of a urinary diversion using autologous cell sources for a tissue-engineered urinary conduit is warranted. Dr. Bivalacqua then details the process by which his team attempted to do this: isolating smooth muscle cells, seeding them on a biodegradable PLGA scaffold, and then implanting the construct after cystectomy, first in porcine subjects and then in human patients during the phase I trial. He notes that while all the NUCs had to be explanted due to stomal stenosis or NUC stricture, his team did successfully regenerate urinary tissue using smooth muscle cells, and he hopes researchers will progress toward the development of a clinically functional urinary conduit in an ongoing multicenter phase I/II trial.