Frontiers in Oncologic Prostate Care and Ablative Local Therapy Archives

Optimal Management of Biochemically Recurrent Nonmetastatic Prostate Cancer

Posted by Aaron Berger, MD | Dec 2024

Aaron Berger, MD, delves into the evolving landscape of non-metastatic castration-sensitive prostate cancer (nmCSPC) and high-risk biochemical recurrence, focusing on diagnostic and therapeutic updates. In this 7-minute presentation, Dr. Berger emphasizes advanced imaging, particularly PSMA PET scans, as the diagnostic standard due to its superior sensitivity over conventional CT and bone scans.

Dr. Berger discusses treatment strategies, including salvage radiation therapy and the use of androgen deprivation therapy (ADT). For radiation-treated patients, focal salvage therapies, including cryoablation, HIFU, and electroporation, are discussed as options. The presentation underscores the shrinking non-metastatic space due to advancements in imaging technology that now frequently identify micrometastases.

Dr. Berger reinforces the importance of genetic testing and surveillance protocols involving regular PSA monitoring and imaging triggered by symptoms or PSA progression. He highlights the dynamic shifts in prostate cancer management, driven by improved diagnostics and the integration of advanced systemic therapies within an increasingly precise treatment paradigm.

Oligometastatic Prostate Cancer

Posted by Daniel Y. Song, MD | Dec 2024

Daniel Song, MD, explores the evolving role of metastasis-directed therapy (MDT) and androgen deprivation therapy (ADT) in oligometastatic prostate cancer. Initial studies, including SABR-COMET and STOMP, demonstrate that MDT, through approaches like stereotactic body radiotherapy (SBRT) or surgery, improves progression-free and ADT-free survival compared to observation alone. Recent trials also evaluate the combination of MDT and short-term ADT, such as the EXTEND trial, which shows significantly prolonged progression-free survival.

The 9-minute presentation highlights how advanced imaging, particularly PSMA PET scans, outperforms conventional imaging in detecting and targeting metastases, enhancing MDT’s efficacy. Comparisons of PSMA-guided versus choline-guided SBRT reveal superior outcomes in disease-free survival. Furthermore, ongoing research seeks to clarify whether systemic hormone therapy is necessary alongside MDT, with trials like DART exploring novel ADT strategies.

Dr. Song asserts that MDT improves survival metrics in oligometastatic prostate cancer, particularly when informed by advanced imaging. Combining MDT with prostate radiation or systemic ADT offers additional survival benefits.

Metastatic Castrate Sensitive Prostate Cancer

Posted by Rana R. McKay, MD | Dec 2024

Rana McKay, MD, discusses the evolving treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC), emphasizing advancements over the past decade. In this 20-minute presentation, McKay shares that prostate cancer remains a leading cause of mortality among men. While traditional androgen deprivation therapy (ADT) has long been the cornerstone treatment, newer approaches integrating chemotherapy, androgen receptor signaling inhibitors (ARSIs), and combination regimens have transformed patient outcomes. She refers to landmark studies like CHARTED, LATITUDE, and STAMPEDE, highlighting the benefits of early intensifying treatment and showing significant survival advantages with doublet and triplet therapies. She also shares recent trials, including PIECE-1 and ARASENS, that underscore the effectiveness of adding agents like abiraterone or darolutamide to ADT and docetaxel for high-risk, high-volume disease.

Dr. McKay asserts clinical decision-making now incorporates disease factors such as volume and risk, patient comorbidities, and drug-specific considerations like toxicity profiles and cost. Emerging genomic and molecular tools are poised to refine treatment personalization further, with ongoing trials exploring the optimal integration of novel agents.

Genetic Testing in Prostate Cancer Management

Posted by Abhinav Sidana, MD, MPH | Dec 2024

Abhinav Sidana, MD, MPH, highlights the critical role of genetic testing in prostate cancer management, aiming to familiarize urologists with its fundamentals and practical application. In this 17-minute presentation, Dr. Saadana shares a detailed case study of a healthy 63-year-old male with prostate cancer, underscoring the importance of DNA damage repair pathway genes.

Dr. Sidana categorizes genetic mutations into germline mutations and somatic mutations. Both are essential in identifying actionable genetic alterations that guide early diagnosis, prognosis, and treatment. He emphasizes the prognostic implications of genetic testing in driving treatment strategies. Dr. Sidana highlights the utility of multi-gene panels that assess a broad range of cancers and the importance of genetic counseling in addressing the clinical and psychosocial aspects of testing. Current guidelines recommend testing for high-risk, metastatic, or familial prostate cancer cases.

Course Introduction: Description of Terminology and Review of Guidelines

Posted by Natalie Reizine, MD | Dec 2024

Natalie Reizine, MD, delves into the current understanding, treatment options, and future directions for managing prostate cancer. In this 23-minute presentation, Dr. Reizine discusses disease progression, from localized stages to advanced and metastatic forms, emphasizing the evolving role of imaging technologies like PSMA PET scans in early detection and monitoring.

Dr. Reizine reviews the biology of prostate cancer, particularly its reliance on androgen receptor signaling, which forms the foundation for many therapeutic strategies. She highlights the importance of understanding disease-specific nuances, such as low versus high-volume metastases, to tailor treatment strategies.

Bone health in prostate cancer is emphasized, particularly for patients on long-term ADT. Similarly, dental care and endocrinology referrals are underscored as part of comprehensive management.

Dr. Reizine focuses on emerging therapies and personalized medicine approaches, with attention given to biomarkers like DNA damage repair mutations and new treatment modalities, including PARP inhibitors, radioligand therapies, and T-cell activating constructs. She underscores the need for improved predictive and prognostic biomarkers to effectively refine therapy selection and sequence treatments.