International Prostate Cancer Update Archives

Changing Landscape of mHSPC: New Approaches to an Old Problem

Posted by Michael S. Cookson, MD, MMHC | Jun 2020

Michael S. Cookson, MD, MMHC, Professor and Chairman of the Department of Urology at the University of Oklahoma Health Sciences Center in Oklahoma City, gives an overview of the changing landscape of metastatic hormone-sensitive prostate cancer (mHSPC). He reviews the different treatment strategies that have undergone testing over the last eight decades, noting that although treatment options have progressed, there is still work to be done to continue improving results. He presents the findings of key studies that look to improve survival through the use of more potent androgen-targeting techniques, among other cutting edge treatments. These new treatments show promising results in lowering risk of spread and death, bolstering Dr. Cookson’s key point: that the landscape is rapidly changing, and urologists need to adapt quickly.

Usefulness of Adjustable Needle Sizes for Biopsies

Posted by Jelle Barentsz, MD, PhD | Jun 2020

E. David Crawford, MD, Professor of Urology at the University of California, San Diego, discusses the usefulness of adjustable needle sizes for prostate biopsies with Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands. Dr. Barentsz agrees with Dr. Crawford that a needle that can be adjusted from 10 to 60 gauge would be useful in situations such as when the smaller needle sometimes needed to reach an area is unable to pierce through fat to take the needed core sample. Drs. Barentsz and Crawford then address the pros and cons of mapping biopsy of the prostate: Dr. Barentsz contends that the use of 180 needles to obtain only slightly more accurate results than MRI may not be warranted, and Dr. Crawford notes that mapping biopsies are usually reserved for patients with negative MRIs and negative biopsies.

New Approaches to Combining Brachytherapy with Immunotherapy

Posted by Steven E. Finkelstein, MD, FACRO | Jun 2020

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the growing field of brachytherapy-driven immunotherapy and its potential role in prostate cancer treatment. He goes on to discuss the mechanisms behind radiation-induced tumor death, the growing evidence behind the immunostimulatory effects of radiation, and a patent describing a radiation-based applicator and potential method for administering immunotherapy agents to cancerous tissue.

Genetics and Genomic Biomarkers: How Molecular Markers and mpMRI Play a Role

Posted by R. Jonathan Henderson, MD | Jun 2020

R. Jonathan Henderson, MD, a urologist with Regional Urology, LLC, and President-Elect of the LUGPA Board of Directors, discusses the challenges posed by having a plethora of screening tools at a physician’s disposal, as well as how the statistical validity of these tools makes it unclear as to which are best for a given situation. He also uses his personal experience with taking a patient through the prostate cancer screening process in order to highlight the need for free and open communication with the patient, the importance of choosing a process that the physician is comfortable with, and the challenge of helping the patient find peace of mind.

Challenging Cases in Advanced Prostate Cancer: nmCRPC

Posted by R. Jonathan Henderson, MD | Jun 2020

R. Jonathan Henderson, MD, a urologist with Regional Urology, LLC, discusses an unusual case of non-metastatic castration-resistant prostate cancer (nmCRPC) with a panel featuring Laurence Klotz, MD, FRCSC, Daisaku Hirano, MD, and Michael S. Cookson, MD. The case in question involves an asymptomatic patient in his 70s who was successfully treated for localized prostate cancer and then, ten years later, was treated with cryotherapy for recurrent cancer, after which point cancer stopped appearing in imaging, but the patient’s PSA rapidly rose even as he was treated with abiraterone. Drs. Klotz, Hirano, and Cookson discuss whether it is appropriate to give such treatments to a persistently asymptomatic patient and note that his high PSA could be a response to abiraterone. They also consider the possibility that advanced imaging techniques like PSMA-PET would reveal that the man does have metastases and ponder which of the approved treatments for nmCRPC might suit this patient best.