prostate cancer treatments

High-Risk Localized and Oligometastatic Disease

Christopher J. Kane, MD, FACS, provides an overview of current best practices in detecting and treating high-risk localized and oligometastatic prostate cancer. In this presentation, he reviews:
The diagnostic value of PSMA PET versus nodal dissection
The overall survival rates of patients treated with ADT plus XRT versus ADT alone
The risks of long-term ADT

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How to Use Natural Ligands to Kill Tumor Stem Cells

Stephen B. Howell, MD, explores the possibility of using Cancer Stem Cell-Targeted Therapy to fight cancerous tumors and prevent recurrence. He begins with a review of the role of LGR receptors and RSPO ligands in active stem cells.

Dr. Howell then presents data from a trial demonstrating how a particular drug, FcF2-MMAE, can target cancerous tumor cells through a particular LGR receptor. He provides data on FcF2-MMAE’s promising pharmacokinetic and pharmaceutical properties

Dr. Howell concludes by stating that the drug needs to be studied outside of an academic research environment. While most of the academic research has been done on the responsiveness of tumor stem cells in ovarian cancer, he anticipates that the FcF2-MMAE framework may have applications for prostate cancer tumors.

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Advanced Prostate Cancer Challenging Case Discussion

Daniel P. Petrylak, MD, moderates this discussion panel on challenging prostate cancer case studies. Dr. Petrylak describes the first case whereby a patient had a prostate specific antigen (PSA) of 24 and underwent radical prostatectomy; his PSA never normalized and rose to 40. Androgen deprivation therapy (ADT) commenced and continued for five years until his PSA rose despite a castrate testosterone level. The patient’s bone scan demonstrated sacral metastases. Testing demonstrated no germline mutations and the patient received Sipuleucel T and began treatment with abiraterone/prednisone; PSA nadired at .4. A year and a half later the patient’s PSA rose to 4.8 and he was found to have stable bone metastases.

After the panel decides on a treatment plan for the first case, Dr. Petrylak moves to the second case, whereby a patient presented with celiac, para-aortic and iliac chain lymphadenopathy, early right-side hydronephrosis, a PSA of 19.4, and a biopsy of the left neck lymph node mass showed metastatic adenocarcinoma consistent with prostatic primary. Treatment included bicalutamide/leuprolide, switching to abiraterone/prednisone. In six months, PSA was undetectable. The patient progressed in terms of the soft tissue disease and required a stent for the hydronephrosis, began docetaxel with no response after five cycles, and started cabazitaxel with cycles three and four dose-reduced due to neuropathy.

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Experience with Radical Perineal Prostatectomy at a Single Institution in the Era of Robotic-Assisted Laparoscopic Prostatectomy

Thomas E. Keane, MD, presents data on the use and outcomes of Radical Perineal Prostatectomy (RPP) as a treatment for prostate cancer. He begins by reviewing the many options available to patients, allowing their treatment to be customized by their disease, priorities, and functional status. He then focuses on the viability of RPP as a treatment option for a wider population, especially for those who do not qualify for robotic-assisted surgery.

In this presentation, Dr. Keane illustrates:

The equipment necessary to perform RPP
The steps of the surgery, with photographs at each stage
The objectives of the surgery
The results from patients who received RPP over the past ten years

Dr. Keane concludes by comparing the outcomes of patients treated with Robotic-Assisted Laparoscopic Prostatectomy (RALP) to those of RPP patients. After ten years, patients treated with RPP showed no difference in progression to metastatic disease, no difference in rates of urinary symptoms, and higher rates of continence when compared to those treated with RALP.

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When Men with Prostate Cancer Get Prostatitis

J. Curtis Nickel, MD, FRCSC, discusses the diagnosis, treatment, and outlook for prostate cancer patients with co-occurring prostatitis. He begins by addressing the prevalence of prostatitis, chronic prostatitis (CP), and chronic pelvic pain syndrome (CPPS), and the complicated relationship between differing classes of prostatitis and prostate cancer.

Over the course of the presentation, Dr. Nickel addresses:

Warning signs of prostatitis, CP, and CPPS
Diagnostic algorithms for identifying prostatitis
Impacts of prostatitis on patient QOL
Risk factors for pre-existing prostatitis in prostate cancer patients
Prostatitis in patients who no longer have prostates
The lack of concrete treatment guidelines

Dr. Nickel outlines an algorithm for diagnosing and monitoring prostatitis taking into account urinary, psychosocial, organ-centric, and other symptoms. He concludes by highlighting the importance of treating prostatitis/CP/CPPS in patients with prostate cancer.

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The Microbiome and Prostate Cancer

Priya N. Werahera, PhD, presents a comprehensive discussion on the role of microbiomes in cancer, highlighting the sensitivity of detection methods and their potential in cancer research. Microbes have been found in cancer tissues and are implicated in the hallmarks of cancer. Analyzing samples using advanced techniques like NextGen sequencing has improved the identification of microbial DNA, facilitating a deeper understanding of the composition of microbiomes in cancer patients.

Studies have shown significant differences in the microbiomes of cancer patients compared to controls, emphasizing the potential diagnostic and therapeutic implications. Specific bacteria, such as Acne bacterium and F. Magna, have been associated with inflammation and soy metabolism, respectively, indicating their clinical significance in cancer. Further research, including analyzing EPS samples and frozen tissue samples, holds promise in unraveling the complex interplay between microbiomes and cancer development.

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Implementation of Markers in Clinical Practice

David S. Morris, MD, FACS, discusses implementation of various markers in screening, diagnosing, and treating prostate cancer in community practice. He discusses the G-Minor (Genomics in Michigan ImpactiNg Observation or Radiation) trial and a retrospective analysis of the STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) trial, wherein certain markers were able to predict both metastasis-free survival and overall survival.

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Radioligand Therapy in Prostate Cancer

Geoffrey B. Johnson, MD, PhD, Chair of the Division of Nuclear Medicine at the Mayo Clinic in Rochester, MN, discusses radioligand therapy in prostate cancer. Dr. Johnson briefly reviews the specific activity of this therapy, with a focus on Lutetium-177-PSMA-617.
Dr. Johnson highlights the benefits and tolerable side-effects of Lutetium-177-PSMA-617, and mentions the therapy is approved for patients with metastatic castrate-resistant prostate cancer who have been previously treated with androgen receptor pathway inhibition and taxane-based therapy.

The presentation further explores the process of patient selection for PSMA imaging, with the requirement of at least one lesion that shows higher PSMA expression than the liver. Dr. Johnson showcases post-therapy imaging examples, and discusses the potential of advanced scanning techniques, such as CZT-based scanners, which offer higher sensitivity and faster scans for accurate tracking of therapy response.

Dr. Johnson emphasizes the promising future of radionuclide therapy. He mentions the potential combinations of PSMA therapy with hormonal therapy, chemotherapy, immunotherapy, and external radiation. Additionally, he mentions ongoing trials exploring the use of alpha and beta emitters and the incorporation of different targets.

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