Topic: Advanced Disease

Minimizing Morbidity and Maximizing Outcomes with ADT

Laurence Klotz, MD, FRCSC, discusses causes of adverse effects of androgen deprivation therapy (ADT) treatment for prostate cancer and approaches to reducing these side effects. Specifically, Dr. Klotz advises physicians about patient counseling, prescribing innocuous drugs like bisphosphonates and metformin, targeting the adrenal pathway, and utilizing intermittent ADT.

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Does Radiation Therapy Favor Radical Prostatectomy in Long-Term QOL?

Juanita M. Crook, MD, FRCPC, discusses the challenges of assessing modalities for the management of high-risk prostate cancer in terms of quality of life (QOL) outcomes. She then reviews QOL data from the ProtecT trial, the efficacy and toxicity of presented for ASCENDE-RT trial, and data from two large, mature prospective databases. She also shares her opinion on the “tri-modality” approach.

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Incorporating New PET Imaging and Theranostic Approaches into Prostate Cancer Practice | Interesting Cases

Robert R. Flavell, MD, offers an introductory overview of theranostics and advances in nuclear imaging and therapies, especially prostate-specific membrane antigen (PSMA) agents. Subsequently, he leads a panel with Susan F. Slovin, MD, PhD, E. David Crawford, MD, and Phillip J. Koo, MD in reviewing four distinct prostate cancer cases, sharing their thoughts and recommendations with regard to use of recently developed imaging agents and therapies.

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Incorporating New PET Imaging and Theranostic Approaches into Prostate Cancer Practice

Phillip J. Koo, MD, chair of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), discusses advances in nuclear medicine and imaging, basic concepts of the theranostic approach, and controversies in this field. Following Dr. Koo’s discussion of the current state of nuclear medicine, Susan F. Slovin, MD, PhD, discusses the three iterations of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR).

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Is Focal Ablation of Prostate Cancer Ready for Prime Time?

Herbert Lepor, MD, defines focal ablation and its quality of life, oncological, and cost benefits to patients. He then discusses best practices for the procedure, including optimal patient selection, energy source options, and extent of the ablation zone. Furthermore, he explains the research and improvement needed to make focal ablation of prostate cancer ready for prime time.

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M0 Space and The SPARTAN Trial

Eric J. Small, MD, defines nonmetastatic castration-resistant prostate cancer, or M0 disease. He then discusses the design, implementation, and results of the SPARTAN trial, which he presented at the 2018 Genitourinary Cancers Symposium. The study tested the efficacy of apalutamide in men with M0 disease.

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Advanced Disease — A Real Need for Understanding and Shared Care

Daniel P. Petrylak, MD, stresses the importance of taking a multidisciplinary approach when treating prostate cancer. Not only does this mean involving urologists, oncologists, and primary care physicians for better access to therapies and coordination of care, but also involving nutritionist, mental health professionals, and pain management experts for maintaining patients’ quality of life.

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Integrating the AUA Guidelines into Your Practice

Michael S. Cookson, MD, MMHC, describes how urologists can use American Urological Association (AUA) guidelines to better manage metastatic castration resistant prostate cancer (mCRPC) patients. He stresses the importance of urologists serving as the primary caregiver, the multidisciplinary care model, and organized sequencing of treatments and therapeutics.

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