Topic: Prostate Cancer

Novel Ways of Targeting the Androgen Receptor

Novel Ways of Targeting the Androgen Receptor

by | Nov 2024

Daniel P. Petrylak, MD, explores novel approaches for targeting the androgen receptor (AR) in prostate cancer, highlighting that around 90% of prostate cancer specimens express the androgen receptor, which persists through castrate resistance.

In this 7-minute talk, Dr. Petrylak focuses on targeting the AR ligand-binding domain with molecules known as proteolysis-targeting chimeras (PROTACs). Laboratory findings reveal that PROTACs can degrade AR variants resistant to traditional therapies like enzalutamide, showing efficacy against androgen gene amplification mutations.

He shares that ARV-110, a PROTAC developed for clinical use, showed promise in phase 1 trials with castration-resistant prostate cancer patients. However, due to significant side effects, the ARV-110 trials were abandoned in favor of a newer compound, ARV-766. While ARV-110 has demonstrated efficacy in castration-resistant prostate cancer, ARV-766 offers a broader range of AR degradation with improved patient tolerance, making it the preferred candidate for continued clinical evaluation.

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How has the SP Robot Affected Our Approach to Radical Prostatectomy?

How has the SP Robot Affected Our Approach to Radical Prostatectomy?

by | Nov 2024

Jeremy Slawin, MD, MBA, Assistant Professor of Urology at Baylor College of Medicine in Houston, Texas, highlights single-port robotic technology for radical prostatectomy and emphasizes extraperitoneal surgery. In this 21-minute presentation, he advocates for single-port robotic systems in extra-peritoneal radical prostatectomy, highlighting its potential to enhance patient outcomes while adhering to a familiar anatomical approach.

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The Bespoke Future of Cancer Care

The Bespoke Future of Cancer Care

by | Nov 2024

Leonard G. Gomella, MD, explores the concept of “bespoke” cancer care, emphasizing its personalized, patient-centered approach. Originally a British term referring to custom-made items, “bespoke” now highlights the customization of cancer treatments through precision medicine, pharmacogenomics, AI technologies, and individualized care plans.

In this 10-minute presentation, Dr. Gomella stresses that innovations in cancer care reflect the growing trend of leveraging AI to enhance screening efficiency and reduce reliance on traditional biopsy methods. He discusses how precision medicine increasingly enables oncologists to tailor treatment plans by analyzing genetic mutations and matching patients to the most promising therapies or clinical trials. The need to balance technological advancements with affordability and patient access is a central concern.

Bespoke care offers better outcomes and underscores the importance of informed decision-making, empowering patients to actively participate in their treatment journey.

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Devastated Outlet in Men

Devastated Outlet in Men

by | Oct 2024

O. Lenaine Westney, MD, focuses on managing a “devastated outlet” in patients, typically those who have undergone treatments for prostate cancer. The 11-minute presentation highlights how factors such as radiation, High-Intensity Focused Ultrasound (HIFU), and multiple manipulations to treat urinary tract issues can lead to severe complications.
Radiation’s impact on the lower urinary tract is a key concern, with fibrosis and ischemia developing over time. Dr. Westney shares images of recto-urethral or pubic-prostatic fistulas, which are associated with a high morbidity rate and often necessitate complex surgical interventions, such as cystectomy and urinary diversion. The difficulty lies in predicting which patients will develop these severe complications.
Westney emphasizes the importance of early intervention and the potential need to rethink treatment strategies. She also discusses future directions, including the possibility of identifying patients who are more likely to suffer from radiation-induced complications through genetic markers or other predictive tools.

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Alan Partin Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers

Alan Partin Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers

by | Oct 2024

Laurence Klotz, MD, FRCSC, presents the newly-emerging and provocative concept of MRI visibility as a predictor of prostate cancer tumor aggressivity in the Alan W. Partin Distinguished Lecture at IPCU 34. Given that more definitive data on the subject develops, and the urological community accepts it, this could imply significant changes to practice.

Currently, the concern over invisible cancers drives a lot of interventions, such as systemic biopsies in patients who have already undergone targeted biopsies and/or received negative imaging results. Patients on active surveillance derive anxiety from the possibility of having untreated occult cancer.

The clinical implication of imaging-based monitoring has many advantages, such as psychological benefit to the patient, and reduced cost and burden of care from avoiding systematic biopsies. Recent genomic and clinical studies support the idea that tumors invisible on MRI imaging have much more favorable genetics and natural history tha

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Putting Germline Testing into Context: A Primer and Current Knowledge

Putting Germline Testing into Context: A Primer and Current Knowledge

by | Oct 2024

Alan H. Bryce, MD, explores the critical role of germline testing in prostate cancer, providing a primer on its current applications. He emphasizes identifying these genetic markers for patient management and familial risk assessment.

The 9-minute presentation considers the most relevant genes associated with prostate cancer risk, including BRCA1, BRCA2, and ATM. Dr. Bryce also highlights data problems with germline variants, questioning the representation of diverse racial and ethnic groups in clinical trials.

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Micro Ultrasound and MRI of the Prostate

Micro Ultrasound and MRI of the Prostate

by | Oct 2024

Dr. Gerald L. Andriole, Jr., MD, analyzes the evolving role of micro-ultrasound and MRI in the diagnosis and management of prostate cancer and discusses the advancements in imaging technologies that have significantly improved the accuracy of prostate cancer detection.

In this 13-minute talk, Dr. Andriole begins by examining the limitations of utilizing single imaging techniques, particularly in detecting small, clinically significant prostate tumors. Dr. Andriole explores the complementary role of micro-ultrasound and multiparametric MRI (mpMRI) in prostate cancer imaging. This combination of micro-ultrasound and MRI, he notes, enhances the accuracy of prostate cancer diagnosis.

Dr. Andriole also highlights the clinical implications of these imaging modalities and their potential to reduce the need for unnecessary biopsies and more effectively guide active surveillance strategies. He discusses the ongoing research and developments to integrate these technologies into routine clinical practice.

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The Battle of Biopsies: Results of a Multi-institutional Randomized Trial of Transrectal vs Transperitoneal Prostate Biopsy

The Battle of Biopsies: Results of a Multi-institutional Randomized Trial of Transrectal vs Transperitoneal Prostate Biopsy

by | Oct 2024

Mohammed E. Allaf, MD, delivers a compelling analysis of the outcomes from a multi-institutional randomized trial comparing transrectal and transperitoneal prostate biopsy techniques. This study, which Dr. Allaf presents in detail, addresses a critical question in urological practice: which biopsy method offers the best balance between diagnostic accuracy and patient safety?

Dr. Allaf begins this 21-minute conversation by discussing the historical preference for transrectal prostate biopsy. However, he highlights the growing concerns regarding infection rates and the potential for antibiotic resistance associated with this technique. In contrast, although less commonly used, the transperitoneal approach is posited to reduce the risk of infections and complications.

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Early Continence Recovery after Robotic Assisted Radical Prostatectomy: The Role of Prostatic Shape

Early Continence Recovery after Robotic Assisted Radical Prostatectomy: The Role of Prostatic Shape

by | Oct 2024

Pierluigi Bove, MD, explores the role of prostatic shape in continence preservation and recovery after robotic-assisted radical prostatectomy (RARP). Dr. Bove begins with a review of the key preoperative anatomical landmarks and how they inform surgical strategy.

Dr. Bove presents data supporting the relationship between preoperative Membranous Urethral Length (MUL,) bladder neck preservation, prostatic shape, and continence recovery post-RARP. He notes that preserving as much of the MUL and bladder neck as possible led to significantly higher rates of continence. Additionally, he notes that prostates with no membranous urethral overlap, or “apple-shaped” prostates, had the best urinary continence recovery.

Dr. Bove concludes by presenting video examples of RARP surgical strategies which preserve/ promote continence recovery. He presents common complications during RARP and examples of how his institution has compensated for them.

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Renal Ablation Technologies – Impact on the Treatment of Small Renal Masses

Renal Ablation Technologies – Impact on the Treatment of Small Renal Masses

by | Oct 2024

Thomas W. Jarrett, MD, explores the evolving role of renal ablation technologies in managing small renal masses (SRMs), highlighting their increasing importance as an alternative to traditional surgical approaches. In this 20-minute talk, he provides a detailed overview of the various ablation techniques, including radiofrequency ablation (RFA), cryoablation, and microwave ablation, emphasizing their distinct mechanisms of action and clinical applications.

The presentation delves into the outcomes associated with renal ablation, discussing the advantages and disadvantages of the different ablation options. Dr. Jarrett also addresses the limitations and challenges of renal ablation, including the potential for incomplete tumor destruction and the difficulties in monitoring long-term outcomes.

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