PCa Commentary | Volume 171 – November 2022
This Commentary explores treatment regimens combining enzalutamide, apalutamide, or darolutamide with androgen deprivation for nmCRPC.
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2022
Should “Age-Related” Testosterone Deficiency (TD) Be Treated?
Abdulmaged M. Traish, MBA, PhD, Research Director at The Institute for Sexual Medicine and Emeritus Professor of Urology, both at Boston University School of Medicine in Boston, MA, discusses what he calls a fundamental question—whether age-related testosterone deficiency (TD) should be treated. He cites data demonstrating that T therapy in older men with TD produces significant health benefits. Dr. Traish questions why the U.S. Food and Drug Administration (FDA) opposes testosterone (T) therapy in older men but not in men with classical hypogonadism, concluding his talk by asserting that age-related TD does, indeed, merit treatment and by respectfully disagreeing with the FDA stance.
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Current Status of PSMA PET in the United States
Philip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses PSMA PET and how it is poised to supplant conventional imaging techniques in the diagnosis of prostate cancer. He begins by observing the shortcomings of conventional imaging techniques such as bone scintigraphy and computed tomography. While these remain the current standard of care, they result in false negative diagnoses in most patients with biochemical recurrence, especially when the lesion is less than 1 cm with a PSA of <20 ng/ML. Dr. Koo then focuses on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. He cites a study that found PMSA has double the detection rates over fluciclovine, with an exception of lesions in the prostate bed, indicating that different tools may be appropriate depending on lesion location. However, Dr. Koo clarifies that there currently is no data that proves the superiority of a specific PET radiopharmaceutical. Additionally, he cautions that overdiagnosis using next-generation imaging, such as PSMA PET, is likely as physicians continue to learn the benefits and drawbacks. To that end, he notes that there is a spectrum of visible lesions when using PET and a threshold below which it cannot detect disease. Dr. Koo concludes that while conventional imaging is more readily available than next-generation imaging, its limited sensitivity indicates a necessary shift to more advanced tools like PMSA PET. Similarly, since prostate cancer will advance after initial treatment in 30-50% of patients, he sees an opportunity to use PSMA PET to identify patients who require further treatment or who have metastases undetected by conventional imaging.
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Optimizing Urologic Surgical Outcomes: AUA Pre-operative White Paper Recommendations
John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, outlines the purpose of the AUA quality improvement and patient safety recommendations to serve as a standardized reference for urologists as they support patient readiness for, and success after, surgery. The guidelines are broken down according to preoperative, intraoperative, and postoperative recommendations, all of which cross-thread to optimize surgical outcomes for patients.
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Transperineal Mapping Biopsy: Does Technique Matter?
Nelson N. Stone, MD, Professor of Urology, Radiation Oncology, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai and at the Derald H. Ruttenberg Cancer Center at Mount Sinai School of Medicine in New York, discusses transperineal mapping biopsy (TPMB). He explains that treating a single quadrant as identified by MRI may leave unidentified clinically-significant prostate cancer behind. For focal therapy, Dr. Stone advocates for what he calls a unified approach using TPMB, which can be done under local anesthesia.
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