GENITOURINARY CANCERS

Matthew Cooperberg, MD genitourinary cancer specialist, University of California San Francisco (UCSF), discusses the varying management techniques for both low- and high-risk prostate cancers, including radiation therapy, surgery, hormonal therapy, and active surveillance.

​Darren Feldman, MD, assistant attending physician for the Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, discusses how to properly treat neutropenic fever as a toxicity stemming from chemotherapy treatment.

​Daniel Hamstra, MD, PhD, radiation oncologist, Texas Center for Proton Therapy, Texas Oncology, discusses the benefits of shorter radiotherapy treatment sessions for patients with prostate cancer.

Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the appropriateness of a more aggressive approach to men with high-risk prostate cancer. Cooperberg says currently, men will normally respond to surgery followed by adjuvant radiotherapy, as well as systemic therapy.

​Tomasz M. Beer, MD, FACP, deputy director, Knight Cancer Institute, Oregon Health and Science University, discusses the potential for genomic tests to result in new treatments.

Retreatment with radium-223 dichloride (Xofigo) after initial therapy and progression was deemed safe in patients with bone-metastatic castration-resistant prostate cancer (CRPC), according to a recent prospective, open-label phase I/II trial.

A recent paper concluded that docetaxel added to standard of care should be considered the new standard of care for men with hormone-sensitive metastatic prostate cancer.

A recent meta analysis of several literature sources reveals evidence linking polymorphisms of both the GSTM1 and GSTT1 enzymes, which are involved in kidney detoxification of carcinogens to the risk of developing of renal cell carcinoma (RCC).

The FDA has granted olaparib (Lynparza), a first-in-class oral PARP inhibitor, breakthrough therapy designation for patients with BRCA1/2 or ATM-mutated metastatic castration-resistant prostate cancer (mCRPC).

Treatment initiation for hormone-sensitive metastatic prostate cancer should include the addition of docetaxel to androgen deprivation therapy (ADT) as standard of care.

Beer says that while BRCA is normally associated with breast cancer, the gene is found in up to 20% of advanced prostate cancers. He says of this 20% patient population, roughly half inherit the BRCA gene and the other half acquire it.

Kibel cited both the STAMPEDE and CHAARTED trials, which showed the efficacy of docetaxel plus androgen deprivation therapy (ADT) in metastatic prostate cancer.

​Darren Feldman, MD, discusses dose intensification in patients with advanced germ cell tumors who are not responding to BEP chemotherapy.

Hamstra says that shorter regimens of radiotherapy for men whose prostates remained in tact post-surgery proved to be noninferior when compared to longer regimens. He adds that these shorter regimens are more convenient for patients, as well as more cost effective.

Adding celecoxib and zoledronic acid to standard treatment extended survival in men with metastatic prostate cancer commencing first-line hormone therapy, according to updated data from the STAMPEDE trial.

The addition of the CTLA-4 inhibitor ipilimumab to cisplatin and gemcitabine failed to significantly improve the primary endpoint of overall survival (OS) in a phase II study for patients with metastatic urothelial cancer.

The investigational anti-PD-L1 antibody avelumab showed antitumor activity within acceptable safety profile parameters in a recent phase Ib trial for metastatic urothelial cancer refractory to standard therapy.

Hypofractionated radiotherapy and standard radiation therapy demonstrated similar toxicities and neither prevented PSA increases or disease recurrences for men with intermediate-risk prostate cancer better than the other, according to data from the phase III randomized CHHiP trial reported at the 2016 GU Cancers Symposium.

Second-line treatment with atezolizumab (MPDL3280A) resulted in a median overall survival (OS) of 11.4 months in patients with locally advanced or metastatic urothelial carcinoma (mUC) and who showcased high PD-L1 levels.

A post hoc analysis of the phase III COU-AA-302 clinical trial suggests docetaxel can produce antitumor activity as the first subsequent therapy following disease progression with abiraterone acetate in men with chemotherapy-naive, metastatic castration-resistant prostate cancer.

A current estimation shows that roughly 25% of metastatic castration-resistant prostate cancers (mCRPC) contain alterations in DNA repair genes. These would normally code for proteins to correct errors arising when cells duplicate their DNA before cell division.

Sartor says the test would lay out molecular data regarding a patient's malignancy and allow community oncologists to determine what would be the best course of treatment. He added that the hope for this study is to replace the "trial and error" method of treatment with something more concrete.

Agarwal says patients whose penile cancer does not spread to their lymph nodes have a 95% chance of survival over the course of 5 years, while survival for those whose cancer spreads to their lymph nodes is significantly less.

Aspirin, normally associated with heart health, may not extend to the reduction of risk in prostate cancer, according to the results of an observational study.

Resistance to androgen receptor therapies in patients with metastatic castration-resistant prostate cancer (mCRPC) has historically posed a challenge to clinicians. Now, a new blood test that analyzes circulating tumor cells (CTCs) could help overcoming these hurdles.

The FDA has approved a new treatment consisting of a non-alcohol formulation of docetaxel in patients with breast cancer, non-small cell lung cancer, prostate cancer, gastric adenocarcinoma, and head and neck cancer.

Figlin says drugs like lenvatinib, everolimus, and cabozantinib have emerged in recent years as possible first-line therapies for RCC.

Urologists face a challenge in delineating the optimal sequence of treatment more and more as the goal for treating prostate cancer moves toward greater use of targeted therapies. While these treatment eradicate disease, urologists must minimize the risk of adverse events.

With a renewed armory of treatments consisting heavily of immunotherapies, urologists can employ new paradigms of treatment for patients with metastatic castration-resistant prostate cancer (mCRPC).

A new study from the University of California, Los Angeles shows that less than 5% of men who opt for active surveillance of their low-risk prostate cancer receive the proper amount of monitoring.