Prostatic neoplasms - Reviews in Urology

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Thank you for joining us today for our third “Meet the Expert” session with our special guest Shelby Moneer. Shelby is vice president of patient programs and education at ZERO Prostate Cancer. I’m your moderator for today, Benjamin Lowentritt. I’m the medical director of the prostate cancer program at Chesapeake Urology, and I am fortunate enough to be one of the medical advisors for ZERO, as well. Today’s “Meet the Expert” is sponsored by Cipla. For more information about Cipla, please visit their website at www.cipla.com.

Prostatic neoplasms patient advocacy

Volume 23, Number 3 Prostate Cancer

Advances in Radical Prostatectomy: A Narrative Review

Austin Drysch Kathryn E. Fink Chalairat Suk-Ouichai Mitchell M. Huang Kent T. Perry Hiten D. Patel Ashley E. Ross

Radical prostatectomy (RP) is the mainstay surgical treatment for men with localized prostate cancer. The use of robot-assisted RP (RARP) has specifically allowed for the development of novel techniques to improve postoperative quality of life for patients.

Prostatic neoplasms Prostatectomy Robotic-assisted surgery robotic surgical procedures

Volume 23, Number 3 Prostate Cancer

Darolutamide for the Management of Metastatic Hormone-Sensitive Prostate Cancer: A Urologist-Oncologist Perspective

Paul Dato Rana R. McKay

Metastatic prostate cancer accounts for 8% of all prostate cancer cases in the United States and has an estimated 5-year survival rate of 34%. Androgen-deprivation therapy (ADT) is the cornerstone of treatment for men with metastatic hormone-sensitive prostate cancer (HSPC), but there has been a recent focus on early treatment intensification through dual- or triple-therapy approaches, which have shown substantial survival benefit compared with ADT alone. Darolutamide, a distinct androgen receptor inhibitor, is the latest treatment for men with metastatic HSPC. In the Darolutamide in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer (ARASENS) trial (ClinicalTrials.gov identifier NCT02799602), darolutamide in combination with ADT and docetaxel reduced the risk of death by 32.5% (P < .001) compared with ADT plus docetaxel in men with metastatic HSPC. The most recent National Comprehensive Cancer Network guidelines (2023) support the use of triple-therapy regimens for men with high-volume metastatic HSPC, but concerns about the side effects of the short-term chemotherapy component of this regimen necessitate a comprehensive approach to providing supportive care to ensure that patients are willing to begin and remain on treatment. Effective management should involve a well-informed multidisciplinary team with patient education and support to ensure optimal treatment outcomes. Here, we review the results of the ARASENS trial and consider the implications for the management of metastatic HSPC. By showing a statistically significant reduction in risk of death, triple therapy combining darolutamide with ADT and docetaxel has emerged as a new treatment modality that may help men with metastatic HSPC achieve prolonged survival while maintaining an acceptable quality of life.

Prostatic neoplasms Drug therapy Neoplasm metastasis Androgen receptor antagonists

Volume 23, Number 3 Prostate Cancer

Incorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current Guidelines

Aidan Kennedy Jason Hafron

Prostate cancer is a highly prevalent malignancy among men worldwide. Optimal management depends on early detection and accurate surveillance. Several screening and surveillance tools are available to men with prostate cancer, including prostate-specific antigen (PSA) testing, digital rectal examination, prostate biopsy, imaging modalities, and a plethora of biomarkers. Prostate-specific antigen, though widespread in its use, is limited in its specificity. Many adjunctive tests to PSA have been developed. One such test is IsoPSA (Cleveland Diagnostics), a novel PSA assay that focuses on structural differences among PSA isoforms to aid in detecting clinically significant prostate cancer. With an improved understanding of the capability and uses of IsoPSA, physicians can enhance patient outcomes through more accurate risk assessment and save costs by reducing the number of unnecessary prostate biopsies and imaging generated resulting from a nonspecific elevation in serum PSA. This review describes the performance and use of IsoPSA.

Prostatic neoplasms Biomarker Prostate-specific antigen (PSA)Prostate-specific antigen Biomarkers

Volume 23, Number 2 Prostate Cancer

Real-World Comparison of Deep Prostate-Specific Antigen Response in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Apalutamide or Enzalutamide

Benjamin H. Lowentritt Ibrahim Khilfeh Dominic Pilon Shawn Du Carmine Rossi Frederic Kinkead Lilian Diaz Jill Korsiak Patrick Lefebvre Gordon A Brown

Deep prostate-specific antigen reduction of at least 90% (PSA90 response) after androgen receptor pathway inhibitor initiation to treat metastatic castration-sensitive prostate cancer (mCSPC) is associated with longer survival. This real-world study evaluated the proportion of androgen receptor pathway inhibitor–naive patients with mCSPC who achieved PSA90 response 6 months after initiating apalutamide or enzalutamide.

Prostatic neoplasms Prostate-specific antigen (PSA)Prostate-specific antigen Prostate-specific antigens Castration Androgen receptor Androgen receptor antagonists treatment effectiveness

Volume 23, Number 1 Prostate Cancer

Specialty Networks Unveils Revised Advanced Prostate Cancer Clinical Guidelines

David Morris Benjamin H. Lowentritt

In an ongoing effort to support independent urology practices’ work to provide first-class cancer care, Specialty Networks recently unveiled new, expanded clinical guidelines for advanced prostate cancer (PCa) treatment. (See the guidelines, packaged with this issue of Reviews in Urology.)

Prostatic neoplasms Neoplasm practice guidelines clinical decision-making

Volume 23, Number 1 Prostate Cancer

Contemporary Approaches to Diagnosing Prostate Cancer

Ashley E. Ross Alon Lazarovich Aaron S. Dahmen Abhinav Sidana Jack Millot Jonathan E. Shoag Hangcheng Fu John Eifler

The diagnosis of prostate cancer (PCa) has changed substantially over the last decade. An increased understanding of disease behavior has led to the development of more specific biomarkers that may limit the numbers of prostate biopsies performed as well as the overdiagnosis of low-grade disease. We have concurrently seen the refinement of imaging techniques such as multiparametric magnetic resonance imaging (mpMRI), which can also limit overdiagnosis and aid in the discovery of clinically significant disease. We now have various options for performing ultrasound-guided biopsies, including transperineal and transrectal approaches. In this article, we gather perspectives on contemporary pathways toward the diagnosis of PCa from experts practicing in large urology practice groups and academia.

Prostatic neoplasms Biomarkers Magnetic resonance imaging (MRI)

Volume 23, Number 1 Treatment Review

Consistency in Care Opportunities for Prostate Cancer

Wanda Wilt Nicole Smith Katie Grant Jayme Nalley Jody Pinkerton

Through data analysis and multiple interviews and insights, this study attempted to address the inconsistency in care for patients with prostate cancer who shared similar journey time points, demographics, and care center expertise. The Consistency of Care Project aimed to evaluate the impact of efforts to improve targeted metrics surrounding crucial clinical interventions of prostate-specific antigen monitoring, surveillance scanning, and pharmacologic interventions over a 9-month period. For comparison, 15 private urology practices of like size, patient population, and demographics were monitored. Ten of the practices benefitted from reviewed workflow training on the PPS Analytics data platform; access to a PPS Analytics Clinical Analyst, who supported education for identification of actionable patients; consistent data analysis; workflow support; and regular check-in meetings to monitor progress. The 5 control sites were monitored without additional, purposeful intervention. Outcomes support the hypothesis that inconsistency in care can begin to be addressed through focused workflows, strong navigation, and attention to key performance indicators. Attrition rate differences of 32% vs 6% improvements (reengaging patients for care who had no next appointment scheduled). On average, the experimental group increased the metastatic castration-sensitive prostate cancer diagnosis rate by 10%. However, the treatment rates measured a relative increase of 35% but an average of 11% absolute improvement at the supported sites vs 6% at the control sites. Patients with metastatic castration-resistant prostate cancer at the supported sites improved by 20%, compared with those in the control group, who improved by 4%. Care teams with strong workflows, supportive resources, and consistent care pathways—when combined with data analytics—can influence care and drive increased, measurable differences.

Prostate cancer Prostatic neoplasms Urology Neoplasm patient navigation

Volume 2, Supplement 4 Supplement

Sergery, Ultrasound, Adjuvant and Neoadjuvant Therapy

Therapeutic Strategies for Localized Prostate Cancer I:

E David Crawford John P Mulhall John Lynch Martin I Resnick Martin E Gleave Guy Vallancien Karl Pummer

Prostatic neoplasms Ultrasound Prostatectomy, radical Therapy, adjuvant

Volume 2, Supplement 4 Supplement

Perineal Prostatectomy, X-Rays, Protons, Neutrons, and Combination Brachytherapy

Therapeutic Strategies for Localized Prostate Cancer II:

Peter S Albert Michael D Weil Arthur T Porter David C Beyer Douglas Chinn Michael J Harris

Prostatic neoplasms Radiotherapy Survival analysis

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