Genitourinary Cancers

We discuss the current controversies in prostate cancer-PSA screening and approaches to initial treatment for men diagnosed with the disease.

According to a study in the journal Cancer, without the use of PSA screening the number of men presenting with cases of metastatic prostate cancer would be three times greater than the actual number observed today.

Results from a trial of a new therapeutic vaccine for renal cell carcinoma demonstrate that those patients with a measurable immune response to the vaccine have a prolonged overall survival.

The results of the 12-year PIVOT trial shows men with early-stage prostate cancer who had a radical prostatectomy did no better than those actively monitored without surgery.

How should oncologists advise patients about the best surgical approach to use to treat their prostate cancer? Quite simply, it is the surgeon, not the approach. The self-fulfilling prophecy about surgery is that the best surgeons tend to do the most surgeries, so an easy metric is volume.

In summary, both RALP and ORP are excellent operations in experienced hands. They are also technically difficult to perform consistently well, so in my view, surgeons should attempt to master the operation they perform rather than hastily switching to robotic surgery, unless they have an opportunity for significant mentorship and surgical volume.

We fervently hope that all surgeons will participate in a comparative outcomes project for the purpose of quality improvement. However, today we will settle for one, we hope, skilled surgeon, open or robotic.

Over the last decade, robotic-assisted laparoscopic prostatectomy (RALP) has rapidly gained in popularity, primarily for three reasons: the enthusiasm of surgeons keen to try something new, medical marketing, and patients’ desire to avoid side effects from surgery.

There is no question that the robot has leveled the playing field. It has allowed more surgeons to offer patients a minimally invasive approach. In terms of perioperative outcomes, there is clear evidence showing shorter hospital stays, less blood loss, lower complication rates, and shorter convalescence with robotic-assisted laparoscopic prostatectomy.

A new noninvasive blood test for prostate cancer detection won the approval of the FDA last month. The manufacturer believes the test will provide better detection and a decrease in costs.

This review by Aneja et al provides an excellent discussion of prostate external beam hypofractionated radiation therapy and its potential benefits and pitfalls.

In this issue of ONCOLOGY, Aneja and colleagues explore the beneficial aspects of the use of hypofractionated radiotherapy in the treatment of adenocarcinoma of the prostate.

In this issue of ONCOLOGY, Dutcher, Mourad, and Ennis provide a current review of some newer strategies in the surgical and systemic treatment options for localized and advanced renal cell carcinoma (RCC).

Drs. Dutcher, Mourad, and Ennis have provided an excellent review of current and potential future treatments of renal cell carcinoma (RCC); we would like to highlight some salient points from a urologic perspective.

Given that prostate cancer is the most common non-cutaneous cancer among men in the Western world, its treatment is of great medical and public significance.

In the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the two modalities. Finally, we discuss the role of the new systemic agents in non–clear cell RCC.

Researchers reported results of an international phase III trial showing that intermittent hormonal therapy is less effective than continuous therapy in prostate cancer with minimal disease.

Results from a randomized phase II study show that 6 months of treatment with abiraterone (Zytiga), in addition to the hormone therapy leuprolide before prostatectomy, resulted in complete response and near-complete response in one-third of men with high-risk prostate cancer.

In a multicenter phase III trial of 360 patients with muscle-invasive bladder cancer, synchronous chemoradiotherapy provided better locoregional control without significant added toxicity, investigators for the Bladder Cancer 2001 trial have found.

Two experts discuss newly available and upcoming treatment options, such as abiraterone and MDV3100, for patients with castration-resistant prostate cancer.

Radium-223 is a promising agent that represents a new class of alpha pharmaceuticals that gets down to the site of bony metastases. The limited side-effect profile potentially allows for repeat administration to increase durability of pain control, and for its use in combination with novel biologic and chemotherapeutic agents.

One would hope that survival data from at least one more phase III or phase IV clinical trial will convincingly show a prolongation of survival due to treatment with Alpharadin. This will not be inexpensive therapy.

This article will present current information about alpha-pharmaceuticals, a new class of targeted cancer therapy for the treatment of patients with CRPC and bone metastases. It will review preclinical and clinical studies of the experimental radiopharmaceutical radium-223 chloride (Alpharadin).

Use of neoadjuvant metformin prior to radical prostatectomy helped to reduce metabolic effects and slow the growth rate of cancer in a single-center phase II study conducted among men with confirmed prostate cancer.

The antiangiogenic agent pazopanib demonstrated clinically meaningful activity in patients with refractory urothelial cancer in a phase II proof-of-concept study, identifying pazopanib as the first targeted compound to have clinically meaningful activity in patients with refractory urothelial cancer.

Rationale for prostate cancer screening continues to be debated as an update to a large European trial reconfirms a reduction in death rates from prostate cancer in men who are screened for the disease. The study, however, found no significant difference in overall mortality between the two arms of the trial.

Renal cell carcinoma (RCC) had historically been regarded as a disease that was refractory to therapy once surgical options had been exhausted.

The development of vascular endothelial growth factor (VEGF) pathway inhibitors and mammalian target of rapamycin (mTOR) inhibitors for the treatment of renal cancer is a real success story.

The article by Posadas and Figlin on systemic therapy in advanced renal cell carcinoma (RCC) provides a very interesting and comprehensive review of our current knowledge concerning the treatment of RCC.

The new drug, MDV3100, extended overall survival by 4.8 months (P < .001) and reduced the risk for death by 37% as compared to placebo in men with castration-resistant prostate cancer who had progressed after treatment with docetaxel.