Prostate Cancer

Clinical trial results to date show that men with visceral CRPC metastases do not benefit from ipilimumab, while their counterparts with bone- or node-only metastases do. This suggests that visceral metastases should be a stratification factor for future immunotherapy clinical trials.

While evidence points to benefit from highly active hormonal agents in prostate cancer with visceral involvement, the usefulness of immunotherapy is much less clear.

Although the mechanism(s) underlying the relatively poor prognosis of prostate cancer patients with visceral disease have yet to be fully elucidated, these new findings suggest that the microenvironment of bone lesions may be immunologically distinct from those at other sites.

One should not advise a patient with low- or very-low-risk prostate cancer to undergo a focal ablation. The kindest and gentlest approach is to first do no harm.

Investigators and physicians caring for the spectrum of prostate cancer should have a targeted treatment option available for patients who would benefit by it.

A study found that prostate cancer patients with a history of heart problems are at increased risk of cardiac death following androgen-deprivation therapy.

Ultimately, while further follow-up will be enlightening, we believe that there is sufficient evidence now from the primary analysis of CHAARTED to justify the combination of docetaxel and androgen deprivation therapy in all men with metastatic hormone-sensitive prostate cancer.

Meta-analyses of patients with low-volume metastatic hormone-sensitive prostate cancer will likely be required to attain sufficient power to address the role of docetaxel in this setting.

Treatment-emergent small-cell/neuroendocrine prostate cancer is likely to become of increasing clinical relevance in the era of widespread use of potent androgen receptor–targeted therapies.

Aggressive variants of prostate cancer often take the form of neuroendocrine or small-cell carcinomas, which frequently lack androgen receptor expression and respond poorly to hormonal therapies.

Higher levels of triglycerides and cholesterol in the blood may signal an increased risk of recurrence for men with prostate cancer.

A large trial found that men with moderate baldness at age 45 had an increased risk of developing aggressive prostate cancer compared with men with no baldness.

A new study found that the androgen receptor splice variant 7 is associated with resistance to two therapies for metastatic castration-resistant prostate cancer.

The American Society of Clinical Oncology and Cancer Care Ontario released joint guidelines for treating metastatic castration-resistant prostate cancer.

Men who increased their consumption of fruits and vegetables-tomato products in particular-had a lower overall risk of prostate cancer, according to a new study.

Following studies that found no survival or mortality benefit, we discuss the utility of primary androgen deprivation therapy in localized prostate cancer.

The adoption of robot-assisted radical prostatectomy is on the rise in the United States, according to the results of a retrospective study.

Patients with limited life expectancies often undergo routine cancer screenings despite evidence that they are unlikely to benefit and may experience harm.

It is now well established that castration-resistant disease can be effectively treated using newer androgen receptor-targeting agents such as abiraterone and enzalutamide.

This is an exciting time for physicians who care for patients with advanced prostate cancer, and more importantly a time of heightened optimism for these men and their families.

In the past 5 years we have taken at least 7 steps forward for men with prostate cancer-which hopefully will turn into “one giant leap” in our attempt to convert advanced prostate cancer into a chronic disease.

This article reviews the most recent advances in androgen receptor-directed therapies for castration-resistant prostate cancer, and new agents under development.

A large European study found that PSA screening reduces prostate cancer deaths, but that these benefits do not outweigh the harms of overtreatment.

How low-risk prostate cancer is managed depends more on the diagnosing physician than the patient’s disease state. Men who were diagnosed by a urologist were more likely to receive a treatment performed by the urologist and more likely to receive a therapy rather than monitoring.

At the present time, without clear data to suggest improved survival for patients undergoing extended pelvic lymph node dissection, the procedure cannot be universally recommended.

Extended pelvic lymph node dissection represents the most accurate procedure for the detection of lymph node metastases in prostate cancer.

Men who underwent a vasectomy had a modest increase in the incidence of prostate cancer-and particularly lethal prostate cancer.

Dr. Morris discusses results and implications of the CHAARTED trial, which studied the survival impact of androgen deprivation therapy (ADT) plus docetaxel vs ADT alone for hormone-sensitive newly metastatic prostate cancer.

Upfront surgery allows for greater freedom to use all secondary treatment options for local and distant control, including adjuvant radiotherapy and ADT, thereby hopefully obviating the significant adverse quality-of-life sequelae from salvage surgery and brachytherapy for local relapse.

Under current conditions for patients with newly diagnosed node-positive prostate cancer, the benefits of surgery, if any, are highly unlikely to outweigh the known harms--less is still more.