(UroToday.com) At the 2021 ASCO Genitourinary Cancers Symposium (ASCO GU) practical applications of novel imaging and genomic approaches in the management of clinically localized prostate cancer session, Dr. Peter Carroll discussed active surveillance for prostate cancer as it stands in 2021. Dr. Carroll notes that active surveillance is a preferred form of treatment for many men, but should be seen, as well, as a response to the over-detection and over-treatment of prostate cancer brought about by widespread and repeated PSA screening. The uptake of active surveillance by the urology community helped pave the way for an upgraded assessment by The U.S. Preventive Services Task Force (USPSTF) on the early detection of prostate cancer. 

(UroToday.com) Current guidelines for initial staging of intermediate- and high-risk prostate cancer recommend the use of cross-sectional imaging and bone scan, whereas the local staging of prostate cancer relies on systematic or targeted biopsies and multiparametric magnetic resonance imaging (mpMRI). However, the role of prostate-specific membrane antigen (PSMA)-targeted PET in the evaluation of intraprostatic cancer foci and T-staging assessment is not well defined. At the 2021 ASCO Genitourinary Cancers Symposium (ASCO GU), Dr. Ida Sonni and colleagues from UCLA presented results of their study comparing the diagnostic performance of PSMA PET/CT, mpMRI and the combination of the two modalities (PSMA PET/CT plus mpMRI) in the detection, intra-prostatic localization, and local extension of primary prostate cancer with histopathology as the gold standard.

(UroToday.com) Data from the landmark ALSYMPCA trial¹ found that the targeted alpha therapy Radium-223 prolonged overall survival in men with metastatic castration-resistant prostate cancer (mCRPC).¹ However, there is little data to guide clinicians as to the appropriate sequence for use of Radium-223 in men with mCRPC with regards to other life-prolonging therapies. At the 2021 ASCO Genitourinary Cancers Symposium (ASCO GU), Dr. Lawrence Mbuagbaw and colleagues presented results of their real-world study evaluating clinical outcomes of patients when Radium-223 was used early (second-line) or late (third or later lines) among men with mCRPC.

(UroToday.com) Androgen receptor-targeted agents represent one of the main treatment options for men with metastatic castrate-resistant prostate cancer (mCRPC). The addition of stereotactic radiation therapy to ablate metastatic foci may improve clinical outcomes in oligometastatic setting. The ARTO trial (NCT03449719) is a randomized phase II trial testing the benefit of upfront stereotactic body radiation therapy on all sites of metastatic disease in oligometastatic-mCRPC patients undergoing first-line therapy with abiraterone acetate. At the 2021 American Society of Clinical Oncology Genitourinary Cancers annual meeting (ASCO GU), Dr. Giulio Francolini and colleagues presented a preliminary analysis, reporting results after six months of follow up, together with an exploratory analysis of androgen receptor splice variants (ARV7/ARFL) PSA and PSMA expression on circulating tumor cells detected in this cohort of patients.

(UroToday.com) Among men with metastatic castration-resistant prostate cancer (mCRPC), there is a subset who develop aggressive variant or neuroendocrine/small-cell-like (NE/SC) tumors.  These men display particularly poor outcomes. Although a field of active investigation of underlying mechanisms of development, effective therapies remain a clear unmet clinical need.  The current standard of care is typically platinum- or taxane-based chemotherapies.  The investigators conducted a single arm, two-stage phase II trial (PICK-NEPC¹) to evaluate whether men these tumors respond to treatment with avelumab, a PD-L1 inhibitor.