Prostate Cancer and Prostatic Diseases - Results from #80

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Prostate Cancer and Prostatic Diseases

From the Desk of the Editor: Obesity is Linked to High-Grade Prostate Cancer

Obesity is all around us. Over 30% of all Americans are obese. We know obesity is linked with many medical problems – heart disease, diabetes, hypertension, and of course cancer. Indeed, over a dozen different cancers have been linked with obesity. In regards to prostate cancer, while obesity may lower the risk of low-grade indolent cancer, it unequivocally increases the risk of high-grade aggressive disease. Many explanations have been put forward: alterations in insulin levels, changes in sex steroid hormone levels, higher cholesterol,

Periprostatic Adipose Inflammation is Associated with High-Grade Prostate Cancer - Full Text Article

Background: Obesity, a cause of subclinical inflammation, is associated with increased risk of high-grade prostate cancer (PC) and poor outcomes. Whether inflammation occurs in periprostatic white adipose tissue (WAT), and contributes to the negative impact of obesity on PC aggressiveness, is unknown.

Methods: In a single-center, cross-sectional design, men with newly diagnosed PC undergoing radical prostatectomy were eligible for study participation. The primary objective was to examine the prevalence of periprostatic WAT inflammation defined by the presence of crown-like structures (CLS-P) as detected by CD68 immunohistochemistry. Secondary objectives

From the Desk of the Associate Editor: Revisiting Neoadjuvant ADT Prior to Prostatectomy

This compelling study revisits the concept of neoadjuvant adjuvant deprivation therapy (ADT) prior to radical prostatectomy. A small series of randomized clinical trials (RCTs) performed almost 20 years ago failed to demonstrate substantial benefits in patients with localized prostate cancer who received ADT before surgery. Based on these data, the American Urological Association and the European Association of Urology recommend against ADT prior to prostatectomy outside the setting of a clinical trial.

Post Prostatectomy Outcomes of Patients with High-risk Prostate Cancer Treated with Neoadjuvant Androgen Blockade - Full Text Article

Background: Patients with high-risk prostate cancer have an increased likelihood of experiencing a relapse following radical prostatectomy (RP). We previously conducted three neoadjuvant androgen-deprivation therapy (ADT) trials prior to RP in unfavorable intermediate and high-risk disease.

Methods: In this analysis, we report on the post-RP outcomes of a subset of patients enrolled in these studies. We conducted a pooled analysis of patients with available follow-up data treated on three neoadjuvant trials at three institutions. All patients received intense ADT prior to RP. The primary endpoint

From the Desk of Andrew Armstrong - Use of Biopsy-based Genomic Classifier to Predict Distant Metastasis.

Molecular risk tools are being increasingly utilized in men with localized prostate cancer to help in clinical decision making around the need for surgery or radiation vs. active surveillance, and for the need for salvage radiation after surgery. The Decipher Genomic Classifier has recently been demonstrated to predict distant metastases in men undergoing radical prostatectomy, using biopsy or surgical tissue, and may provide a greater level of prognostic discrimination than current NCCN or CAPRA risk groups.

Utilization of Biopsy-Based Genomic Classifier to Predict Distant Metastasis after Definitive Radiation and Short-Course ADT - Full Text Article

BACKGROUND: We examined the ability of a biopsy-based 22-marker genomic classifier (GC) to predict for distant metastases after radiation and a median of 6 months of androgen deprivation therapy (ADT).

METHODS: We studied 100 patients with intermediate-risk (55%) and high-risk (45%) prostate cancer who received definitive radiation plus a median of 6 months of ADT (range 3–39 months) from 2001–2013 at a single center and had available biopsy tissue. Six to ten 4 micron sections of the needle biopsy core with the highest Gleason score and percentage of tumor involvement were

From the Desk of the Associate Editor: Prostate Cancer Radiation and Urethral Strictures: A Systematic Review and Meta-analysis

Urethral strictures do not tend to be at the forefront of most clinicians’ minds when considering the adverse effects of radiotherapy for prostate cancer. Quite correctly, the first considerations would be for those associated with any collateral damage to the rectum or bladder. But all urologists are well aware of radiation-related urethral strictures because the great majority would have these patients in their clinical workload. They are ‘heavy’ patients in that they need a lot of counseling and often require a lot of work to ‘manage’ their disease. It is often a case of where a few patients as such can

Prostate Cancer Radiation and Urethral Strictures: A Systematic Review and Meta-analysis - Full Text Article

BACKGROUND: We performed a systematic review and meta-analysis to determine the prevalence and predictors of urethral stricture development post radiation therapy (RT) for prostate cancer (PCa).

METHODS: Published articles in PubMed/Medline, Cochrane, and Embase databases from January 2000 to April 2016 were queried. Inclusion criteria were any study that reported the prevalence of urethral strictures

Saturated Fat Intake and Prostate Cancer Aggressiveness: Results from the Population-based North Carolina-Louisiana Prostate Cancer Project - Full Text Article

BACKGROUND:
Epidemiological and laboratory evidence supports a role for cholesterol in prostate cancer (PC). Dietary saturated fat content impacts serum cholesterol levels. However, epidemiological associations between saturated fat and PC aggressiveness are inconsistent. We hypothesized that high saturated fat intake would be associated with increased PC aggressiveness, and that statin use would modify this association.

From the Desk of the Editor: Saturated Fat Intake and Prostate Cancer Aggressiveness

Race, family history, and age. Those are the three classic risk factors for prostate cancer that are etched in stone in every textbook and course taught. While absolutely true, the challenge is that none of these are modifiable. We can’t change our race. We can’t grow younger and as much as some of us would like, we can’t change our parents. As such, we are stuck. Our risk is our risk. Or is it? Are there modifiable risk factors for prostate cancer? It is now clear that obesity and smoking are modifiable risk factors for fatal prostate cancer. While avoiding obesity and not smoking sound like overall good advice, is there more specific advice we can give to our patients or to men at risk who don’t want to become patients in the first place.

Is Active Surveillance a Suitable Option for African American Men with Prostate Cancer? A Systemic Literature Review - Full Text Article

Background: Certain patients presenting with either low or very-low-risk prostate cancer (PCa) can represent a therapeutic dilemma for physicians. The oncologic outcomes of active surveillance (AS) for men with very-low-risk PCa are overall excellent. However, there are concerns about AS related to the potential for upgrading or upstaging. The African American (AA) population is under-represented in studies evaluating AS outcomes and this is particularly important because of the unique epidemiology of PCa in AA men.

From the Desk of the Associate Editor: Is Active Surveillance a Suitable Option for African American Men with Prostate Cancer?

Active surveillance (AS) provides a safe management option for men with low-risk and selected men with intermediate-risk prostate cancer. However, concerns persist that African American (AA) men pursuing AS are at increased risk of adverse clinical outcomes relative to other races.

These investigators undertook a systematic review of studies of AA men with low-risk prostate cancer and AS. They identified eleven studies focused on pathologic features at time of surgery and five on other clinical outcomes. Further, they reviewed genetic characteristics of prostate cancer and the AA population. They did not

Radiographic Progression with Non Rising PSA in mCRPC: PREVAIL: PCAN Full Text Article

BACKGROUND: Advanced prostate cancer is a phenotypically diverse disease that evolves through multiple clinical courses. PSA level is the most widely used parameter for disease monitoring, but it has well-recognized limitations. Unlike in clinical trials, in practice, clinicians may rely on PSA monitoring alone to determine disease status on therapy. This approach has not been adequately tested.

METHODS: Chemotherapy-naive asymptomatic or mildly symptomatic men (n = 872) with metastatic castration-resistant prostate cancer (mCRPC) who were treated with the androgen receptor inhibitor enzalutamide in the PREVAIL study were analyzed post hoc for rising versus nonrising PSA (empirically defined as 41.05 vs ⩽ 1.05 times the PSA level from 3 months earlier) at the time of radiographic progression. Clinical characteristics and disease outcomes were compared between the rising and nonrising PSA groups.

From the Desk of the Associate Editor: Progression on Enzalutamide: Data from the PREVAIL Trial

Enzalutamide is a second generation AR inhibitor that engages AR through the ligand binding domain, inhibiting DNA binding and AR activity. In the PREVAIL study, enzalutamide improved overall survival in chemotherapy naïve men with mCRPC, and enzalutamide is presently a standard of care for these men, with greater activity observed when used prior to docetaxel as compared to following docetaxel. While most men respond to enzalutamide in this setting, all men develop treatment resistance between 1-3 years. This present article explores how men progress on enzalutamide, using data from the PREVAIL trial.

From the Desk of the Associate Editor: Blood-based and Urinary Prostate Cancer Biomarkers: A Review and Comparison of Novel Biomarkers for Detection and Treatment Decisions

PSA screening has allowed for the detection of prostate cancer at curable clinical stages, and accordingly, there has been a reduction in prostate cancer-specific mortality in the PSA era. Criticisms of PSA based screening and its utilization for decision making regarding biopsy have focused on its sensitivity, and lack of specificity for prostate cancer. Use of PSA alone can lead to unnecessary initial and repeat biopsies, and to the detection of indolent prostate cancer, all of which cause health and economic burdens.

Blood-based and Urinary Prostate Cancer Biomarkers: A Review and Comparison of Novel Biomarkers for Detection and Treatment Decisions

BACKGROUND: The diagnosis of prostate cancer (PCa) is currently based on serum PSA testing and/or abnormal digital rectal examination and histopathologic evaluation of prostate biopsies. The main drawback of PSA testing is the lack of specificity for PCa. To improve early detection of PCa more specific biomarkers are needed. In the past few years, many new promising biomarkers have been identified; however, to date, only a few have reached clinical practice.

From the Desk of the Editor: Meta-analysis of Metabolic Syndrome and Prostate Cancer

Metabolic syndrome is a constellation of conditions including obesity, diabetes, hypertension, and alterations in serum lipids. It was originally defined as a syndrome that is linked with increased risk of heart disease. As the obesity epidemic has swept through the Western world, the rates of metabolic syndrome have likewise risen dramatically. As many of the conditions that constitute the metabolic syndrome have individually been linked with cancer, there is growing interest in the role of the metabolic syndrome with cancer.

Meta-analysis of Metabolic Syndrome and Prostate Cancer

Abstract

BACKGROUND: Metabolic syndrome (MetS) and prostate cancer (PCa) are highly prevalent conditions worldwide. Current evidence suggests the emerging hypothesis that MetS could play a role in the development and progression of several neoplasms. The aims of this study are to evaluate the impact of MetS and MetS factors on PCa incidence, on the risk of high-grade PCa and to analyze the role of MetS and single MetS components on the development of aggressive PCa features.

From the Desk of the Associate Editor: PET imaging of prostate-specific membrane antigen in prostate cancer: current state of the art and future challenges.

Recently, there has been a great deal of interest in prostate specific membrane antigen (PSMA) as a basis for positron emission tomography (PET) imaging of prostate cancer. As recently as a few years ago, there were only handfuls of abstracts on this subject matter at the major international urology conferences. Over the past couple of years, there has literally been an explosion of clinical abstracts, particularly in the evaluation of Ga68 PSMA PET/CT as a staging tool at diagnosis and in the setting of evaluating biochemical recurrence following primary definitive treatment of localised disease.

From the Desk of the Editor: Androgen deprivation therapy for prostate cancer and dementia risk

Hot flashes. Loss of Libido. Impotence. Fatigue. Osteoporosis. Weight gain. Diabetes. Loss of muscle mass. Gain in fat mass. Testicular shrinkage. Cardiovascular disease (still controversial). What do these all have in common? No, they are not the rare side effects that may occur from a drug that you hear on a TV commercial. These are all real and common side effects of androgen deprivation therapy (ADT) for prostate cancer.

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