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7th Annual Interdisciplinary Prostate Cancer Congress™

7th Annual Interdisciplinary Prostate Cancer Congress™


Resources

7th Annual Interdisciplinary Prostate Cancer Congress™: Meeting-in-a-Box
The Meeting-in-a-Box components are designed for you to share the information with colleagues, fellows, and other health care professionals.

PER Pulse™ Recap
Three PER Pulse™ Recaps presenting key topics from the 7th Annual Interdisciplinary Prostate Cancer Congress™, which was held on March 15, 2014.



PER Meeting in a Box

Welcome and Prostate Cancer Year in Review

Daniel P. Petrylak, MD

What criteria do you consider when deciding to perform PSA-based screening in your patients?

Do you use any prostate cancer biomarkers besides PSA in your patients? If so, what assays do you perform?

How do you address the first-line treatment of patients with prostate cancer?

PSA Screening for Prostate Cancer

A. Oliver Sartor, MD

Do you closely follow the AUA 2013 Guidelines regarding PSA screening?

In those patients for whom you do perform PSA screening, how often do you assess/reassess PSA levels (eg, every year, every 4 years)?

In general, would you treat a Gleason 6 organ-confined tumor?

Novel Imaging Modalities

Daniel P. Petrylak, MD

How many of your newly diagnosed patients with prostate cancer have metastatic disease?

What imaging modality do you most commonly use to detect metastatic prostate cancer?

How do multidisciplinary teams of medical oncologists and radiologists collaborate to best identify appropriate radioisotopes and imaging modalities for patients with prostate cancer?

Biopsy of Prostate Cancer

E. David Crawford, MD

Do you believe there is currently an overdiagnosis of prostate cancer in the United States?

Do you believe that physicians are overtreating patients with prostate cancer?

What is the Gleason score of your “average” patient with prostate cancer? Do you believe that this score is heterogeneous throughout the tumor?

State of the Art: Prostate Cancer Genomics

E. David Crawford, MD

Have you used novel assays such as ConfirmMDx, Decipher, Prolaris, or Oncotype DX?

If so, do you believe that these assays assist in decisions such as when to biopsy, when to re-biopsy, or which patients should or should not be treated?

Therapeutic Overview of Castration-Resistant Prostate Cancer

Daniel P. Petrylak, MD

With 5 new drugs approved in a 2-year period, what considerations do you make when sequencing agents for prostate cancer?

Should overall survival be the primary endpoint when comparing docetaxel + prednisone with novel agents + docetaxel?

Novel Antiandrogen Therapies for Castration-Resistant Prostate Cancer

Robert Dreicer, MD

What criteria facilitate the decision between using abiraterone and enzalutamide for antiandrogen treatment of patients with prostate cancer?

Have you enrolled any of your patients with prostate cancer in clinical trials examining investigational antiandrogen therapies?

How many of your patients with prostate cancer receiving antiandrogen therapies develop resistance?

What's New in Radiation Therapy

Peter B. Schiff, MD, MS, PhD

How many of your patients with prostate cancer develop a detectable level of PSA after radical prostatectomy? Do you believe that this biochemical recurrence is clinically significant?

What are the advantages/disadvantages of adjuvant vs salvage radiation therapy after radical prostatectomy?

What dose of radiation do you typically use in the adjuvant setting? In the salvage setting?

Novel Therapies: Radiopharmaceuticals for Castration-Resistant Prostate Cancer

A. Oliver Sartor, MD

How frequently do you include a bone-targeted agent along with other systemic therapies for your patients with metastatic disease?

Do you use radium-223 only in symptomatic patients with prostate cancer, and not asymptomatic patients?

How does radium-223 fit along with bisphosphonates in the treatment paradigm?

Immunotherapeutic Approaches for Prostate Cancer

Robert Dreicer, MD

How many of your eligible patients with prostate cancer have you treated with sipuleucel-T?

Does the lack of an objective tumor response with sipuleucel-T concern you? Or does the overall survival benefit overcome any concerns?

Have you enrolled any of your patients in clinical trials investigating novel immunotherapies such as vaccines or immune-checkpoint inhibitors?

Practical Considerations of Prostate Cancer Care

Leonard G. Gomella, MD, FACS

Which of the following adverse events do you most commonly observe with androgen-deprivation therapy: hot flashes, loss of libido, fatigue, anemia, muscle loss, obesity, or osteoporosis?

Do you supplement vitamin D and/or calcium in your patients receiving androgen-deprivation therapy?




PER Pulse™ Recap

PER Pulse™ Recap
Medical Writer: Kathleen Casey Krafton, MA


1 of 3
PER Pulse™ Recap
7th Annual Interdisciplinary Prostate Cancer Congress

The 7th Annual Interdisciplinary Prostate Cancer Congress™, which was held March 15, 2014, was convened to provide current, practical information on the management of prostate cancer (PCa), as well as look at the novel agents and strategies that will shape the future of PCa diagnosis and care.
  • Dr. Daniel P. Petrylak presented a year-in-review talk that covered developments and controversies regarding PCa diagnosis (specifically, PSA testing) and care (how to treat, when to treat, when/whether to stop treatment). Repeat biopsies, overtreatment, and the need for active monitoring are pressing issues for which there is a lack of expert consensus and clear guidelines. Many of these issues relate to the unmet need for improved testing and pathology in order to stratify patients and determine best treatment courses. Additionally, randomized controlled trials are needed to confirm the role of preventive agents, such as statins. Exciting developments include preliminary results from E3805, which indicate that early chemotherapy improves survival, with a 20% reduction in the risk of death at 3 years; such data could potentially aid in the selection of patients for chemotherapy. Early treatment with hormone therapy has also emerged as a potential means to improve outcomes, as seen in the ALSYMPCA and IMPACT trials. Other exciting developments include the approvals of several biomarkers; ongoing trials of biomarkers are continuing in many arenas.
  • Dr. Leonard G. Gomella discussed the practical considerations of PCa care, particularly in men with advanced cancer. Improved survival rates associated with androgen-deprivation therapy (ADT) mean that men are on these therapies for increasingly longer periods of time, necessitating the need to prevent and treat associated adverse effects (AEs). The constellation of AEs associated with long-term ADT includes metabolic syndrome (diabetes, osteoporosis/sarcopenia, and cardiovascular disease), a growing concern because long-term ADT appears to be placing men at increased risk. Practical recommendations include screening at baseline and yearly thereafter, lifestyle modifications, and pharmaceutical interventions when necessary. Due to the dramatic decline in bone mineral density associated with ADT, all patients with or without metastatic disease are at heightened risk for fracture and associated comorbidities. Prevention and treatment includes vitamin D and calcium supplementation. However, recent data reveal that >100 mg/day of calcium increases the risk of CVD mortality by 20%. Therefore, the new recommendations are for men to obtain most calcium through their diets and, if needed, supplement with 600 mg/day of calcium. Intermittent ADT may mitigate these and other AEs; this remains a controversial topic, however, warranting further study. 
  • Dr. E. David Crawford delivered a presentation on state-of-the-art PCa genomics. Biomarkers are needed to help increase initial positive biopsies and to stratify low-risk and high-risk patients. Biomarkers can aid in determining stage of disease, a critical area that is currently missing from PCa diagnosis and which can inform clinicians as to the appropriate therapeutic monitoring. One example includes the Oncotype DX genomic assay, which has the ability to evaluate aggressiveness in newly diagnosed patients, aiding in treatment decisions and moving the field of PCa care closer to personalized medicine. The potential ability of biomarkers to enable clinicians to more easily know when to biopsy, when to rebiopsy, and when to treat represents a significant advance in the field.

Other important PCa topics that were discussed included:

  • Novel Imaging Modalities by Daniel P. Petrylak, MD
  • Immunotherapeutic Approaches for Prostate Cancer and Novel Anti-androgen Therapies for Castration-Resistant Prostate Cancer by Robert Dreicer, MD, MS, FACP, FASCO
  • What’s New in Radiation Therapy by Peter B. Schiff, MD, MS, PhD
     

2 of 3
PER Pulse™ Recap
7th Annual Interdisciplinary Prostate Cancer Congress

The 7th Annual Interdisciplinary Prostate Cancer Congress™, which was held March 15, 2014, was convened to provide current, practical information on the management of prostate cancer (PCa), as well as look at the novel agents and strategies that will shape the future of PCa diagnosis and care.
  • Dr. Daniel P. Petrylak gave a talk concerning the therapeutic landscape for castration-resistant prostate cancer (CRPC), including current and emerging treatments. The field is advancing rapidly, with five new agents approved in the last 24 months. Improvements in survival benefit are being seen with agents such as MDV3100, abiraterone, radium-223 (Ra-223), and cabazitaxel in metastatic, minimally symptomatic CRPC, symptomatic or poor-prognosis CRPC, and in CRPC that progresses after chemotherapy. The activity of agents may be dependent on sequencing, as cross-resistance is currently unknown and remains an area for further study. Therapeutic classes include hormonal (eg, MDV3100, abiraterone), cytotoxic (eg, docetaxel, cabazitaxel), immunotherapeutic (sipuleucel-T), and DNA damage (Ra-223). Evolving understanding of the pathogenesis of CRPC has resulted in the androgen receptor now being recognized as a valid target. New data from the AFFIRM trial indicate the use of chemotherapy later in the treatment process.
     
  • Dr. A. Oliver Sartor delivered a presentation on the tremendous advances that have been made in radiopharmaceuticals for CRPC, particularly since 2010. Prostate cancer has a unique pattern of metastases: bone/soft tissue ratios are exceptionally high in PCa as compared with other solid tumors; it is extremely osteoblastic; and bone metastases are often the only metastases radiographically detected in patients with advanced PCa. As such, targeting the bone makes sense. Radium targets osteoblastic bone metastases by acting as a calcium mimetic and binding to hydroxyapatite. Sequencing is still an area of ongoing investigation; however, in patients with bone metastases, radium in conjunction with the newer hormones may be an appropriate choice. Although the label of Ra-223 excludes its use in asymptomatic patients, the presence of pain may or may not be clinically important.
     
  • Dr. Robert Dreicer presented a talk on immunotherapeutic approaches to PCa, particularly how immunotherapy can be integrated into a multipronged approach to the treatment of CRPC. For instance, in clinical trials, sipuleucel-T has shown potential impact on survival. Although it has no antitumor activity, it could be used as an adjunct to other agents to hit multiple targets, an important strategy for any cancer that develops resistance to treatments. Immunotherapy appears to be most promising when used early on, in asymptomatic patients with metastatic CRPC, due to the length of time needed for an immune response to develop. Used in the right patient population, agents such as sipuleucel-T and Prostvac may have positive impact on survival.

Other important PCa topics that were discussed included:

  • Novel Imaging Modalities by David P. Petrylak, MD
  • What’s New in Radiation Therapy by Peter B. Schiff, MD, MS, PhD
     

3 of 3
PER Pulse™ Recap
7th Annual Interdisciplinary Prostate Cancer Congress

The 7th Annual Interdisciplinary Prostate Cancer Congress™, which was held March 15, 2014, was convened to provide current, practical information on the management of prostate cancer (PCa), as well as look at the novel agents and strategies that will shape the future of PCa diagnosis and care.
  • Dr. Peter Schiff delivered a presentation highlighting recent trial data and the 2013 AUA/ASTRO guidelines concerning adjuvant and salvage radiotherapy after radical prostatectomy. The clinical significance of radiotherapy after radical prostatectomy has been the subject of much debate, as many studies have indicated that most patients died of something other than PCa. Data from the EORTC trial (2005) demonstrate significant improvements in clinical progression-free survival (PFS) and biochemical PFS in patients who received radiation after radical prostatectomy; however, no effect on distant failure or overall survival (OS) was seen (follow-up, 5 years). Similarly, in the ARO/AUO trial (2009), significant improvement in biochemical PFS was found in the group of patients who received radiotherapy after radical prostatectomy; again, no impact on OS or distant failure was found (median follow-up, 53.7 months). However, a major finding from the most recent update to the SWOG study (2009) showed significant improvement in metastatic-free survival and improved OS in the group that received adjuvant radiation when follow-up was extended (median follow-up, 12.7 years). Another important topic concerned the AUA/ASTRO guidelines presentation of data regarding dose escalation. In sum, higher radiation dosages in salvage therapy are considered practical and safe when performed with good technique.
     
  • Dr. Robert Dreicer gave a talk on novel antiandrogen therapies for castration-resistant prostate cancer (CRPC). Data have confirmed the clinical significance of maintaining patients at castration-level testosterone throughout the disease course. The COU-AA-301 trial found that abiraterone improves OS, while CO-AA-302 found that castration levels of testosterone have a dramatic impact on radiographic PFS. Enzalutamide is a new hormone that has been developed to target androgen receptor signaling. Data also confirm its positive effect on OS and PFS. However, cross-resistance continues to be a major issue, resulting in lower response rates and arising from multiple molecular pathways to resistance, making it difficult to combat. Other issues in need of ongoing study include the risk of small-cell/undifferentiated carcinoma with androgen receptor antagonists, optimal timing, the role of combination therapy, when to cease therapy, and the optimal doses of steroids.
     
  • Dr. E. David Crawford discussed biopsies for PCa in view of the controversy concerning overdiagnosis and overtreatment. Staging of disease is needed in order to better match patients with appropriate treatments, including active surveillance. Data from CaPSURE indicate that <10% of men are currently receiving active surveillance, despite its potential utility for reducing overtreatment. Information to better stage and stratify patients can be gained from performing mapping biopsy; obtaining molecular, tissue, and cellular markers; and gene-based testing. With more information early in the disease course, overtreatment can be effectively reduced and active surveillance can be increased.

Other important PCa topics that were discussed included:

  • Novel Imaging Modalities by Daniel P. Petrylak, MD
  • PSA Screening for Prostate Cancer by A. Oliver Sartor, MD, MS, FACP, FASCO


Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


This activity is not approved for AMA PRA Category 1 Credit™.

This activity is supported by educational grants from AbbVie Inc., Astellas and Medivation, Inc., Bayer HealthCare Pharmaceuticals Inc. and Algeta US, Dendreon Corporation, Exelixis, Inc., and Teva Pharmaceuticals.







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