Latest Clinical Edge

Post date: 03/23/2021 - 10:59

Key clinical point: Androgen deprivation therapy has been known to have a negative effect on cognitive function, however, data are conflicting and an association between ADT and cognitive dysfunction remains unconfirmed.

Major finding: In a longitudinal study of 2,974 men, bioavailable testosterone was not associated with increased dementia risk, but higher levels of bioavailable estradiol were significant predictors of Alzheimer’s disease.

Study details: The data come from a review of recent...

Post date: 03/23/2021 - 10:56

Key clinical point: Diabetes was associated with prostate cancer-specific mortality in obese men, but not in nonobese men.

Major finding: Among obese men, diabetes was significantly associated with increased risk of prostate cancer-specific mortality in a multivariate analysis (adjusted hazard ratio 3.06).

Study details: The data come from a cohort of 4,688 men who underwent radical prostatectomy between 1988 and 2017.

Disclosures: The study...

Post date: 03/23/2021 - 10:54

Key clinical point: Use of intravenous glycopyrronium bromide had no significant impact on radiation toxicity in prostate cancer patients treated with the prostate-specific membrane antigen 177Lu/225Ac-PSMA.

Major finding: The average PSMA uptake in the parotid glands in the intervention group vs. control were 5.72 and 5.57; average PSMA uptake in the submandibular glands for the two groups was 5.89 and 6.25, respectively.

Study details: The data come from 10 prostate cancer...

Post date: 03/23/2021 - 10:53

Key clinical point: Increased positive surgical margin was significantly associated with the poorest biochemical recurrent-free survival in prostate cancer patients after radical prostatectomy.

Major finding: Among patients with positive surgical margins (PSM), biochemical recurrence was associated with more than 2 PSM (hazard ratio 2.723), PSM length of 3mm or higher (HR 1.024) and a Gleason score of 4 or higher (HR 2.356).

Study details: The data come from a retrospective study of 150 prostate...

Post date: 03/23/2021 - 10:51

Key clinical point: Minority men were more likely than white men to have undergone prostate cancer-specific antigen (PSA) testing but were less likely to be told about risks and benefits, which may contribute to lack of shared decision-making and perceived disparities in disease outcomes.

Major finding: Compared with white men, non-Hispanic Black men reported significantly less communication from health care professionals about how some doctors but not others recommend PSA screening (odds ratio 0.16), and less communication about whether PSA tests...

Post date: 03/09/2021 - 10:34

Key clinical point: GnRH receptor antagonists degarelix and relugolix continue to show safety and effectiveness when used for endocrine therapy in prostate cancer

Major finding: Prostate cancer patients treated with the oral GnRH antagonist relugolix showed a faster return to normal testosterone levels compared to those treated with leuprolide; relugolix also was associated with fewer adverse events than degarelix, although degarelix may be more beneficial for patients with preexisting cardiovascular disease.

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Post date: 03/09/2021 - 10:33

Key clinical point: Approximately half of prostate cancer patients received risk assessment for cardiovascular disease; nearly one-third of those with uncontrolled risk factors were not receiving medication to reduce their risk.

Major finding: In a population of veterans with prostate cancer, 68.1% underwent comprehensive assessment for cardiovascular risk factors; 54.1% of those assessed had uncontrolled risk factors, and 29.6% of those with uncontrolled risk factors were not receiving medications to address those factors. ...

Post date: 03/09/2021 - 10:32

Key clinical point: The dual mTORC1-2 inhibitor Rapalink-1 reduced tumor growth in prostate cancer cells in a mouse model.

Major finding: Treating mice with Rapalink-1 every 6 days resulted in significantly reduced tumor growth and decreased expression of CD44 based on tumor size and Ki67 staining on lysates-matched tumor sections.

Study details: The data come from a molecular analysis of breast and prostate cancer bone metastasis using patient-derived xenografts (PDX) from 5 prostate cancer...

Post date: 03/09/2021 - 10:29

Key clinical point: Men with prostate cancer who underwent radical prostatectomies showed a range of skeletal muscle mass measures, but these had no apparent impact on early functional outcomes.

Major finding: The average skeletal muscle index (SMI) of the patients was 54.06 cm2/m2; 73 patients were considered non-sarcopenic and 26 were considered sarcopenic. Sarcopenia had no apparent impact on erectile function, continence, or biochemical recurrence in multivariate analysis.

Study details: The...

Post date: 02/23/2021 - 10:25

Key clinical point: Oncological outcomes were similar for hormone naïve metastatic prostate cancer patients treated with either combined androgen blockade (CAB) therapy or luteinizing hormone-releasing hormone analog (LH-RHa) monotherapy.

Major finding: No significant differences appeared between the CAB and LH-RHa groups for 5-year overall survival (56.7% vs. 52.5) cancer-specific survival (61.1% vs. 56.4), and castrate-resistant prostate cancer-free...

Post date: 02/23/2021 - 10:24

Key clinical point: Bone loss may occur in up to 90% of prostate cancer patients with advanced disease and has been shown to impact quality of life in approximately 80% of metastatic prostate cancer patients.

Major finding: Bone targeting agents (BTAs) such as the bisphosphonate zoledronic acid and the receptor activator of nuclear factor kappa-B (RANK) ligand inhibitor denosumab, are approved for preventing skeletal-related events, but new evidence suggests...

Post date: 02/23/2021 - 10:22

Key clinical point: The RNA-binding protein Staufen1 was increased in multiple lines of human prostate cancer cells.

Major finding: Staufen1 has a direct impact on prostate cancer development in several ways; knockdown of Staufen1 was associated with significantly decreased cell motility and cell invasion levels in PC3 and DU145, and with lower proliferative capacity for LNCaP.

Study...

Post date: 02/23/2021 - 10:15

Key clinical point: Virtual microscopy was noninferior to standard light microscopy for the histopathological evaluation of prostate cancer.

Major finding: The agreement for Gleason grading score characteristics for primary and secondary patterns were similar with both methods, and virtual microscopy showed narrower limits of agreement than light microscopy, which suggests better repeatability.

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Post date: 02/09/2021 - 16:07

Key clinical point: Androgen receptors and the splice variant AR-V7 both regulated subsets of target genes and also induced alternative splicing of mRNAs in prostate cancer cells.

Major finding: A novel exon linked to exon 4 notably increased the induction of the PGAP2 gene by the androgen receptor variant known as AR-V7 to a 50-fold induction.

Study details: The data come from an examination of two endogenous genes, PGAP2 and...

Post date: 02/09/2021 - 16:06

Key clinical point: Adding prostate radiation therapy to standard prostate cancer treatment improved quality of life and reduced costs compared to standard androgen deprivation therapy alone.

Major finding: Over a 37-month follow-up period, adding prostate radiation therapy to androgen deprivation therapy resulted in a gain of approximately 2 months of perfect health (0.16 quality of life years) and a net cost reduction of $19,472 because fewer patients experienced cancer progression....

Post date: 02/09/2021 - 16:05

Key clinical point: Abiraterone acetate and apalutamide were associated with significantly improved overall survival and relatively low rates of serious adverse events for castration-resistant prostate cancer.

Major finding: In a meta-analysis of 7 trials comparing 6 treatments for prostate cancer, the treatments with the most significant improvements in overall survival were abiraterone acetate (hazard ratio 0.61), apalutamide (HR 0.67), and docetaxel (HR 0.79).

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Post date: 02/09/2021 - 16:04

Key clinical point: Greater expression of the RNA-binding protein SNRPA1 was associated with worse prognosis in prostate cancer.

Major finding: Expression of SNRPA1 (small nuclear ribonucleoprotein polypeptide A) was positively associated with Gleason score, a measure of disease severity in prostate cancer, and SNRPA1 increased with Gleason score increases from 6 to 10.

Study details: The data come from an analysis of a database...

Post date: 02/09/2021 - 16:02

Key clinical point: Abiraterone-only treatment appeared to improve overall survival among black men with prostate cancer.

Major finding: A large cohort study showed that for prostate cancer patients treated with abiraterone only or abiraterone first, overall survival was significantly higher among black patients compared to white patients, with a 3 months’ survival benefit (25.4 months vs. 22.4 months, P =0.02).

Study details:...

Post date: 01/19/2021 - 10:06

Key clinical point: The antimalarial agent bruceantin inhibited full length aberrant androgen receptor (AR-FL) and AR variant 7 (AR-V7) in cell cultures of castration-resistant prostate cancer.

Major finding: Bruceantin demonstrated binding to the protein and molecular chaperone HSP90, which prevented the interaction of HSP90 and AR-FL/AR-V7 that contributes to treatment resistance in prostate cancer.

Study details: The data come from an assay test of antimalarial agents including bruceantin (BCT)...

Post date: 01/19/2021 - 10:05

Key clinical point: Standard of care for castration-resistant prostate cancer involves androgen receptor signaling inhibitors (ARSI), but this treatment is largely ineffective because of the development of ARSI drug resistance.

Major finding: Data suggest that AR function could be stopped biochemically with antagonists that target the ligand-binding domain and biophysically with cryo electron microscopy (Cryo-EM) but more research is needed.

Study details: The data come from a review of biochemical...

Post date: 01/19/2021 - 10:04

Key clinical point: Micro-ultrasound showed similar or better sensitivity and similar specificity to multiparametric MRI for imaging prostate cancer.

Major finding: Micro-ultrasound and multiparametric MRI sensitivities for imaging prostate cancer were 94% vs. 90%, respectively, and negative predictive values were 85% vs. 77%, respectively, while specificities of both were 22% and positive predictive values were 44% and 43%, respectively.

Study details: The data come from a multicenter,...

Post date: 01/19/2021 - 10:03

Key clinical point: Most of the unusual benign uptakes in PET/CT scans of prostate cancer patients were associated with inflammatory processes, and also were found in the thyroid, adrenal gland, brain, liver, bowel, frontal sinus, lungs, parotid gland, and bone.

Major finding: Unusual uptakes appeared in 47 of 368 patients (12.8%). Of these, 41 were benign uptake, mostly because of inflammatory processes (22 of 47).

Study details: The data come from a retrospective study of 368 prostate cancer...

Post date: 01/19/2021 - 10:02

Key clinical point: Differences in region and county-level variables accounted for 17% of differences in active surveillance of low-risk prostate cancer in multivariate analysis.

Major finding: Overall use of active surveillance or watchful waiting was 22.1% across 79,825 men with low-risk prostate cancer but ranged from 42.4% in the San Francisco-Oakland area to 4.1% in rural Georgia.

Study details: The data come from a cohort study of 79,825 men using the Surveillance, Epidemiology, and End...

Post date: 01/06/2021 - 15:14

Key clinical point: Although patients younger that 50 years still constitute a small proportion of overall cases, their disease at presentation is less localized.

Major finding: During 2000-2015, 84.9% of younger patients presented with regional/distant disease, compared with 77.6% of patients aged 50-69 years and 67.8% of patients 70 years and older.

Study details: The data come from a population-based review of 34,443 patients with esophageal adenocarcinoma identified from the Surveillance, Epidemiology, and End Results database for the periods of 1975-1989,...

Post date: 01/06/2021 - 14:07

Key clinical point: Tumor reduction after neoadjuvant therapy could be a prognostic indicator in patients who undergo surgery for pancreatic ductal adenocarcinoma.

Major finding: A reduction of 47% or more was associated with a 64% 3-year survival, compared with 32%.

Study details: A retrospective analysis of 905 patients.

Disclosures: The study was funded in part by the National Pancreas Foundation, Sky Foundation, and the Pittsburgh Liver Research Center at the University of Pittsburgh. One author disclosed receiving an honorarium from...

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