MRI Targeted Biopsy Superior to Standard TRUS Guided Biopsy for Prostate Cancer Diagnosis

June 12th, 2018

TransRectal UltraSound (TRUS) guided biopsy has been the standard of care for diagnosing prostate cancer in men with a clinical suspicion of prostate cancer. TRUS guided biopsy is a blind biopsy of the lateral and posterior peripheral zone of the prostate using a template, and 10 to 12 cores of prostate tissue is obtained. Even though this may result in a higher rate of prostate cancer detection, many detected are low grade tumors that do not benefit from treatment. The major limitation of this biopsy procedure is the risk of under-sampling a more significant tumor that is located in a region of the prostate not usually targeted with a template.
Multiparametric MRI (mp-MRI) combines anatomic imaging in the form of T2-weighted imaging, with functional imaging, and is being used to detect or rule out cancer in men who have persistent concern for prostate cancer. It can be used as a triage test to avoid a biopsy if the results were negative, and if positive could be used for targeting abnormal areas in the prostate during biopsy. In the PRECISION study, mp-MRI was superior to standard TRUS guided biopsy, and was able to identify a high proportion of men who would benefit from treatment, and minimizes the identification of men with clinically insignificant cancer, thereby preventing overtreatment. Utilizing mp-MRI, more than 25% of the participants in this study were able to avoid a biopsy.

FDA Approves ZYTIGA® for High-Risk Metastatic Castration-Sensitive Prostate Cancer

March 1st, 2018

The FDA on February 7, 2018, approved ZYTIGA® (Abiraterone acetate) in combination with Prednisone for metastatic high-risk Castration Sensitive Prostate Cancer (CSPC). The FDA initially approved ZYTIGA® with prednisone in 2011 for patients with metastatic Castration Resistant Prostate Cancer (CRPC), who had received prior chemotherapy, and the FDA expanded the indication in 2012, for patients with chemo naïve metastatic CRPC. The addition of ZYTIGA® along with Prednisone, to Androgen Deprivation Therapy, significantly increased Overall Survival and radiographic Progression Free Survival, in men with newly diagnosed, metastatic, Castration Sensitive Prostate Cancer. The new approval will change the treatment landscape for patients with metastatic CSPC.

ZYTIGA® improves survival without impacting Quality of Life in CRPC

April 18th, 2014

In a recent article published in The Lancet Oncology,  ZYTIGA® (Abiraterone) given along with prednisone delayed patient-reported pain progression and deterioration of Quality of Life in chemotherapy-naive patients with metastatic Castrate Resistant Prostate Cancer (CRPC). This was accomplished  without compromising efficacy, which was survival benefit. This is relevant because, patients with Prostate Cancer in general are elderly and it is important that any treatment intervention in this patient population with asymptomatic or mildly symptomatic CRPC improves overall survival without negatively impacting Quality of Life.

Prostate Cancer – Is Prevention Worthwhile?

August 30th, 2013

In the landmark Prostate Cancer Prevention Trial (PCPT), Finasteride (PROSCAR®) reduced the risk of Prostate Cancer development and therefore the symptoms associated with it by 33%, compared to placebo. However,  in those who did develop Prostate Cancer while on PROSCAR®, there was an increased risk of more aggressive disease. After 18 years of follow up of these patients (NEJM 2013), it appears that in spite of this set back, there was no difference in the overall survival between the PROSCAR® group and the placebo group. The U.S. Preventive Services Task Force (USPSTF) has been against Prostate Cancer screening, as the consensus is that majority of the Prostate Cancers detected by screening would never become apparent in an individual’s lifetime, if this individual was not screened and therefore would never cause a problem.  This long term data begs a very important question – Is it worthwhile taking PROSCAR® for Prostate Cancer prevention?

Oncoprescribe Blog: Prostate Cancer – Androgen Independent or Castrate Resistant

December 7th, 2010

It is not semantics anymore. Prostate Cancer is a heterogeneous disease. It appears that in patients touted to have Hormone Refractory Prostate Cancer (HRPC), the cells continue to produce androgen receptor message even in the absence of androgens. The tumor cells are therefore not androgen independent. On the contrary, they continue to  thrive, having access to androgens or androgen precursors, by various different mechanisms. It is for this reason imperative that one continue chemical castration with LHRH agonists concurrently with other lines of treatment including chemotherapy.

So the appropriate term should be Castrate Resistant Prostate Cancer rather than Androgen Independent Prostate Cancer.

Oncoprescribe Blog: Personalized medicine for prostate cancer patients

November 12th, 2010

Prolaris is a molecular diagnostic tool developed by Myriad Genetics, Inc. This 46 gene panel is capable of predicting  aggressiveness of prostate cancer and can be used in conjunction with Gleason score and PSA. By measuring the  expression level of genes involved with cell cycle progression, this test is able to differentiate indolent from aggressive prostate cancers and therefore predict disease outcome.

In a retrospective analysis of 366 patients who had undergone radical prostatectomy and 337 patients with clinically localized prostate cancer, this gene panel was able to give a favorable and unfavorable score to patient subsets and thus predict clinical outcomes. This prognostic information will allow clinicians to recommend appropriate therapy at the time of diagnosis of prostate cancer.

So we have gene signature assays for breast cancer, colon cancer, lung cancer (oncoprescribe blog) and now for prostate cancer as well. In the end, patients benefit.

Oncoprescribe Blog: Abiraterone – another promising agent in CRPC

November 11th, 2010

Abiraterone is a steroidal agent and inhibits CYP17A, an enzyme necessary for the production of androgen precursors and subsequently testosterone. It is capable of inhibiting testosterone production both in the adrenals as well as the testes.

Data from a recent phase III trial was presented at the ESMO meeting and in this International trial involving 1,195 patients, Abiraterone plus a steroid was compared with placebo plus steroid in patients with CRPC (Castrate-Resistant Prostate Cancer) who had failed chemotherapy with Docetaxel. Following an interim analysis and upon recommendation from the Independent Data Monitoring Committeee, the study had to be unblinded, as there was a significant improvement in overall survival in the group receiving Abiraterone. With the availability of several new agents for the treatment of CRPC, it may be important to properly sequence these available drugs to get the best of each treatment intervention and thus improve long term survival with limited toxicity.

Oncoprescribe Blog: Cabazitaxel – Another new agent for CRPC

November 9th, 2010

Cabazitaxel is a microtubule inhibitor approved for the treatment of patients with CRPC (Castrate-Resistant Prostate Cancer) who have progressed on Docetaxel. This agent in a randomized phase III trial (TROPIC) demonstrated a significant improvement in Overall Survival (OS) compared with Mitoxantrone, with a 30% reduction in the risk of death. We now have another option for the treatment of CRPC which until not too long back was considered as a disease for which chemotherapy was not effective.

Oncoprescribe Blog: CRPC – A wave of new agents, but first Sipuleucel-T

November 7th, 2010

This year 2 new agents have been approved for the treatment of Castrate-Resistant Prostate Cancer – Sipuleucel-T and Cabazitaxel. Sipuleucel-T is composed of autologous antigen-presenting cells (APC’s) from the patient, cultured with a fusion protein PA2024 (Prostate Acid Phosphatase-PAP linked to granulocyte/macrophage colony-stimulating factor). Prostatic Acid Phosphatase (PAP) is an antigen expressed in most prostate cancers. When administered, Sipuleucel-T an autologous active cellular immunotherapy stimulates T cell immunity against PAP and thus the prostate cancer cells. This agent demonstrated improvement in median survival and is best suited for those patients who are asymptomatic or have minimal symptoms with CRPC. It is important to note that this agent is given as three infusions 2 weeks apart and one may not see a drop in the PSA or improvement in the bone scan findings until after three months following treatment. For this reason it is best to consider this agent well before chemotherapy with docetaxel is planned. The number of patients who can be treated with this agent presently is limited due to various barriers associated with the processing of autologous Antigen Presenting Cells. It is important to realize that steroids may counter the T cell response associated with this agent and therefore should be avoided.