Articles related to PROSTATE CANCER

In this case, the second in a three-part series, a man was diagnosed with prostate cancer based on a prostate-specific antigen (PSA) level of 6.5 ng/mL. The initial diagnosis was stage 3 disease (T3, N0, M0), with a Gleason score of 3+4=7. The rationale for the treatment decisions is explained, along with the trials (ARAMIS, SPARTAN, PROSPER) that influenced the decisions.

Some physicians believe that Gleason 6 should be reclassified as something other than cancer, which could be a valid argument because Gleason 6 isn’t going to cause any harm and therefore can be safely observed. This commentary provides arguments as to why that reclassification idea is a flawed concept.

The study was comprised of 17,913 men with a median age of 64 years with pT2-4N1M0 prostate cancer (PC) consecutively treated between 1995 and 2017, with postradical prostatectomy (RP) and pelvic lymph node (LN) assessment. The patients were then followed for possible treatment with adjuvant radiation therapy (aRT) or early salvage radiation therapy (sRT). It was determined that men with pN1 PC and 4 or more as compared with 1-3 positive pelvic LNs appear to benefit the most from the use of aRT.

To date, FDA has approved three next-generation AR inhibitors for nonmetastatic CRPC: apalutamide, enzalutamide, and darolutamide. All three agents improve metastasis-free survival and overall survival. Selection of treatment can be guided by factors such as the patient’s overall health and frailty, potential drug-drug interactions, and the safety profile associated with each agent. This review summarizes the data from the practice-changing SPARTAN, PROSPER, and ARAMIS trials and provides insights on implementation in practice and promotes early intervention with AR inhibitors as standard of care for patients with high-risk nonmetastatic CRPC.

RhoVac AB’s RV001 (onilcamotide) was granted Fast Track designation by FDA based on positive performance in its phase I/II trial. Unfortunately, in the follow-on Phase IIb BRaVac trial, the drug failed to demonstrate superiority over the placebo.

This editorial comments on Tilki and colleagues’ “Adjuvant Versus Early Salvage Radiation Therapy After Radical Prostatectomy for pN1 Prostate Cancer and the Risk of Death.” Those researchers found that adjuvant radiotherapy (RT) was associated with a lower all-cause mortality risk compared with early salvage RT. Yet in today’s practice environment, early salvage radiotherapy (sRT) is being broadly embraced over aRT despite a continuous lack of randomized data for certain high-risk groups. The editorialist recommends that “all patients with pN1 prostate cancer—and particularly those with increasing node positivity— should be counseled on the potential survival benefits of upfront adjuvant RT demonstrated in this study and the risk that early salvage RT may not be early enough.”