ASCO GU 2017: Best of Journals: Prostate Cancer - Surgeon's Perspective - Session Highlights
Among SEER data alone, metastatic disease at diagnosis has increased since the USPSTF recommendation which highlights more aggressive disease being diagnosed in recent years. In another study from the Dana Farber Cancer Institute published in the Journal of Clinical Oncology in 2016 examining PSA values and prostate cancer-specific mortality, it is estimated that 1 of 7 men with PSA>3 ng/mL age 55-59 years and 1 of 12 men with PSA >2.1 ng/mL at 50 to 54 years may experience lethal prostate cancer within 30 years. The PROMIS trial compared MRI targeted + systematic biopsy (SB) v SB where SB cores were obtained at every 5mm of prostate with noted improved detection of clinically significant prostate cancer and decreased detection of indolent disease.
In the PROMIS trial, 27% of men would avoid SB prostate biopsy with use of mpMRI, however, SB may still be required given the low sensitivity among targeted biopsies alone. The University of Michigan group published their data regarding molecular profiling to determine clonality of mpMRI targeted biopsies from men on active surveillance and concluded men on AS fusion biopsy is accurate method to determine suitability among men considering AS.
Focal ablation, particularly HIFU, studies have emerged during the past year with initial short term results supporting use of this technology, however, limited long-term follow-up and costs need to be considered prior to widespread adoption of focal therapy with ongoing trials encouraged.
Presenter: Jim C Hu, Cornell University
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX
at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA