ORLANDO, FL, USA (UroToday.com) - At this year’s symposium, 475 abstracts and more than 2,100 cancer specialists will be in attendance during the three day meeting. American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO) are co-sponsoring the symposium. Bruce J. Roth, MD, moderated the ASCO GU symposium presscast (via a live webcast Feb. 12, 2013), previewing three studies:
PSA screening guidelines are in flux based on the USPSTF recommendation. Current scientific evidence is limited regarding PSA-detected prostate cancer. A University of Rochester Medical Center study reported by Hong Zhang aimed to determine the frequency of various risks for developing PSA-detected prostate cancer based on patient characteristics and PSA levels.1 The population-based study (70,345 U.S. men with AJCC stage T1cN0M0 prostate disease) used the SEER data to identify these men between 2004 and 2008. Patients were categorized by: 1) Low risk for developing the disease (PSA <10mg/L, Gleason score ≥ 6 , representing 47.6% of all men in the study); Intermediate risk (PSA 10-20 mg/L, Gleason score 7, representing 35.9% men); and High risk (PSA ≥20 mg/L, Gleason score ≥8 , representing 16.5% men). In the high-risk disease group, men 75 years and older represented 40 percent of all patients with PSA-detected prostate cancer and had a 9.4 fold higher likelihood of having high-risk disease at diagnosis compared with men younger than 50. African Americans of any age were more likely to have high-risk disease than white men. Zhang concluded men age 75 and older and African American men have the highest risk of presenting with intermediate or high risk prostate cancer.
Dr. Roth, commented, "In this study the older patient (defined in this study as 75 years and older) are at higher risk for developing PSA-detected prostate cancer suggesting using a numeric age may not be a great determinate for who should receive PSA screening. Alternatively, consider co-morbidities, reasonable life expectancy and quality of life. This information may warrant a discussion with the patient as to when PSA screening should be undertaken. Asymptomatic men should discuss the relative risk and benefits of PSA screening with his physician to make an informed decision."
The Canadian study reported by Abdenour Nabid, MD, FRP(C), Centre Hospitalier Universitaire de Sherbrooke, Quebec, evaluated the outcomes in 630 men with high-risk prostate cancer who were treated with pelvic radiotherapy and androgen blockade either for 36 months (n=310 patients) or 18 months (320 patients) this phase III trial.2 With a median 77 month follow-up , Dr. Nabid reported there was no statistical difference. He recommended the duration of androgen blockade therapy can be safely reduced to 18 months to achieve the same clinical benefit as in 36 months. The five year survival rates were the essentially the same for either group (81-84%). In this patient population, the primary causes of death in this order were second cancer (7.3%), prostate cancer (4.9%) , and CVD (4.4%). The Nabid said, "The finding implies that the standard course of androgen blockade, 24-36 months, could be safely shortened, potentially decreasing side effects (referred to as the castration syndrome) and costs to patients and society." Dr. Root added, "Based on these findings, I am comfortable changing the treatment pattern to 18 months, with an expected benefit that the patient may get a testosterone level back at the end of therapy and avoid increased incidence of CVD and diabetes. " When asked about a six or 12 month course of treatment, Dr. Roth replied, "We know from other studies that six months is inferior; there is currently no evidence-based studies supporting a 12 month course of treatment."
The final featured abstract identifies a population-based study that examined the uses and outcomes of surveillance versus surgery in management of small renal masses.3 William C. Huang, MD, NYU School of Medicine, New York, NY discussed whether surveillance is a safe alternative to surgery for elderly patients. "There is emerging evidence that surgery in older patients may not beneficial," said Huang. With the use of imaging for unrelated conditions, a majority of these small renal masses are non-malignant or have a slow growing pattern. Although surgery is the standard treatment for these small masses, the retrospective analysis of more than 8,300 elderly patients diagnosed with small masses in their kidneys showed that kidney cancer-related death rates are comparable whether a patient undergoes surveillance or surgery to remove the mass. Based on a median follow-up of 58 months, 2,053 (25%) patients had at least one CV event and 2,078 (25%) patients died, including 277 (3%) who died from kidney cancer. Compared with surgery, surveillance was associated with a significantly lower risk of death from any cause. The use of surveillance has increased from 25% in 2000 to 37% in 2007. Dr. Huang concluded, "Watchful waiting (surveillance) should be considered an option for patients with small renal masses who are not otherwise acceptable candidates for surgical treatment."
References:
1 PSA-detected prostate cancer in the United States: A population-based study of 70,345 men with AJCC stage T1cN0M0 disease. J Clin Oncol 31, 2013 (suppl 6; abstr 50)
Author(s): Hong Zhang, Lois B. Travis, Edward M. Messing, Ollivier Hyrien, Rui Chen, Michael T. Milano, Ralph Anthony Brasacchio, Yuhchyau Chen; University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY; University of Rochester, Rochester, NY; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
2 High-risk prostate cancer treated with pelvic radiotherapy and 36 versus 18 months of androgen blockade: Results of a phase III randomized study. Clin Oncol 31, 2013 (suppl 6; abstr 3)
Authors: Abdenour Nabid, Nathalie Carrier, André-Guy Martin, Jean-Paul Bahary, Luis Souhami, Marie Duclos, François Vincent, Sylvie Vass, Boris Bahoric, Robert Archambault, Céline Lemaire; Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada; Centre Hospitalier Universitaire de Québec, Québec, QC, Canada; Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal University, Montreal, QC, Canada; McGill University, Montreal, QC, Canada; McGill University Health Centre, Montreal, QC, Canada; Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, QC, Canada; Centre de Santé et Services Sociaux de Chicoutimi, Chicoutimi, QC, Canada; Jewish General Hospital, Montréal, QC, Canada; Hôpital de Ganineau, Gatineau, QC, Canada; Hôpital Maisonneuve-Rosemont de Montréal, Montréal, QC, Canada
3 Surveillance for the management of small renal masses: Utilization and outcomes in a population-based cohort. J Clin Oncol 31, 2013 (suppl 6; abstr 343)
Author(s): William C. Huang, Laura C. Pinheiro, Paul Russo, William Thomas Lowrance, Elena B. Elkin; NYU School of Medicine, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
Preview of the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
Reported for UroToday by Karen Roberts, Medical Editor
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