Genitourinary Cancers

Targeting prostate cancer stem cells may be a method of treating prostate cancer while avoiding the development of resistance to androgen deprivation therapy, according to preclinical results presented at the annual meeting of the American Association for Cancer Research.

Researchers have identified a mechanism by which prostate cancer resists hormonal therapy to develop into castration-resistant prostate cancer (CRPC). The protein SIAH2 keeps a fraction of androgen receptors constitutively active in prostate cancer cells.

Imaging is important for both the diagnosis and management of prostate cancer. Standard techniques used in everyday clinical practice depend on the stage of the disease. Several new experimental modalities are currently in development to better identify and diagnose patients with progressive disease.

Radiolabeled small molecules targeting prostate-specific membrane antigen are well-tolerated tools for detection of metastatic prostate cancer, according to results of a phase I clinical trial.

This review focuses on targeted therapies related to these pathways of interest for the treatment of advanced urothelial carcinoma, describing the evidence to support further investigation of these approaches.

Current efforts utilizing genomic strategies to unravel the biology of urothelial carcinoma will undoubtedly lead to rational targets, new therapies, and a renewed enthusiasm among researchers and clinicians working in this field-which ultimately will improve the lives of patients with this devastating disease.

Acetaminophen and nonaspirin nonsteroidal anti-inflammatory drugs were associated with a 28% increased risk of developing kidney cancer, according to the results of a recently published meta-analysis.

Substitution of estrogen patches for luteinizing hormone-releasing hormone agonist therapy in men with castration-resistant prostate cancer has similar testosterone-depleting effects while improving metabolic side effects, according to results from the PATCH trial.

High levels of physical activity were linked with a 22% decreased risk for renal cancer, according to a meta-analysis that looked at results from 19 studies that quantified the relationship with physical activity and renal cancer.

Men being treated for their prostate cancer with a gonadotropin-releasing hormone had a significantly increased risk for biliary disease compared with men who underwent no treatment, according to the results of a large, population-based study.

One way of framing the ethical question in this case might be: “What are my ethical obligations to provide an anticancer therapy when I think it is unlikely to benefit the patient?” The broader clinical questions involved in this case are fundamentally the same in most patients.

In a trial of 64 patients, neoadjuvant chemotherapy with methotrexate, doxorubicin, vinblastine, and cisplatin (MVAC) had promising results in the treatment of muscle-invasive bladder cancer.

A trial comparing axitinib to sorafenib as first-line therapy for metastatic renal cell carcinoma showed a statistically significant improvement in progression-free survival for the drug; however, the difference failed to meet the phase III trial’s prespecified significance level of 0.025.

The use of presurgical characteristics to assign the clinical stage of a patient with bladder cancer was found to be highly inaccurate with a clinical/pathological stage discrepancy rate of 47.8% found in a large sample of patients taken from the National Cancer Data Base between 1998 and 2009.

Results from a retrospective analysis indicate that the use of the antiangiogenic, VEGF inhibitor sorafenib for the treatment of advanced renal cell carcinoma was well tolerated in patients aged 65 years or older.

The use of adjuvant radiotherapy in patients with pT3 prostate cancer subsequent to radical prostatectomy is safe, according to 10-year follow-up results presented at the 2013 Genitourinary Cancers Symposium.

In two phase III studies-READY and VENICE-targeted agents combined with standard first-line chemotherapy failed to increase overall survival for men with metastatic castration-resistant prostate cancer.

Physicians treating men with high-risk prostate cancer can safely reduce the duration of androgen blockade given in combination with pelvic radiation from 36 months to 18 months without compromising outcomes, including survival.

New data suggest that surveillance of patients with small kidney tumors may be a safe alternative to surgery, especially in older patients or those with comorbid conditions.

Ahead of the ASCO GU meeting, we spoke with two symposium committee members, Dr. Mack Roach, of the University of California, San Francisco, and Dr. Hans T. Chung, of the University of Toronto, about early treatment and surveillance of prostate cancer patients.

In a new study, researchers show that sunitinib, an FDA-approved TKI for advanced renal cell carcinoma, does not result in accelerated growth of kidney tumors after discontinuing treatment.

Localized prostate cancer treatment with surgery or radiation results in similar long-term side effects, such as erectile dysfunction and urinary incontinence.

The mTOR inhibitor everolimus (Afinitor) has been found to significantly reduce the size of angiomyolipomas, the slow-growing benign tumors commonly associated with tuberous sclerosis complex (TSC) and sporadic lymphangioleiomyomatosis, according to the results of the phase III EXIST-2 study.

Researchers have identified bladder cancer markers that can predict which patients may have the most aggressive, fatal type of the disease. It was also discovered that smoking can affect the course of bladder cancer development, leading to more aggressive forms of the disease.

Focal therapy is an appealing addition to our current AS strategies. As a “lesser evil,” focal therapy is showing promise as a therapy that can provide cancer control, while also avoiding many of the radical treatment–associated morbidities.

The ideal utilization of focal therapy is to treat a smaller prostate cancer in which you can ablate, excise, or render inconsequential a tumor that affects a relatively small fraction of the gland.

In this review we focus on the recent evolution of the concept of focal therapy and the potential applications of this management approach within an array of options currently available for patients with localized prostate cancer.

A new technique of robotic partial nephrectomy has the potential for better preservation of kidney function and better cancer control during partial nephrectomy by allowing surgeons more time to perform the procedure compared with traditional open surgery, according to the results of a recently published case series.

A new study shows that chemoprevention with anti-androgen therapies does not benefit all patients at risk for prostate cancer, and that in patients with a certain genetic mutation they can spur on more aggressive disease.

Recent progress in our understanding of the pathogenesis of advanced prostate cancer has heralded a new era in treatment. Numerous agents now populate the treatment landscape, and an impressive number of novel agents are in development. However, many questions remain unanswered, paving the path for discovery in the future.