Genitourinary Cancers

This review summarizes recent findings in clinical prostate cancer research reported at the 2012 Annual Scientific Meeting of the American Society of Clinical Oncology (ASCO) and addresses their relevance to clinical practice.

Screening patients with renal masses with iodine-124-girentuximab had both a high specificity and sensitivity for identifying clear cell renal cell carcinoma, according to the results of a newly published open-label multicenter study.

A phase II study indicates that cabozantinib has strong antitumor activity in advanced castration-resistant prostate cancer and improves bone scan lesions.

The expanded FDA approval of abiraterone acetate (Zytiga) now includes its use prior to chemotherapy in men with metastatic castration-resistant prostate cancer.

In mid-October, Pfizer announced that its phase III study being conducted examining axitinib (Inlyta) in treatment-naive patients with advanced renal cell carcinoma failed to meet its primary endpoint of improving progression-free survival compared with sorafenib.

Black patients diagnosed with renal cell carcinoma had worse survival than white patients regardless of several patient and tumor characteristics including tumor stage and size, according to data from 39,350 patients in the National Cancer Institute’s SEER program.

A phase I study of the use of stereotactic radiosurgery as a therapeutic option for patients with localized, inoperable primary renal cancer showed that the treatment modality effectively stabilized or decreased disease in a large percentage of patients.

Researchers have identified a targetable metabolic pathway important for the growth of prostate cancer. The research may also have identified a potentially useful biomarker that can measure the aggressiveness of primary prostate tumors.

Radiotherapy directly after a prostatectomy in prostate cancer patients has long-term benefits, says a 10-year study. The study shows that radiation can prevent biochemical progression, as measured by rising prostate-specific antigen (PSA) levels.

We describe areas where major inroads were initially achieved by targeting angiogenesis and by unraveling pathways in the heterogeneous tumors of mesenchymal origin-spurred by the identification of c-Kit–activating mutations in GIST and the regressions that ensued when tumors harboring these mutations were exposed to the tyrosine kinase inhibitor imatinib (Gleevec).

The randomized COMPARZ trial of pazopanib vs sunitinib for metastatic renal cell carcinoma found a similar response to both, but pazopanib was more tolerable.

AVEO Pharmaceuticals Inc has announced that it has submitted a new drug application for tivozanib to the US Food and Drug Administration for the treatment of metastatic renal cell carcinoma.

Two groups have each identified distinct gene signatures that may better predict the aggressiveness of prostate cancer at diagnosis.

Data presented from phase II trials at the ESMO 2012 Congress show that two new agents, ODM-201 and tasquinimod, are active in prostate cancer.

Using available data from published studies, researchers found that the advantage for men treated for early low-risk prostate cancer with radical prostatectomy have only a two or three month advantage compared to those who are actively monitored.

The FDA has approved the production and use of 11C choline, an agent used to detect recurrent prostate cancer during PET imaging.

Researchers have linked recreational marijuana use to an increased risk of developing germ-cell tumors, a type of testicular cancer that often has a poor prognosis.

A new study found that aspirin use was associated with a reduced risk of prostate cancer mortality in patients previously treated with prostatectomy or radiotherapy.

Intermittent androgen deprivation was shown to be as effective as continuous therapy in terms of overall survival for men with prostate cancer whose PSA levels were rising after initial or salvage radiotherapy.

The FDA approved enzalutamide, a once-daily oral therapy for men with metastatic castration-resistant prostate cancer that has either spread to other organs or recurred, despite prior surgical or medical treatment.

Results of the phase III AFFIRM trial shows that enzalutamide (MDV3100) significantly prolonged survival of men with metastatic castration-resistant prostate cancer after chemotherapy

We discuss the current controversies in prostate cancer-PSA screening and approaches to initial treatment for men diagnosed with the disease.

According to a study in the journal Cancer, without the use of PSA screening the number of men presenting with cases of metastatic prostate cancer would be three times greater than the actual number observed today.

Results from a trial of a new therapeutic vaccine for renal cell carcinoma demonstrate that those patients with a measurable immune response to the vaccine have a prolonged overall survival.

The results of the 12-year PIVOT trial shows men with early-stage prostate cancer who had a radical prostatectomy did no better than those actively monitored without surgery.

How should oncologists advise patients about the best surgical approach to use to treat their prostate cancer? Quite simply, it is the surgeon, not the approach. The self-fulfilling prophecy about surgery is that the best surgeons tend to do the most surgeries, so an easy metric is volume.

In summary, both RALP and ORP are excellent operations in experienced hands. They are also technically difficult to perform consistently well, so in my view, surgeons should attempt to master the operation they perform rather than hastily switching to robotic surgery, unless they have an opportunity for significant mentorship and surgical volume.

We fervently hope that all surgeons will participate in a comparative outcomes project for the purpose of quality improvement. However, today we will settle for one, we hope, skilled surgeon, open or robotic.

Over the last decade, robotic-assisted laparoscopic prostatectomy (RALP) has rapidly gained in popularity, primarily for three reasons: the enthusiasm of surgeons keen to try something new, medical marketing, and patients’ desire to avoid side effects from surgery.

There is no question that the robot has leveled the playing field. It has allowed more surgeons to offer patients a minimally invasive approach. In terms of perioperative outcomes, there is clear evidence showing shorter hospital stays, less blood loss, lower complication rates, and shorter convalescence with robotic-assisted laparoscopic prostatectomy.