June issue: Enzalutamide shows increased longevity in advanced prostate cancers
Some Biden info
Because of President' Biden’s diagnosis with Gleason 9 (Grade Group 5) cancer, prostate cancer is part of everyday conversation these days, Here’s a couple of items that are relevant.
—Researchers will present a new study at the AMerican Society of Clinical Oncology on June 3 in Chicago showing the benefit of combining the drug enzaludamide and Androgen Deprivation Therapy (ADT), a possible approach that will be taken by Biden.
Researchers found enzalutamide combined with (ADT) significantly increased the chance of five-year survival for men with metastatic hormone-sensitive prostate cancer, according to a five-year follow-up of the global ARCHES study led by the Duke Cancer Institute.
The five-year survival rate improved by 13% for men with high-volume disease, which occurs in patients with five or more bone metastases or cancer that has spread to the liver or lungs. These patients typically have the shortest survival after diagnosis.
The study found the combination therapy extended the lives of patients with high-volume disease by three additional years, from approximately four to now seven years. The survival rate also improved by 9% in patients with low-volume disease, and more than 75% of such men lived beyond five years with this new treatment.
(Dr. Anthony Armstrong)
“We haven’t seen that kind of median improvement in any trial in prostate cancer. Having three extra years of life on average is huge for our patients,” said lead author Andrew Armstrong, MD, professor in the Department of Medicine at Duke University School of Medicine. “These data show that with more intensive treatment, patients can stay in remission, enjoy a good quality of life, keep their disease under control and live to reach key milestones.”
(Check out an earlier interview I had with Armstrong:
Enza has been discussed as a possible therapy for patients with low-risk prostate cancer. No new progress on that front, researchers told me.
—There has been skepticism over the sudden appearance of a Gleason 9 tumor in former Presidnet Biden. But chaplain Jeffery Crim, himself a Lutheran pastor and a Gleason 9 patient, explains why he accepts this in The Hill: “Lots of political commentators have speculated about the timeline and severity of Biden’s recent diagnosis. If you don’t believe he only just found out, or if you’re wondering whether the short timeframe described in the White House’s public statement could really be accurate, I understand your skepticism. But I also understand this disease. And based on what I have lived and what I have seen in hundreds of patients, I want to explain why the official timeline is entirely plausible.
“My cancer was found by mistake. A non-routine blood test was ordered in error, and that’s what flagged the concern. Just days before, I had undergone a prostate exam that came back completely normal. After my diagnosis, I consented to a follow-up evaluation by three different urologists to see if a more expert or aggressive technique would have caught it earlier. Only one thought he maybe felt something unusual. Maybe.
“In other words, this is a cancer that hides well — even from the well-trained.”
Crim concluded: “I don’t know Biden personally, and my views on his politics are not even relevant. What I do know is this: He is a man with cancer, and I am deeply sorry he is going through this. I wish his family love and strength, and I hope they find the best path forward for him — one that makes sense for him and brings peace to those he loves. Full stop.”
Amen.
——Focal therapy has been a hot topic. In part, it’s because of hard sells given to men with Gleason 6. But also a dearth of randomized studies for men with localized intermediate-risk cancers.
Norwegian researchers reported at the American Urological Association that partial removal of the prostate has been shown to be the equal of radical prostatectomy in a randomized controlled study of focal ultrasound ablation for selected pateients with localized intermediatae-risk prostate cancer. The FARP (Focal Ablation versus Radical Prostatectomy) study is the first randomized controlled trial of focal ultrasound ablation and surgery for prostate cancer.
MedPage Today reported: “After 3 years of follow-up, treatment failure had occurred in 5.6% of patients treated with focused ablation and 7.9% of the prostatectomy groups. The difference did not achieve statistical significance but met the trial's primary endpoint of non-inferiority for focal ablation versus surgery.”
Eduard Baco, MD, PhD, of Oslo University Hospital in Norway, told MedPage:."The findings from this randomized controlled trial provide significant additional evidence that support the use of focal ablation with ultrasound energy for the management of organ-localized prostate cancer, in particular HIFU [high-intensity focused ultrasound]."
The study included 213 patients with intermediate-risk, unilateral prostate cancer on MRI and biopsy. Patients randomized to focal ablation received HIFU for posterior tumors and TULSA for anterior tumors. Patients randomized to surgery underwent robotic unilateral nerve-sparing prostatectomy. All patients had follow-up that included PSA measurement, and patients treated with focal ablation had MRI assessment and systematic biopsies at 1 and 3 years.
David Chen, MD, of Fox Chase Cancer Center in Philadelphia, who is studying multiple types of focal therapy, told MedPage:"We've gone from being a fringe option to being recognized as a level of treatment on par with surgery and radiation. All of these [technologies] are probably similar in their effectiveness, and we're gaining a better understanding of the specific scenarios that one may have some particular benefit over another."
—Top cause of death in patients with PCa? It’s not prostate cancer—it was #2. It’s heart disease. The top cause of death for the overall cohort of men treated for localized prostate cancer was cardiovascular disease at 26%, Samuel Tremblay, MD, of the University of Chicago, and colleagues told the American Urological Association’s annual meeting. Prostate cancer was the second leading cause of death at 13%. Researchers studied the causes of death among 24,164 deceased US male veterans treated for localized prostate cancer from 2005 to 2015. The median age at prostate cancer diagnosis was 66 years, and the median age at death was 74 years.
For patients with metastatic prostate cancer, the leading cause of death was prostate cancer accounting for 68%, 71%, and 59% of deaths among those surviving less than 2, 2-5, and more than 5 years, respectively.
Now some words from our sponsors:
Today TAS goes live for the Q&A with uropathologist Dr.Epstein. But a video will be available for all registrants ASAP.
By Howard Wolinsky
Join Dr. Jonathan Epstein May 31 noon to 1 p.m. Eastern for a Q&A . Ask what’s on your mind regarding low-risk prostate cancer.
Register in advance:
https://us02web.zoom.us/meeting/register/sazI-npeR3OdGWyRIrVRYg
Send any questions to The Active Surveillor: Howard.wolinsky@gmail.com
Try to keep the questions on point and applicable to the broad audience. We can’t offer personal medical advice.
If you can’t make it to the live event, register so you’ll be notified when the viudeo is posted at The Active SUrveillor YouTube channel.
(Dr. Jonathan Epstein)
Meanwhile, the video of Dr. Jonathan Epstein’s webinar for The Active Surveillor on May 17 has posted in The Active Surveillor’s YouTube channel:
Many rave reviews came in on the program, where Dr. Epstein told us about Active Surveillance, cribriform and loads more. You can view the recording here
More than 2.4 thousand have viewed in the past week,
While you’re there, check out other videos posted in The Active Surveillor’s YouTube Channel. Please like and subscribe.
Dr. Epstein recently launched Advanced Uropathology of New York: Global Consultation Services in New York City after nearly 40 years on the faculty at Johns Hopkins University School of Medicine. Advanced Uropathology is affiliated with Integrated Medical Professionals, PLLC, (IMP) (https://www.imppllc.com/about-imp-2/), a subsidiary of Solaris Health.
You can reach Dr. Epstein at https://advanceduropathology.com/consultation/
Contact him directly at: jonathaniraepstein@gmail.com
Come to the ASPI webinar June 28: Cracking the Code on Pathology Reports—Helping Patients Navigate Medicalese to Get Better Health Results
Most patients have a hard time deciphering pathology reports they get after prostate biopsies. At the same time, many are puzzled with their Gleason score.
Cathryn J. Lapedis, MD, MPH, a Clinical Assistant Professor of Pathology at Michigan Medicine in Ann Arbor, has found in her research that patient-centered reports can help patients understand the reports.
She will be the featured speaker at the ASPI webinar from noon to 1:30 p.m. on Saturday, June 28.
Please register for the meeting here.
Cracking the Code on Pathology Reports: Helping Patients Navigate Medicalese and Get Better Health Results
Lapedis was the lead author of a recent study in JAMA that found a 93% comprehension of patient-centered pathology reports compared with 39% of those who read a report from the University of Michigan and 56% reading a pathology report from the Veterans Administration.
While 93% of participants who received the PCPR accurately identified that the report showed prostate cancer, only 39% of those who received the university report and 56% of those who received the VA report did so.
She also looked at how these patients interpreted Gleason scores: 84% reading specially prepared patient-centric reports understood their scores vs 48% for the university group and 40% for the VA group.
She has fellowship training in medical renal and gastrointestinal pathology. Her research centers on rethinking the way pathology results are communicated to patients and the healthcare system. She completed an in-depth analysis of key stakeholders’ attitudes towards patient-pathologist interactions, and is currently piloting early interventions in patient-centered pathology communications.
Please send questions in advance to: contactus@aspatients.org