Oncology – Urological
RCT: Impact of single PSA screening invitation on 15-year prostate cancer mortality – JAMA
25 May, 2024 | 19:01h | UTCStudy Design and Population: This study is a secondary analysis of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), which focused on the long-term effects of prostate-specific antigen (PSA) screening on prostate cancer mortality. It involved 415,357 men aged 50 to 69 years from 573 primary care practices across England and Wales. Participants were randomized to either receive a single invitation for a PSA screening or to a control group receiving standard practice without invitation. The follow-up period concluded on March 31, 2021, after a median duration of 15 years.
Main Findings: The intervention group, which received one PSA screening invitation, showed a prostate cancer mortality rate of 0.69% compared to 0.78% in the control group, translating to a rate ratio of 0.92 and demonstrating a statistically significant but modest reduction in death from prostate cancer. Additionally, the screening led to increased detection rates of low-grade and localized prostate cancer. However, there were no significant differences in detection of more advanced cancer stages between the two groups. All-cause mortality rates were similar across both groups.
Implications for Practice: While the introduction of a single PSA screening invitation was associated with a slight decrease in prostate cancer mortality over 15 years, the absolute reduction was small. These findings suggest that while PSA screening can detect cancer earlier, its impact on long-term survival is limited and should be weighed against the potential for overdiagnosis and overtreatment. Future strategies in prostate cancer screening might need to focus more on risk stratification and personalized screening approaches to maximize benefits and minimize unnecessary interventions.
Reference (link to abstract – $ for full-text):
AUA/ASCO/SUO Updated guidelines for muscle-invasive urothelial bladder cancer
1 May, 2024 | 21:40h | UTCThe 2024 update to the muscle-invasive bladder cancer (MIBC) guidelines provides a risk-assessed framework for the treatment of this high-risk patient group, which constitutes about 25% of all bladder cancer diagnoses. These guidelines, revised through the AUA amendment process, integrate new research findings from May 2020 to November 2023, involving a rigorous review of 3739 abstracts and 46 full-text articles. Key updates include refined protocols for neoadjuvant and adjuvant chemotherapy, radical cystectomy, and multi-modal bladder-preserving therapies. Recommendations are categorized based on evidence strength, ranging from high to low, and are supplemented by clinical principles and expert opinions in areas lacking robust data. This structured approach aims to enhance clinical outcomes by updating practitioners on optimal management strategies and emphasizing the need for ongoing research to refine these recommendations.
Reference (link to free full-text):
Meta-Analysis: Efficacy of MRI in prostate cancer screening for reducing unnecessary biopsies
28 Apr, 2024 | 20:13h | UTCThis meta-analysis evaluated the effectiveness of incorporating magnetic resonance imaging (MRI) into prostate cancer screening pathways, compared to prostate-specific antigen (PSA)–only screening strategies. Analyzing data from 80,114 men across 12 studies, the findings demonstrate that MRI-based screening, particularly when using a sequential approach and a PI-RADS score ≥3 cutoff for biopsy, significantly increases the odds of detecting clinically significant prostate cancers (OR, 4.15) while reducing unnecessary biopsies (OR, 0.28) and detection of clinically insignificant cancers (OR, 0.34). Implementing a higher PI-RADS score of ≥4 further decreased the detection of insignificant cancers and biopsies performed, without impacting the detection rate of significant cancers. These results support the integration of MRI into screening programs to enhance diagnostic precision and reduce patient harm.
Reference (link to abstract – $ for full-text):
The Lancet Commission: Global projections and recommendations for managing the increasing burden of prostate cancer
27 Apr, 2024 | 18:42h | UTCThe Lancet Commission’s report on prostate cancer highlights the expected doubling of annual cases from 1.4 million in 2020 to 2.9 million by 2040, driven by demographic changes and increased life expectancy. This comprehensive analysis divides the issue into epidemiology, diagnostics, management of localized and advanced disease, emphasizing disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Key findings indicate that late diagnoses are common, particularly in LMICs, leading to worse outcomes. The Commission advocates for significant changes in the diagnostic pathways and increased use of current technologies tailored to available resources to improve outcomes. Education and awareness programs are recommended to facilitate early detection and shift the treatment paradigm from palliative to curative, focusing on surgery and radiotherapy. Without decisive action, the global mortality from prostate cancer is set to rise, highlighting the need for urgent interventions across all countries, with a special focus on underserved populations.
Reference:
RCT | No significant recurrence-free survival improvement with everolimus post-renal carcinoma surgery
3 Aug, 2023 | 13:17h | UTCAdjuvant everolimus after surgery for renal cell carcinoma (EVEREST): a double-blind, placebo-controlled, randomised, phase 3 trial – The Lancet (link to abstract – $ for full-text)
M-A | High-volume disease, T stage 4 show largest docetaxel benefit in prostate cancer
2 Aug, 2023 | 13:51h | UTCCommentaries:
Disease Volume and T Stage Affect Docetaxel/ADT Efficacy in Prostate Cancer – Cancer Network
Commentary on Twitter
NEW: A systematic review and meta-analysis of individual patient data from the STOPCAP M1 collaboration aims to obtain up-to-date estimates of the effects of docetaxel in patients with metastatic hormone-sensitive prostate cancer. #pcsmhttps://t.co/7mqXeIXMQ5 pic.twitter.com/A7AmjipnVq
— The Lancet Oncology (@TheLancetOncol) July 5, 2023
Single-arm study | Pembrolizumab plus Lenvatinib shows potential as first-line treatment for advanced non-clear-cell renal cell carcinoma
17 Jul, 2023 | 13:33h | UTCPembrolizumab plus lenvatinib as first-line therapy for advanced non-clear-cell renal cell carcinoma (KEYNOTE-B61): a single-arm, multicentre, phase 2 trial – The Lancet Oncology (link to abstract – $ for full-text)
RCT | Brachytherapy alone sufficient for intermediate-risk prostate cancer, no FFP improvement with additional EBRT
7 Jul, 2023 | 16:06h | UTCEffect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial – Journal of Clinical Oncology (link to abstract – $ for full-text)
M-A | Increased risk of cognitive toxic effects and fatigue in prostate cancer treatment with second-generation antiandrogens
16 Jun, 2023 | 14:00h | UTCAssociation of Second-generation Antiandrogens With Cognitive and Functional Toxic Effects in Randomized Clinical Trials: A Systematic Review and Meta-analysis – JAMA Oncology (link to abstract – $ for full-text)
RCT | Talazoparib plus enzalutamide prolongs radiographic PFS vs. enzalutamide alone in metastatic castration-resistant prostate cancer
14 Jun, 2023 | 14:29h | UTCTalazoparib plus enzalutamide in men with first-line metastatic castration-resistant prostate cancer (TALAPRO-2): a randomised, placebo-controlled, phase 3 trial – The Lancet (link to abstract – $ for full-text)
Review | Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps
13 Jun, 2023 | 13:52h | UTCScreening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps – BMJ Oncology
RCT | Atezolizumab and cabozantinib combo fails to outperform cabozantinib alone in renal cell carcinoma
7 Jun, 2023 | 13:54h | UTCAtezolizumab plus cabozantinib versus cabozantinib monotherapy for patients with renal cell carcinoma after progression with previous immune checkpoint inhibitor treatment (CONTACT-03): a multicentre, randomised, open-label, phase 3 trial – The Lancet (free registration required)
Commentary from the author on Twitter (thread – click for more)
1/ Results from #CONTACT03 are out both @ASCO #ASCO23 and @TheLancet . The 1⃣st phase 3 trial to assess the efficacy of rechallenge with anti-PDL1 in ANY cancer type.
Kudos to @montypal, SC members, @roche, our patients, = for this phenomenal job. https://t.co/p7hYD4snXA pic.twitter.com/CXk1vqfB26— Toni Choueiri, MD (@DrChoueiri) June 5, 2023
M-A | Robot-assisted radical cystectomy versus open radical cystectomy
6 Jun, 2023 | 14:11h | UTC
Commentary from the author on Twitter (thread – click for more)
Our meta-analysis of 8 RCTS comparing open (ORC) and robot-assisted radical cystectomy (RARC) is now online on @EUplatinum 1/6https://t.co/b9TYe2yd9Y@JimCatto @Jkurol @drtanws @DrTanWP @SWilliams_MD @SBoorjian @roboturoloog @dipenjparekh @nikhilvasdevuro @ProfShamimKhan1 pic.twitter.com/M4u0iXTuwN
— Pramit Khetrapal (@p_khetrapal) May 10, 2023
SR | Management of lymph node–positive penile cancer
24 May, 2023 | 13:03h | UTCManagement of Lymph Node–positive Penile Cancer: A Systematic Review – European Urology
Epidemiology of bladder cancer in 2023: a systematic review of risk factors
22 May, 2023 | 13:23h | UTCEpidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors – European Urology
RCT | Cabozantinib addition to nivolumab and ipilimumab extends progression-free survival in renal-cell carcinoma
18 May, 2023 | 13:38h | UTCCabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Cabozantinib in Renal-Cell Carcinoma – NEJM Resident 360
Commentary on Twitter
Clinical Pearls & Morning Reports: Cabozantinib in Renal-Cell Carcinoma. How did the addition of cabozantinib to nivolumab and ipilimumab affect outcomes in the trial by Choueiri et al.? https://t.co/x1FzWBiasr #MedEd #MedTwitter pic.twitter.com/w4sns1ifLG
— NEJM Resident 360 (@NEJMres360) May 16, 2023
M-A | First‐line therapy for adults with advanced renal cell carcinoma
12 May, 2023 | 13:33h | UTCSummary: Initial treatment for adults with advanced kidney cancer (renal cell carcinoma) – Cochrane Library
A review of modern imaging landscape for prostate cancer: a comprehensive clinical guide
9 May, 2023 | 14:34h | UTC
RCT | Long-term survival benefit with abiraterone plus ADT in metastatic PC, but no advantage with enzalutamide association
8 May, 2023 | 13:02h | UTC
Commentary on Twitter
NEW: Final results from two randomised ph 3 trials of the STAMPEDE platform protocol suggest that enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. #pcsmhttps://t.co/P1uqzE4Wsv pic.twitter.com/l8U7DQZIoe
— The Lancet Oncology (@TheLancetOncol) May 4, 2023
21-y clinical trial update | Effects of a PSA–based screening on morbidity and mortality of prostate cancer
5 May, 2023 | 14:56h | UTC
AUA/SUO Guideline | Part I – Early detection of prostate cancer: prostate cancer screening
2 May, 2023 | 13:49h | UTC
AUA/SUO Guideline | Part II – Early detection of prostate cancer: considerations for a prostate biopsy
2 May, 2023 | 13:47h | UTC
AUA/SUO Guideline | Diagnosis and management of non-metastatic upper tract urothelial carcinoma
2 May, 2023 | 13:44h | UTC
AUA/SUO Guideline | Updates to Advanced Prostate Cancer
2 May, 2023 | 13:46h | UTCUpdates to Advanced Prostate Cancer: AUA/SUO Guideline (2023) – The Journal of Urology
Clinical trial 2y update | Avelumab first-line maintenance for advanced urothelial carcinoma
2 May, 2023 | 13:30h | UTCOriginal Article: Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma – New England Journal of Medicine