Prostate cancer presents a range of challenges for urologists and oncologists, from decisions about treatment options to the management of complications and therapy toxicity.
Five experts will discuss some of those challenges as well as recent research advances during Tuesday’s Complex Cases session Prostate Cancer. Ian M. Thompson, Jr., MD, will moderate the 30-minute session, which begins at 8 a.m. in Ballroom East of the Boston Convention and Exhibition Center.
“We intend for this to be a very practical set of discussions and recommendations,” said Dr. Thompson, President of the Christus Santa Rosa Hospital-Medical Center.
The session’s panelists will review prostate specific antigen (PSA) recurrence in patients who have undergone radical prostatectomy.
“This is a challenging group of patients,” Dr. Thompson said. “Prostate cancer patients who undergo surgery and later die of the malignancy will almost always first manifest their recurrent disease with a PSA recurrence, so it is a critically important issue.”
However, other patients have PSA recurrences that ultimately prove to be indolent. PSA levels can gradually rise over time causing no symptoms, but adding anxiety and difficult treatment questions for the patient and physician.
“There has been little strong evidence regarding the management of men with PSA recurrence, though a recent paper in The New England Journal of Medicine did find that adding two years of antiandrogen therapy with bicalutamide to radiation yielded better survival outcomes than radiation alone,” Dr. Thompson said. “We’ll be discussing how to evaluate these patients, what features indicate that treatment may be more appropriate and the features of patients who can be safely observed.”
In addition, the panel will discuss the management of the primary tumor in the face of metastatic disease.
“There are some very interesting observations suggesting that, in the patient with newly diagnosed metastatic prostate cancer, treatment of the primary tumor with either surgery or radiation — or potentially both — may make a difference in long-term patient outcome,” Dr. Thompson said. “There are limited prospective data on this question, but there are currently clinical trials in development aimed at providing an answer. In general, management of patients with advanced disease has progressed dramatically over the last several decades, with median survival rising from approximately 18 months to beyond five years.”
The panel will also discuss issues related to the management of treatment toxicity in prostate cancer, including complications such as erectile dysfunction, which is associated with several prostate cancer treatments.
“At the end of the day, the goal of the session is to highlight the areas where we simply don’t have definitive answers to prostate cancer management, and to describe how urologic scientists around the world are addressing those questions in the hope of answering them,” Dr. Thompson said.
The panel includes Martha Terris, MD, professor of Surgery and Chief of Urology at Augusta University; Christopher A. Warlick, MD, PhD, assistant professor of Urology at the University of Minnesota; Thomas J. Guzzo, MD, associate professor of Urology in Surgery and Chief of the Division of Urology at the Hospital of the University of Pennsylvania; and Francesco Montorsi, IV, MD, FRCS, Chairman of the Department of Urology at University Vita-Salute San Raffaele in Milan, Italy.