What’s being presented at the AUA in May: Part II

Here is information about more papers being presented at the annual meeting on the American Urological Association annual meeting in May.

The session entitled “Prostate Cancer: Advanced II” is also occurring on May 20, and includes 18 moderated poster presentations altogether. Among the more interesting of these posters are:

  • A poster by Cooperburg et al. (abstract no. MP70-02) giving early data on patients participating in the sipuleucel-T PROCEED registry study, which had enrolled ~ 1,300 of a proposed 1,500+ patients as of May 2013.
  • A poster by Matsumoto et al. (abstract no. MP70-03) on timing of initiation of androgen deprivation therapy (ADT) as salvage therapy in Japanese men with progressive forms of prostate cancer after radical prostatectomy (as indicated by a rising PSA post-surgery). The paper suggests that early initiation of ADT is appropriate for high-risk patients, whereas men at lower risk can safely delay initiation of ADT.
  • A poster by Cipolla et al. (abstract no. MP70-08) providing the results of a randomized, double-blind, placebo-controlled, multi-center trial of sulforaphane compared to a placebo in men with a rising PSA following radical prostatectomy. The data suggest a degree of activity of sulphorane in such patients with low toxicity, but efficacy does appear to be limited.
  • A poster by Yu et al. (abstract no. MP70-17) that examined the free serum testosterone (T) levels of 114 men with advanced prostate cancer treated by surgical orchiectomy. The median free serum T level was 0.92 pg/ml (range, 0.35 to 33.95 pg/ml) with a mean level of 1.71 ± 2.77 pg/ml.  The authors posit that these levels are the “ideal” levels that should be achieved by any form of drug therapy used to apply medical castration as opposed to surgical castration.
  • A poster by Sooriakumaran et al. (abstract no. MP70-18) suggesting — on the basis of a retrospective analysis of data from the National Prostate Cancer Registry of Sweden — that patients with advanced prostate cancer might have extended survival if they were managed with radical therapy (followed by ADT) as their primary treatment rather than ADT alone. In other words, the authors are suggesting that debulking of the primary tumor and evident metastatic tumors together with long-term ADT might significantly impact overall patient survival compared to ADT alone.

One Response

  1. The “sip-T” study and revelation about type of ADT employed pre-treatment

    This is about bullet 1 above: “A poster by Cooperburg et al. (abstract no. MP70-02) giving early data on patients participating in the sipuleucel-T PROCEED registry study, which had enrolled ~ 1,300 of a proposed 1,500+ patients as of May 2013.”

    I would have thought that patients being offered Provenge would have previously had well-done ADT. At least by the standards of some well-regarded doctors who use ADT/IADT heavily in practices dedicated exclusively to prostate cancer patients, it appears most of the men in the study were not given optimum ADT. I’m basing that opinion (it’s a controversial topic) on the fact that Table 1 of the poster abstract, which lists the types of ADT given patients as prior therapy, shows that only 59.4% were given an antiandrogen (and that may have been short-term in many cases to prevent PSA flare), though virtually all had some form of blockade of testosterone produced by the testes. That means that at least 40% did not have combined ADT, let alone triple ADT. (My own treatment has involved four cycles of IADT3, usually Lupron/Casodex-bicalutamide/finasteride with Fosamax or Boniva in support for non-metastatic disease lasting for 14.3 years until I stopped the drugs last Tuesday, with last PSA falling to 0.02, and allowing me a solid shot at a cure last year with TomoTherapy IMRT radiation. My PSA, testosterone and DHT were regularly monitored, and therapy adjustments occasionally resulted based on those results.)

    Moreover, I was really stunned that so few men with metastatic prostate cancer who were on ADT had one of the powerful drugs (zoledronic acid or denosumab) to help prevent loss of bone density (with a possible side benefit of helping counter bone metastases). Table 1 indicates that a total just over 10% had such therapy!

    This is very important as it suggests that many men classed as “castration resistant” were potentially still capable of responding very well to well-done, well-supported ADT. I suspect that a substantial proportion of these men gave up on ADT prematurely, perhaps losing months if not years of additional time before needing to move on to Provenge.

    I’m really surprised! I’m confident Drs. Sartor and Higano, and perhaps several others among the authors appreciate the value of such tactics, so I’m also really puzzled.

    A small voice is suggesting to me that the doctors may have been aware of these issues but were finding an acceptable way to give Provenge to patients who were likely at an earlier stage of disease — pre-castration resistant, than those for whom the drug was approved. A lot of us have been thinking that Provenge would likely work better when given earlier in the disease process.

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