Dr. Zachary Klaassen and UroToday have provided us with four more interesting summaries of presentations by faculty at the European Association for Urology (EAU)’s meeting in Vienna last weekend.
Again, rather than regurgitate the content, we have provided a set of links to the content on the UroToday web site:
- Dr. Mark Emberton, of University College London, London, England, offered an update on “The future of focal therapy“, with a particular focus on the role of MRI in the selection of appropriate candidates for treatment with focal therapy and the importance of patient understandings about risk for follow-up or salvage therapies (depending on their initial risk category).
- Dr. Manfred Wirth, of the University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany. addressed issues related to “The future of biomarkers and genomics“, the broad spectrum of new biomarkers that have bceome available already and that will be coming available shortly, but noting the need for high quality prospective data to validate the use of all these new biomarkers in the real world of clinical practice.
- Prof. Louis Denis, of the Oncology Centre Antwerp, Antwerp, Belgium, spoke on the subject of “Patient-centered care” (a subject near to your sitemaster’s heart) and the importance of “not just treating the patient during a procedure/hospitalization, but also taking care of the patient and side effects post-treatment”. The sitemaster is pleased to see that this topic is becoming a far more frequent and important topic in the discussion for prostate cancer diagnosis and its management.
- Dr. Jochen Walz, of the Institut Paoli-Calmettes, Marseille, France, was asked to deal with the subject of “The future of molecular and functional imaging” in the diagnosis, work-up, and management of men with prostate cancer, which ties back nicely to the presentation by Dr. Emberton already mentioned above, as well as to our commentary from yesterday on the continuing evolution of “theranostics” in the management of prostate cancer.
Once again, we appreciate the hard work being done by Dr. Klaassen and the staff of UroToday in providing timely updates from meetings like this that Prostate Cancer International is unable to cover directly ourselves.
Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: biomarkers, care, focal, functional, genomics, imaging, molecular, patient-centered, therapy |
THE "NEW" PROSTATE CANCER INFOLINK 
Dr. Emberton’s talk: dutasteride reduced tumor volume per MRI imaging per small study
Dr. Emberton’s talk, mainly about focal therapy and use of mpMRI, featured a number of interesting developments, one of which was a study indicating success of dutasteride (Avodart®) in reducing tumor volume in low- and favorable intermediate-risk patients.
Here are key lines from the results of this randomized, double-blind, placebo-controlled trial (MAPPED):
“In the dutasteride group, the average volumes at baseline and 6 months were 0.55 and 0.38 ml, respectively and the average reduction was 36%. In the placebo group, the average volumes at baseline and 6 months were 0.65 and 0.76 ml, respectively, and the average reduction was -12%. The difference in percent reductions between the groups was 48% (95% CI 27.4-68.3, p < 0.0001). The most common adverse event was deterioration in erectile function, which was 25% in men randomized to dutasteride and 16% in men randomized to placebo.”
This constitutes additional evidence that such drugs have some effect against prostate cancer, even when used alone. The effect, though substantial, also appears to be limited, at least within the 6 months constraint of the trial, which is also consistent with other evidence.
One key objective of this trial was to use mpMRI assessment of change in tumor volume as a trial endpoint.
(I have a special interest in dutasteride as it is one of two 5-alpha-reductase inhibitor (5-ARI) drugs that constitute the third leg of ADT3/IADT3 which was my only therapy [plus supporting drugs and lifestyle tactics] for 14 years prior to apparently successful curative radiation in 2013 supported by a fourth round of ADT3. I am currently taking three dutasteride tablets a week as part of my safety net against recurrence. I have been taking one or the other of these drugs since September 2000.)
Dear Jim:
In trying to make any reasonable interpretation of the meaningfulness of the (small; 42-patient) MAPPED study, one would also need to know what the effect of dutasteride had been on the overall volumes of the prostates of the 42 patients. Just shrinking the tumor volume would be pretty meaningless unless dutasteride is shrinking tumor volume by more than it shrinks the overall prostate volume for such patients.
Maybe that information is in the full text of this article. It certainly isn’t in the abstract. I would further note that the conclusion you draw (“such drugs have some effect against prostate cancer, even when used alone”) is not a conclusion necessarily drawn by the authors, who (at least in the abstract) conclude only that, “Dutasteride was associated with a significant reduction in prostate cancer volume on T2-weighted magnetic resonance imaging compared to placebo.”
It was not clear to me from Klaassen’s summary what the relevance of the MAPPED study was to the rest of Emberton’s talk.
Emberton is very enthusiastic about focal therapies as initial treatment of prostate cancer, so I guess the point was that some lesions could be shrunk by dutasteride to make them amenable to focal treatment, since some kinds of focal treatment are limited in the size of lesion they can treat.
Of course, the shrinking of the whole prostate could also help with this, since some focal therapies (e.g., HIFU) cannot reach lesions that are too far from the rectum.
Dear Sitemaster,
Building on your comment on dutasteride shrinking the whole prostate as well as the tumor: actually, isn’t this fresh evidence? We have known for some time that the 5-ARI drugs shrink the prostate, in fact by roughly the amount in the MAPPED study, but has it been previously documented that these drugs (or even just dutasteride) shrink at least some tumors? After all, healthy and tumor tissue is not the same; it could have been that the 5-ARI drugs shrank just the healthy tissue but not tumor tissue.
I hope we see details of this study, especially the mix of Gleason score 6 and Gleason score 7 patients. I suspect — mostly informed hunch rather than anything well based — that Gleason grade 3 tissue is reduced but that Gleason grade 4 tissue is not. Of course, it is unlikely we will get detail about the amount of Gleason pattern 3 versus Gleason pattern 4 tissue in the Gleason score 7 cases.