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IN THIS ISSUE:
ESMO Visitor's Report 2019
Practice Changing Study?
Contingent Knowledge and Looping Effects - A 66-Year-Old Man with PSA-Detected PCa and Regrets
Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer: The European Association of Urology Position in 2019
Quality of Life Responses Will Exceed 2,000
Board Meets in Prague
Please make it better - In Bad Taste?
God's Improvement
Radiation Therapy After Prostate Surgery Offers No Benefit
Focal Laser Ablation of Prostate Tumors With Gold Nanoparticles

ESMO Visitor's Report 2019

This year’s ESMO, held in the cavernous halls of the Fira Conference Centre in Barcelona was again, as always, packed with new information, lots of new medicines, breakthrough results in clinical trials and so much more. 

It was noticeable that the pattern of these annual meetings show more sessions on prostate cancer treatments and this year for the first time there was a novel treatment based on a real biomarker.

One of the highlights was the Apalutamide trial known SPARTAN.

Apalutamide (APA) and overall survival (OS) in patients with non-metastatic Castration-resistant prostate cancer (nmCRPC*).



All patients in the trial received androgen deprivation therapy (ADT) as standard of care. The primary endpoint of the trial was metastasis free survival (MFS). This is the time taken until the disease progresses with metastasis and the patient needs appropriate treatment for this development. 

The SPARTAN trial shows a significant improvement of the time to metastasis.  A significant 25% reduction in the risk of death. 

Erik Briers, PhD 

Read Erik’s fuller report here


 

Practice Changing Study?

On the Monday evening as the ESMO meeting was drawing to a close the audience was huge for the evening President’s Meeting which was rumoured to include a practice-changing presentation regarding prostate cancer treatment. And so it proved.

Men who have metastatic castration-resistant prostate cancer (mCRPC) and certain altered DNA repair genes may benefit more from olaparib, a drug that inhibits an enzyme involved in DNA repair, than from newer antiandrogen medications, according to the study presented. 

Data from the phase 3 PROfound trial showed that olaparib, an inhibitor of poly-ADP ribose polymerase (PARP), slowed cancer progression by about 4 months compared with enzalutamide or abiraterone, lead investigator Maha Hussain, MD, of Robert H. Lurie Comprehensive Cancer Center at Northwestern University in Chicago, reported.
 
In addition, olaparib-treated patients experienced decreased time to pain progression and a higher objective response rate (ORR) compared with enzalutamide or abiraterone recipients.

The confirmed ORR was significantly higher among olaparib than antiandrogen recipients in Cohort A (33.3% vs 2.3%) and the overall study population (21.7% vs 4.5%).

See the fuller report from Renal & Urology News:
https://www.renalandurologynews.com/home/news/urology/prostate-cancer/parp-inhibiting-drug-may-improve-mcrpc-outcomes/?utm_source=newsletter&utm_medium=email&utm_campaign=run-spotlight-hay-20191009&cpn=uro_all&hmSubId=d1PGWU1AZwI1&hmEmail=hkjuWacer5sHrH2BdwLZ3BDkyAcl-gSf31LP7LVx8w01&NID=&c_id=&email_hash=edf1c900487b7cedf6c636775500adfd&mpweb=1323-70103-922184



 

Contingent Knowledge and Looping Effects - A66-Year-Old Man with PSA-Detected Prostate Cancer and Regrets

In 2006, Mr. B., a 66-year-old economics professor, learned from his general internist that his prostate-specific antigen (PSA) level was 4.5 ng per ml, up from 3.0 ng per ml the previous year. His urologist, who found only mild prostatic enlargement on examination, confirmed an elevated PSA level and recommended a biopsy. Mr. B. consented. Two of 12 biopsy specimens showed cancer, with a Gleason score of 7. After presenting the options of radical prostatectomy, radiation, and active surveillance, the urologist indicated a strong preference for surgery, while acknowledging that it could lead to impotence and incontinence. Before consenting, Mr. B. met with a medical oncologist to discuss the option of active surveillance.

Supplied with a number of studies, plus the oncologist’s review of expert guidelines, led the patient to recommend surgery or radiation.

Influenced by this evidence, by a colleague’s recent painful death from prostate cancer, and by his wife’s strong opinion that he should “do everything” to avoid death from prostate cancer, Mr. B. underwent robot-assisted radical prostatectomy. Afterward, he had urinary incontinence, which slowly resolved, and impotence that has continued despite several rehabilitation programs and pharmaceutical interventions. His PSA has remained at the zero-to-negligible level.

Mr. B. initially saw his impotence as the unfortunate effect of a rational decision that may have saved his life. But in 2009, early results in two large, randomized, controlled trials of PSA screening showed equivocal or no benefit. The rationality of Mr. B.’s decision to undergo surgery now seemed to be undermined by earlier decisions that he’d made casually: consenting to the initial PSA test and to the biopsy. His doubts increased when, a few years later, a trial that began after PSA screening became routine revealed no overall survival benefit of surgery over active surveillance for localized disease. Mr. B. struggled to understand how the data he’d reviewed just a few years earlier had made him confident about surgical intervention.

Fuller report:
https://www.nejm.org/doi/full/10.1056/NEJMp1811521?query=oncology-hematology


 

Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer: The European Association of Urology Position in 2019

The EAU’s major change of policy this year is spelt out extremely clearly in this paper and it provides the platform for member organisations of Europa Uomo to lobby at a national level for the necessary changes. At the European level Europa Uomo sees it as vital that we work with all those who accept the underlying policy and that we work as a priority to have that policy adopted as the appropriate way forward for Europe. This will be a priority objective for our organisation in the period ahead.

Click here for the full policy statement


 

Quality of Life Responses Will Exceed 2,000

Board Likely to Decide on Closure Date for Some Time in Mid-November

Congratulations to all those who have responded or who have been organising the responses.    Forty nine days since launch the total of responses received as of 9 October was just short of the 2,000 at 1998.  
 
Norway remains out in front at 502 followed by Sweden, France, The Netherlands, Germany and Denmark. The Board is taking steps to find out what is the problem in countries with a nil or very low return for their size. In places events are planned for group completions of the survey.
 
The Board is considerably advanced in its planning for the publication and dissemination of the Survey results next year. 

If you have not yet taken the survey do so now on this link:
https://www.qualityoflifesurvey.co/wix/p1874284546.aspx

    
It is absolutely confidential. We will never know who has actually taken the survey and you have a choice of 19 languages and it will take you about 15 minutes. The only qualification is that you have had a prostate cancer diagnosis at some point. You don’t have to be a member of a Prostate Cancer Support Group. If your language is not included in the 19 please use English and write in your country in the “Other” box.  Many thanks.
Interim Responses of Quality of Life Survey By Europa Uomo

Board Meets in Prague

The Board meets in Prague on 10 October in conjunction with the EAU’s Training Conference for Urologists PCa19

The Agenda will consider a number of reports and proposals from Board members and will be reported in next week’s Update.


 

PLEASE MAKE IT BETTER - In Bad Taste?

A lovey-dovey couple are sitting on a bench in the park and she says, “My ear hurts me…” He kisses it gently and asks, “Is it better now, my darling?”
“It’s all gone,” giggles the girl, “but now I have a pain here,” and she points to her neck. 
The boy kisses it tenderly and asks, “Better now, sweety pie?”
“It’s all healed, my love! But now I have a very bad pain here,” she replies and points to her clavicle.
“Excuse me,” politely interrupts an old lady from a neighbouring bench, “this is really very impressive! Do you heal haemorrhoids as well?”


 

GOD's IMPROVEMENT

A little girl was sitting on her grandfather’s lap as he read her a bedtime story.
From time to time she would take her eyes off the book and reach up to touch his wrinkled cheek. She was alternately stroking her own cheek, then his again. Finally, she spoke up, “Grandpa, did God make you?”
“Yes, sweetheart,” he answered, “God made me a long time ago.
“Grandpa, did God make me too?”
“Yes, indeed, honey,” he said, “God made you just a little while ago.”
Feeling their respective faces again, she observed, “God’s getting better at it, isn’t he?”


 

Radiation Therapy After Prostate Surgery Offers No Benefit

Study findings suggest that many men can be spared radiation therapy following radical prostatectomy for high-risk prostate cancer.

Radiation therapy (RT) following radical prostatectomy (RP) for high-risk localized prostate cancer offers no advantage in terms of biochemical recurrence compared with delaying radiation therapy until development of biochemical recurrence, study findings presented at the European Society for Medical Oncology (ESMO) annual congress in Barcelona, Spain, show.

Consequently, many men will be able to avoid the adverse effects of radiotherapy, which include urinary incontinence and urethral stricture, according to investigators.

Click on the link below to read the full report in Renal & Urology News:
https://www.renalandurologynews.com/home/news/urology/prostate-cancer/radiation-therapy-after-prostate-surgery-offers-no-benefit/?utm_source=newsletter&utm_medium=email&utm_campaign=run-spotlight-hay-20191009&cpn=uro_all&hmSubId=d1PGWU1AZwI1&hmEmail=hkjuWacer5sHrH2BdwLZ3BDkyAcl-gSf31LP7LVx8w01&NID=&c_id=&email_hash=edf1c900487b7cedf6c636775500adfd&mpweb=1323-70103-922184


 

Focal Laser Ablation of Prostate Tumors With Gold Nanoparticles

Ardeshir R. Rastinehad, DO

Practice Community: New York

Hospital and Institutional Affiliations: Associate Professor of Urology and Radiology and Director of Focal Therapy and Interventional Urologic Oncology at Icahn School of Medicine at Mount Sinai in New York.

Practice Niche: Urologic Oncology
Dr. Rastinehad invented a technique by which gold nanoparticles mediate a focal laser ablation procedure to destroy prostate tumors. He was the lead investigator of a pilot study in which 16 men underwent the treatment. Dr. Rastinehad and his colleagues recently reported the initial results of that study in the Proceedings of the National Academy of Sciences (2019;10;116:18590-18596).

For the full article use the link:
https://www.renalandurologynews.com/home/ask-the-experts/ardeshir-rastinehad-do/?utm_source=newsletter&utm_medium=email&utm_campaign=run_xtandi_ask_the_experts_native&mpweb=1323-70727-922184


 
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This Update is published by the Board
of Europa Uomo for its member organisations.

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Editorial & Writing - John Dowling
Production - Anja Vancauwenbergh
Copyright © 2019 Europa Uomo, All rights reserved.


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