X, Y and Z of Prostate Cancer

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "X, Y and Z of Prostate Cancer"

Transcription

1 X, Y and Z of Prostate Cancer Dr Tony Michele Medical Oncologist

2 Prostate cancer Epidemiology Current EUA (et al) guidelines on Advanced Prostate Cancer Current clinical management in specific scenarios (cases) Met CRPC Met Non Castrate Disease High tumour burden at diagnosis M0 CRPC search for oligometastatic disease Pivotal Trials

3

4

5

6 Histopathology >95% adenocarcinoma Gleason score; Sum of the 2 most common cell type in biopsy Max score is 5+5=10 Grade; Low 2-4 Intermediate 5-7 High 8-10

7 RP Case 1 70yo PCa Dx 11/3/10 based on PSA Biopsy Gleason 4+4=8 WBBS normal Definitive RT PSA 5/12 = 0.6 PSA 2/14 = 28.5 Lucrin commenced PSA 6/14 = 0.18 PSA 8/15 = 1.25 added Anandron/Cosudex PSA 3/17 = 218 WBBS positive Please review

8

9

10

11

12

13 RP Case 1 issues Is he castrate resistant? What is his prognosis without systemic treatment? Management decisions RT Systemic treatment options Chemotherapy AR modulation Bone protection

14 CRPC is defined as castrate serum testosterone <50 ng/dl or 1.7 nmol/l plus one of the following types of progression: Biochemical progression: Three consecutive rises in PSA 1 wk apart, resulting in two 50% increases over the nadir, and PSA >2 ng/ml Radiologic progression: The appearance of new lesions: either two or more new bone lesions on bone scan or a soft tissue lesion using the Response Evaluation Criteria in Solid Tumours

15 Chemotherapy With Mitoxantrone Plus Prednisone or Prednisone Alone for Symptomatic Hormone-Resistant Prostate Cancer: Canadian trial 1996 PCPA 2017 Tony Michele 161 symptomatic patients Randomised M (12mg/m2 q3weeks) +P (5mg bd) vs P Primary endpoint palliative response 29% vs 12% (p=0.01) Other results Longer duration of palliation 48 vs 18 weeks (p<0.001) Quality of life improvement Well tolerated Cardiac toxicity 5 No change in OS Tannock, IF J Clin Oncl

16

17

18

19 Docetaxel plus Prednisone or Mitoxantrone plus Prednisone for Advanced Prostate Cancer Ian F Tannock et al TAX PCPA 2017 Tony Michele Phase 3, 1006 patients with mhrpc Docetaxel 75mg/m2 q 3weeks + Pred Docetaxel 30mg/m2 weekly + Pred Mitoxantone 12mg/m2 3 weekly + Pred Primary endpoint OS Secondary endpoints Pain PSA levels Quality of Life NEJM 351; Oct

20 TAX 327 Median OS T q3w 18.9mo MP 16.5mo

21 TAX 327 T q 3 weekly T q weekly MP >50% decrease PSA 48% 45% 32% Pain improvement 31% 35% 22% Quality of life 23% 22% 13% Adverse events 26% 29% 20%

22 Docetaxel and Estramustine Compared with Mitoxantrone and Prednisone for Advanced Refractory Prostate Cancer Daniel P Petrylac et al SWOG PCPA 2017 Tony Michele Phase 3 trial 674 patients Docetaxel + Estramustine Mitoxantrone + Prednisolone Primary endpoint Overall Survival DE(17.5 mo) Vs MP (15.6 mo) AE 15% grade 3 or higher in DE NEJM 351; Oct

23 SWOG 9916 PCPA 2017 Tony Michele

24 A Randomized, Placebo-Controlled Trial of Zoledronic Acid in Patients With Hormone-Refractory Metastatic Prostate Carcinoma Fred Saad et al 2002 PCPA 2017 Tony Michele Bisphosphonate Phase 3 double blind trial 643 patients bone mets Zometa 4mg IV 3 weekly for 15 months Zometa 8mg IV 3 weekly (reduced to 4mg due to renal toxicity) Placebo IV 3 weekly Primary objective Proportion of patients experiencing 1 or more SRE Fracture, spinal cord compression, surgery or RT to bone or change of antineoplastic treatment for bone pain

25 Zometa - Results Approx 1/3 patients completed trial Proportion of patient experiencing an SRE Significantly reduced in Z 4mg (33.2%) v Placebo (44.2%) Median time to 1 st SRE Placebo Zometa 8/4mg Zometa 4mg 321 days 363 days not reached Better pain control (NS) No changes in disease control, QoL scores, Performance status AE Flu like symptoms, hypocalcaemia, renal impairment in 8mg dose. No ONJ

26 Zometa PCPA 2017 Tony Michele

27 Targeting Bone Denosumab (Xgeva) PCPA 2017 Tony Michele Human monoclonal antibody targeting RANK L RANK ligand regulates osteoclasts International randomised double blind phase 3 study 1901 men with bony met mcrpc Primary endpoint Non inferiority to zometa Time to first on study SRE Secondary endpoint Time to first or subsequent on study SRE

28 Skeletal related event Fracture, Radiation to bone, Surgery to bone Spinal cord compression 1:1 randomisation Denosumab 120mg subcutaneosly Q4 weeks Zometa 4mg IV infusion (15min) Q4weeks

29 Results 1 st SRE HR 0.82 >1 st SRE HR 0.82 AE ONJ 22 (D) 12(Z) Overall survival and time to disease progression unchanged

30 ONJ PCPA 2017 Tony Michele

31

32

33

34

35

36

37

38 RP Case 1 management check testosterone level continue Lucrin withdraw anti androgen OPG and dental review Urgent RT review to treat sacrum Offered Docetaxel after completion of RT if not tolerant or unsuitable then could offer AA or Enza Xgeva if possible on progression 2nd line cabazitaxel, Enza or AA

39 JH Case 2 56 yo married man, referred acutely via Emerg with significant back pain. PMHx hypercholesterolaemia, otherwise fit MRI spine; bony lesions, enlarged pelvic and retroperitoneal nodes no urinary symptoms, hard mass on DRE LHD 603 ( ), ALP 204 (35-110) PSA 3768

40

41

42

43 JH Case 2 issues Diagnosis Core biopsy of paraaortic nodes - Prostate adenocarcinoma Gleason 4+4 = 8 de novo metastatic disease Pain management Systemic therapy options; ADT (LHRH analogues vs antagonists) +/- Chemotherapy Radiotherapy

44

45

46

47 JH Case 2 treatment Admitted for analgesia titration Firmagon (degarelix) LHRH antagonist commenced Docetaxel x 6 cycles PSA nadir /15 persistent pain in low spine despite chemotherapy so pall RT

48

49

50 JH Case 2 Developed CRPC April 2016 Rapid PSA DT Commenced Enzalutamide (Xtandi) Denosumab (Xgeva) after dental review PSA DT improved but PSA climbing clinically well Jan 2017 new bone mets from baseline and L hip pain Commenced Cabazitaxel

51 The Oncologist 2013, 18: PCPA 2017 Tony Michele

52 GN Case 3 60 yo 2012 dx PCa abnormal DRE biopsy Gleason 4+3=7 adenocarcinoma PSA 2.9, staging negative Brachytherapy as definitive treatment PSA nadir to 1.9 PSA 4 by 6/14, MRI prostate heterogeneous gland but no focally suspicious areas repeat prostate biopsy Gleason 8 confirmed Referred for salvage surgery, CT/WBBS staging negative PSMA PET - low volume metastatic disease

53 GN Case 3 issues not offered radical surgery Role of PSMA PET Guidelines suggest limited value in PSA < 1.0 Treatment of oligometastatic disease 3 or fewer non-castrate met lesions outside of the prostate Metastasis directed therapy Treatment of asymptomatic met disease ADT vs ADT/chemotherapy

54 SB Case 4 68 yo, PHx GORD, Type 2 DM Metastatic PCa 2013, PSA 8, Gleason 4+4=8 Commenced Lucrin July PSA 139 Cosudex added, no response Seen Oct 2016 PSA 445, testosterone < 0.09 nmol/l Leucoerythroblastic blood picture; Hb 83, Wcc 6.8 Plt 28 LDH 418, Ca CT multiple bone and nodal metastases

55 SB Case 4 management Analgesia for back pain Commenced Xtandi and Xgeva Transfused Over the following 4 weeks Plt 87, still anaemia At 8 weeks Plt 229, Hb 92, PSA 99 March 2017 PSA rise but normal FBE Commenced Docetaxel

56

57 Conclusions mcrpc No longer considered a chemotherapy resistant disease Available 2 nd line drugs post docetaxel Cabazitaxel Abiraterone or Enzalutamide Sequencing and PBS access to be sorted Where does Immunotherapy fit into the schema? Increasing understanding of resistance mechanisms Current trials Abi/Enza + ADT in de novo met disease Lutetium labelled PSMA (Peter Mac)

58

Advanced Prostate Cancer. November Jose W. Avitia, M.D

Advanced Prostate Cancer. November Jose W. Avitia, M.D Advanced Prostate Cancer November 4 2017 Jose W. Avitia, M.D In 2017 161,000 new cases of prostate cancer diagnosed in US, mostly with elevated PSA 5-10% will present with metastatic disease In 2017: 26,000

More information

In autopsy, 70% of men >80yr have occult prostate ca

In autopsy, 70% of men >80yr have occult prostate ca Prostate Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: Two randomized trials showed survival benefit of adding docetaxol to ADT in fit man with very high localized disease

More information

Incorporating New Agents into the Treatment Paradigm for Prostate Cancer

Incorporating New Agents into the Treatment Paradigm for Prostate Cancer Incorporating New Agents into the Treatment Paradigm for Prostate Cancer Dr. Celestia S. Higano FACP, Professor, Medicine and Urology, Uni. of Washington Member, Fred Hutchinson Cancer Research Center

More information

Management of castration resistant prostate cancer after first line hormonal therapy fails

Management of castration resistant prostate cancer after first line hormonal therapy fails Management of castration resistant prostate cancer after first line hormonal therapy fails Simon Crabb Senior Lecturer in Medical Oncology University of Southampton WHAT ARE THE AIMS OF TREATMENT? Cure?

More information

The management and treatment options for secondary bone disease. Dr Jason Lester Clinical Oncologist Velindre Cancer Centre

The management and treatment options for secondary bone disease. Dr Jason Lester Clinical Oncologist Velindre Cancer Centre The management and treatment options for secondary bone disease Dr Jason Lester Clinical Oncologist Velindre Cancer Centre Aims Overview of bone metastases management in castrate-refractory prostate cancer

More information

When exogenous testosterone therapy is. adverse responses can be induced.

When exogenous testosterone therapy is. adverse responses can be induced. Theoretical tips It has been reasoned that discontinuation of ADT in nonorchiectomized patients may have detrimental effect on patients with CRPC as discontinuation of ADT can result in renewed release

More information

Challenging Cases. With Q&A Panel

Challenging Cases. With Q&A Panel Challenging Cases With Q&A Panel Case Studies Index Patient #1 Jeffrey Wieder, MD Case # 1 72 year old healthy male with mild HTN Early 2011: Preop bone scan and pelvic CT = no mets Radical prostatectomy

More information

Management of castrate resistant disease: after first line hormone therapy fails

Management of castrate resistant disease: after first line hormone therapy fails Management of castrate resistant disease: after first line hormone therapy fails Rob Jones Consultant in Medical Oncology Beatson Cancer Centre Glasgow Rhona McMenemin Consultant in Clinical Oncology The

More information

Management of castrate resistant disease: after first line hormone therapy fails

Management of castrate resistant disease: after first line hormone therapy fails Management of castrate resistant disease: after first line hormone therapy fails Rob Jones Consultant in Medical Oncology Beatson Cancer Centre Glasgow Relevant Disclosure I have received research support

More information

Updates in Prostate Cancer Treatment 2018

Updates in Prostate Cancer Treatment 2018 Updates in Prostate Cancer Treatment 2018 Mountain States Cancer Conference Elaine T. Lam, MD November 3, 2018 Learning Objectives Understand the difference between hormone sensitive and castration resistant

More information

Advanced Prostate Cancer

Advanced Prostate Cancer Advanced Prostate Cancer SAMO Masterclass 4 th March 2016 Aurelius Omlin Conflicts of interest Advisory Rolle: Astra Zeneca, Astellas, Bayer, Janssen, Pfizer, Sanofi Aventis Research support: TEVA, Janssen

More information

Clinical Management Guideline for Planning and Treatment. The process to be followed when a course of chemotherapy is required to treat:

Clinical Management Guideline for Planning and Treatment. The process to be followed when a course of chemotherapy is required to treat: Clinical Management Guideline for Planning and Treatment The process to be followed when a course of chemotherapy is required to treat: PROSTATE CANCER Patient information given at each stage following

More information

The Role of the Medical Oncologist in the Treatment of Prostate Cancer. Alireza saadat hematologist and oncologist

The Role of the Medical Oncologist in the Treatment of Prostate Cancer. Alireza saadat hematologist and oncologist The Role of the Medical Oncologist in the Treatment of Prostate Cancer Alireza saadat hematologist and oncologist When should you see an oncologist? High risk localized disease Rising PSA after local therapy

More information

Advanced Prostate Cancer

Advanced Prostate Cancer Advanced Prostate Cancer January 13, 2017 Sindu Kanjeekal MD FRCPC Medical Oncology and Hematology Regional Systemic Quality Lead Erie St Clair Adjunct Professor Schulich School of Medicine and University

More information

When exogenous testosterone therapy is. adverse responses can be induced.

When exogenous testosterone therapy is. adverse responses can be induced. Theoretical tips It has been reasoned that discontinuation of ADT in non orchiectomized patients may have detrimental effect on patients with CRPC as discontinuation of ADT can result in renewed release

More information

SYSTEMIC THERAPIES FOR CRPC: Chemotherapy and Radium-223

SYSTEMIC THERAPIES FOR CRPC: Chemotherapy and Radium-223 SYSTEMIC THERAPIES FOR CRPC: Chemotherapy and Radium-223 ELENA CASTRO Spanish National Cancer Research Centre Prostate Preceptorship. Lugano 4-5 October 2018 Disclosures Participation in advisory boards:

More information

Optimizing Outcomes in Advanced Prostate Cancer

Optimizing Outcomes in Advanced Prostate Cancer Optimizing Outcomes in Advanced Prostate Cancer Module 3: Focus on Recent CRPC Guidelines and Advanced Hormone-Sensitive Disease Sébastien J. Hotte, MD, MSc (HRM), FRCPC Medical Oncologist and Head, Phase

More information

Joelle Hamilton, M.D.

Joelle Hamilton, M.D. Joelle Hamilton, M.D. www.urologycentersalabama.com Case Presentation: CRPC, Rising PSA 70 yo healthy, fit, active man post RALP 8 years prior with rising PSA Rising PSA from 0.02 nadir to 3.4 thus ADT

More information

Prostate Cancer. Dr. Andres Wiernik 2017

Prostate Cancer. Dr. Andres Wiernik 2017 Prostate Cancer Dr. Andres Wiernik 2017 Objectives YES!!! 1. Epidemiology 2. Biology or Natural History of Prostate Cancer 3. Treatment NO!!! 1. Prostate Cancer Screening - controversies Which is the most

More information

Early Chemotherapy for Metastatic Prostate Cancer

Early Chemotherapy for Metastatic Prostate Cancer Early Chemotherapy for Metastatic Prostate Cancer Daniel P. Petrylak, MD Professor of Medicine and Urology Smilow Cancer Center Yale University Medical Center Disclosure Consultant: Sanofi Aventis, Celgene,

More information

www.drpaulmainwaring.com Figure 1 Androgen action Harris W P et al. (2009) Nat Clin Pract Urol doi:10.1038/ncpuro1296 Figure 2 Mechanisms of castration resistance in prostate cancer Harris W P et al. (2009)

More information

Saad et al [12] Metastatic CRPC. Bhoopalam et al [14] M0 PCa on ADT <1 yr vs >1 yr ADT

Saad et al [12] Metastatic CRPC. Bhoopalam et al [14] M0 PCa on ADT <1 yr vs >1 yr ADT Evolution of Treatment Options for Patients with and Bone Metastases Trials of Treatments for Castration-Resistant Prostrate Cancer Mentioned in This Review Bisphosphonates (Zometa) 4 mg IV 8 mg IV ( to

More information

Prostate Cancer 2009 MDV Anti-Angiogenesis. Anti-androgen Radiotherapy Surgery Androgen Deprivation Therapy. Docetaxel/Epothilone

Prostate Cancer 2009 MDV Anti-Angiogenesis. Anti-androgen Radiotherapy Surgery Androgen Deprivation Therapy. Docetaxel/Epothilone Prostate Cancer 2009 Anti-Angiogenesis MDV 3100 Anti-androgen Radiotherapy Surgery Androgen Deprivation Therapy Docetaxel/Epothilone Abiraterone DC therapy Bisphosphonates Denosumab Secondary Hormonal

More information

Castrate-resistant prostate cancer: Bone-targeted agents. Pr Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France

Castrate-resistant prostate cancer: Bone-targeted agents. Pr Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Castrate-resistant prostate cancer: Bone-targeted agents Pr Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Disclosure Participation in advisory boards or as a speaker for: Amgen, Astellas,

More information

Prostate cancer update: Dr Robert Huddart Cancer Clinic London

Prostate cancer update: Dr Robert Huddart Cancer Clinic London Prostate cancer update: 2013 Dr Robert Huddart Cancer Clinic London Recent developments Improved imaging New radiotherapy technologies Radiotherapy for advanced disease Intermittent hormone therapy New

More information

LONDON CANCER NEW DRUGS GROUP RAPID REVIEW

LONDON CANCER NEW DRUGS GROUP RAPID REVIEW LONDON CANCER NEW DRUGS GROUP RAPID REVIEW Abiraterone for the treatment of metastatic castration-resistant prostate cancer that has progressed on or after a docetaxel-based chemotherapy regimen Disease

More information

Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy

Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy October- 2015 ESMO 2004 October- 2015 Fyraftensmøde 2 2010 October- 2015 Fyraftensmøde 3 SWOG 9916 OS

More information

Management of Prostate Cancer

Management of Prostate Cancer Management of Prostate Cancer An ESMO Perspective Alan Horwich Conflicts of Interest Disclosure Alan Horwich I have no personal conflicts of interest relating to prostate cancer. European Incidence and

More information

Current role of chemotherapy in hormone-naïve patients Elena Castro

Current role of chemotherapy in hormone-naïve patients Elena Castro Current role of chemotherapy in hormone-naïve patients Elena Castro Spanish National Cancer Research Centre Lugano, 17 October 2017 Siegel, Ca Cancer J Clin,2017 Buzzoni, Eur Urol, 2015 -Aprox 15-20% of

More information

Cancer de la prostate: best of 2016

Cancer de la prostate: best of 2016 Cancer de la prostate: best of 2016 Dr Christophe Massard GR2016, 3 DEC 2016 Disclosure Participation to advisory boards, speaker or investigator for: Amgen, Astellas, Astra Zeneca, Bayer, Celgene, Genentech,

More information

Elderly men with prostate cancer + ADT

Elderly men with prostate cancer + ADT Elderly men with prostate cancer + ADT Background and Rationale ADT and Osteoporosis Proportion of Patients With Fractures 1-5 Yrs After Cancer Diagnosis 21 18 +6.8%; P

More information

SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract on Prostate Cancer) In Oncologia

SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract on Prostate Cancer) In Oncologia SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract on Prostate Cancer) In Oncologia Divisione di Oncologia Medica Unità Tumori Genitourinari SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract

More information

Advanced Prostate Cancer. SAMO Masterclass 17 th of March 2017 PD Dr. med. Aurelius Omlin

Advanced Prostate Cancer. SAMO Masterclass 17 th of March 2017 PD Dr. med. Aurelius Omlin Advanced Prostate Cancer SAMO Masterclass 17 th of March 2017 PD Dr. med. Aurelius Omlin aurelius.omlin@kssg.ch Conflicts of Interest Research Support: TEVA, Janssen Advisory Rolle: Astra Zeneca, Astellas,

More information

Definition Prostate cancer

Definition Prostate cancer Prostate cancer 61 Definition Prostate cancer is a malignant neoplasm that arises from the prostate gland and the most common form of cancer in men. localized prostate cancer is curable by surgery or radiation

More information

METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 /

METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 / METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 / 2 0 1 8 Prostate Cancer- Statistics Most common cancer in men after a skin

More information

New Treatment Modalities and Clinical Trials for HRPC 계명의대 김천일

New Treatment Modalities and Clinical Trials for HRPC 계명의대 김천일 New Treatment Modalities and Clinical Trials for HRPC 계명의대 김천일 Castrate-Resistant Prostate Cancer (CRPC) Current standard therapy Androgen receptor (AR) in CRPC New systemic therapies Hormonal therapy

More information

Until 2004, CRPC was consistently a rapidly lethal disease.

Until 2004, CRPC was consistently a rapidly lethal disease. Until 2004, CRPC was consistently a rapidly lethal disease. the entry in systemic disease is declared on a an isolated PSA recurrence after local treatment so!!! The management of CRPC and MCRPC is different

More information

Summary of Phase 3 IMPACT Trial Results Presented at AUA Meeting Webcast Conference Call April 28, Nasdaq: DNDN

Summary of Phase 3 IMPACT Trial Results Presented at AUA Meeting Webcast Conference Call April 28, Nasdaq: DNDN Summary of Phase 3 IMPACT Trial Results Presented at AUA Meeting Webcast Conference Call April 28, 2009 Nasdaq: DNDN PROVENGE sipuleucel-t is an autologous active cellular immunotherapy that activates

More information

Sequencing Strategies in Metastatic Castration Resistant Prostate Cancer (MCRPC)

Sequencing Strategies in Metastatic Castration Resistant Prostate Cancer (MCRPC) Sequencing Strategies in Metastatic Castration Resistant Prostate Cancer (MCRPC) Amit Bahl Consultant Oncologist Bristol Cancer Institute Clinical Director Spire Specialist Care Centre UK Disclosures Advisory

More information

Index Patients 3& 4. Guideline Statements 10/11/2014. Enzalutamide Reduced the Risk of Death

Index Patients 3& 4. Guideline Statements 10/11/2014. Enzalutamide Reduced the Risk of Death //4 Prolonged Radiographic Progression-Free Survival Reduced the Risk of Death Overall ITT Population Estimated median rpfs, months (9% CI): : NYR (.8 NYR); placebo:.9 (.7.4) rpfs (%) ( Enza 9 8 7 4 8

More information

Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer

Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group

More information

Initial Hormone Therapy

Initial Hormone Therapy Initial Hormone Therapy Alan Horwich Institute of Cancer Research and Royal Marsden Hospital, London, UK Alan.Horwich@icr.ac.uk MANAGEMENT OF PROSTATE CANCER Treatment windows Subclinical Localised PSA

More information

The Return of My Cancer -Emerging Effective Therapies Jianqing Lin, MD

The Return of My Cancer -Emerging Effective Therapies Jianqing Lin, MD Februray, 2013 The Return of My Cancer -Emerging Effective Therapies Jianqing Lin, MD Why/How my cancer is back after surgery and/or radiation? Undetected micro-metastatic disease (spreading) before local

More information

ACTUALIZACIONES EN TRATAMIENTOS DIRIGIDOS AL HUESO. COMBINACIÓN CON OTRAS ESTRATEGIAS TERAPÉUTICAS.

ACTUALIZACIONES EN TRATAMIENTOS DIRIGIDOS AL HUESO. COMBINACIÓN CON OTRAS ESTRATEGIAS TERAPÉUTICAS. ACTUALIZACIONES EN TRATAMIENTOS DIRIGIDOS AL HUESO. COMBINACIÓN CON OTRAS ESTRATEGIAS TERAPÉUTICAS. ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz IdiPAZ, Madrid INTRODUCTION High

More information

Prostate Cancer UK Best Practice Pathway: ACTIVE SURVEILLANCE

Prostate Cancer UK Best Practice Pathway: ACTIVE SURVEILLANCE Prostate Cancer UK Best Practice Pathway: ACTIVE SURVEILLANCE Low risk localised PSA < 10 ng/ml and Gleason score 6, and clinical stage T1 - T2a Intermediate risk localised PSA 10-20 ng/ml, or Gleason

More information

Philip Kantoff, MD Dana-Farber Cancer Institute

Philip Kantoff, MD Dana-Farber Cancer Institute CHEMOTHERAPY FOR MCRPC Philip Kantoff, MD Dana-Farber Cancer Institute Harvard Medical School 1 Disclosure of Financial Relationships With Any Commercial Interest Name Nature of Financial Commercial Interests

More information

Radical Prostatectomy: Management of the Primary From Localized to Oligometasta:c Disease

Radical Prostatectomy: Management of the Primary From Localized to Oligometasta:c Disease Radical Prostatectomy: Management of the Primary From Localized to Oligometasta:c Disease Disclosures I do not have anything to disclose Sexual function causes moderate to severe distress 2 years after

More information

National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design:

National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design: Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A PHASE III STUDY OF IRESSA

More information

Prostate Case Scenario 1

Prostate Case Scenario 1 Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has

More information

Cancer de la prostate métastatique: prise en charge précoce

Cancer de la prostate métastatique: prise en charge précoce Cancer de la prostate métastatique: prise en charge précoce Stéphane Oudard, MD, PhD Georges Pompidou Hospital, Oncology Department, Paris, France stephane.oudard@egp.aphp.fr SAGB.CAB.14.08.0382c 3/02/2016

More information

Management of Incurable Prostate Cancer in 2014

Management of Incurable Prostate Cancer in 2014 Management of Incurable Prostate Cancer in 2014 Julie N. Graff, MD, MCR Portland VA Medical Center Assistant Professor of Medicine Knight Cancer Institute, OHSU 2014: Cancer Estimates Stage at Diagnosis

More information

Evolution of Chemotherapy for. Cancer

Evolution of Chemotherapy for. Cancer Evolution of Chemotherapy for Hormone Refractory Prostate t Cancer Ian F Tannock MD, PhD Daniel E Bergsagel Professor of Medical Oncology Princess Margaret Hospital and University of Toronto In 1985, two

More information

STAMPEDE trial (MRC PR08): Arm J overview. Enzalutamide and abiraterone comparison and trial update

STAMPEDE trial (MRC PR08): Arm J overview. Enzalutamide and abiraterone comparison and trial update STAMPEDE trial (MRC PR08): Arm J overview Enzalutamide and abiraterone comparison and trial update Arm J Hypotheses and rationale STAMPEDE: Hypothesis Will addition of enzalutamide and abiraterone to standard-of-care

More information

Review of the Stampede Results. Charles Ryan MD University of California San Francisco

Review of the Stampede Results. Charles Ryan MD University of California San Francisco Review of the Stampede Results Charles Ryan MD University of California San Francisco Se#ng and hypothesis Se

More information

Medical Treatments for Prostate Cancer

Medical Treatments for Prostate Cancer Medical Treatments for Prostate Cancer Ian F Tannock MD, PhD Daniel E Bergsagel Professor of Medical Oncology, Princess Margaret Hospital and University of Toronto March 17, 2005 Brampton 1 A hypothetical

More information

GU Guidelines Update Meeting: M0 Castrate Resistant Prostate Cancer. Dr. Simon Yu Nov 18, 2017

GU Guidelines Update Meeting: M0 Castrate Resistant Prostate Cancer. Dr. Simon Yu Nov 18, 2017 GU Guidelines Update Meeting: M0 Castrate Resistant Prostate Cancer Dr. Simon Yu Nov 18, 2017 Faculty/Presenter Disclosure Faculty: Dr. Simon Yu Relationships with commercial interests: Grants/Research

More information

Initial Hormone Therapy

Initial Hormone Therapy Initial Hormone Therapy Alan Horwich Institute of Cancer Research and Royal Marsden Hospital, London, UK Alan.Horwich@icr.ac.uk MANAGEMENT OF PROSTATE CANCER Treatment windows Subclinical Localised PSA

More information

Isotopes and Palliative Radiotherapy for bone metastases

Isotopes and Palliative Radiotherapy for bone metastases Isotopes and Palliative Radiotherapy for bone metastases Rationale for Bone-seeking Isotope Therapies in Prostate Cancer > 90% of patients with advanced prostate cancer have bone metastases which can be

More information

Bone targeting: bisphosphonates, RANK-ligands and radioisotopes. Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017

Bone targeting: bisphosphonates, RANK-ligands and radioisotopes. Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017 Bone targeting: bisphosphonates, RANK-ligands and radioisotopes Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017 Disclosures Institutional Research Support/P.I. Employee

More information

SIMPOSIO. Radioterapia stereotassica e nuovi farmaci nel tumore e della prostata metastatico

SIMPOSIO. Radioterapia stereotassica e nuovi farmaci nel tumore e della prostata metastatico SIMPOSIO Radioterapia stereotassica e nuovi farmaci nel tumore e della prostata metastatico Definition of Oligometastatic PCa 1-3 synchronous metastases (bone and/or lymph nodes) 2-5 synchronous metastases

More information

HOW I DO IT. Introduction. BARKIN J. How I Do It: Managing bone health in patients with prostate cancer. Can J Urol 2014;21(4):

HOW I DO IT. Introduction. BARKIN J. How I Do It: Managing bone health in patients with prostate cancer. Can J Urol 2014;21(4): HOW I DO IT How I Do It: Managing bone health in patients with prostate cancer Jack Barkin, MD Department of Surgery, University of Toronto, Humber River Hospital, Toronto, Ontario, Canada BARKIN J. How

More information

Second line hormone therapies. Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017

Second line hormone therapies. Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017 Second line hormone therapies Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017 Disclosures Institutional Research Support/P.I. Employee Consultant Major Stockholder Speakers

More information

PLAATS VAN DE CHEMOTHERAPIE IN DE BEHANDELING VAN EEN PROSTAATCARCINOOM: EEN UPDATE. Daan De Maeseneer, Medisch Oncoloog

PLAATS VAN DE CHEMOTHERAPIE IN DE BEHANDELING VAN EEN PROSTAATCARCINOOM: EEN UPDATE. Daan De Maeseneer, Medisch Oncoloog PLAATS VAN DE CHEMOTHERAPIE IN DE BEHANDELING VAN EEN PROSTAATCARCINOOM: EEN UPDATE Daan De Maeseneer, Medisch Oncoloog 1 Overview DEAT PSA/Tumor Burden METASTASES INITIAL DIAGNOSIS & THERAPY ADT CRP SREs/

More information

The management and treatment options for secondary bone disease. Omi Parikh July 2013

The management and treatment options for secondary bone disease. Omi Parikh July 2013 The management and treatment options for secondary bone disease Omi Parikh July 2013 Learning Objectives: The assessment and diagnostic process of patients with suspected bone metastases e.g bone scan,

More information

Perspective on endocrine and chemotherapy agents. Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy

Perspective on endocrine and chemotherapy agents. Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy Perspective on endocrine and chemotherapy agents Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy Disclosures Dr. Sternberg has received research funding for

More information

Community care of Prostate Cancer. Shaun Costello Southern Cancer Network

Community care of Prostate Cancer. Shaun Costello Southern Cancer Network Community care of Prostate Cancer Shaun Costello Southern Cancer Network Introduction Why is GP follow up of prostate cancer important 4Years In Waikato Faster Cancer Treatment Reporting against the 3

More information

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED PLACEBO-CONTROLLED, DOUBLE-BLIND

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Radium-223 chloride for the treatment of bone metastases in castrate resistant prostate cancer Draft scope Draft

More information

Clinical Case Conference

Clinical Case Conference Clinical Case Conference Intermediate-risk prostate cancer 08/06/2014 Long Pham Clinical Case 64 yo man was found to have elevated PSA of 8.65. TRUS-biopies were negative. Surveillance PSA was 7.2 in 3

More information

ASCO 2012 Genitourinary tumors

ASCO 2012 Genitourinary tumors ASCO 2012 Genitourinary tumors Post ASCO Bern 14-06-2012 Dr. med. Richard Cathomas leitender Arzt Onkologie, KSGR, Chur Renal cell cancer Changes in first line treatment? Prostate cancer 3 positive phase

More information

Prostate Cancer UK s Best Practice Pathway

Prostate Cancer UK s Best Practice Pathway Prostate Cancer UK s Best Practice Pathway TREATMENT Updated October 2018 To be updated in vember Active surveillance What is the patient s stage of disease? Low risk localised PSA < 10 ng/ml and Gleason

More information

Denosumab (AMG 162) for bone metastases from solid tumours and multiple myeloma

Denosumab (AMG 162) for bone metastases from solid tumours and multiple myeloma Denosumab (AMG 162) for bone metastases from solid tumours and multiple myeloma September 2008 This technology summary is based on information available at the time of research and a limited literature

More information

Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia

Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia Virginia - Chesapeake Bay Landfall: Virginia Beach, April 29 th, 1607 PSA Failure after Radical Prostatectomy

More information

UPDATE ON RECENT CUTTING-EDGE TRIALS: TREATMENTS NOW AVAILABLE FOR NEWLY DIAGNOSED mhspc PATIENTS

UPDATE ON RECENT CUTTING-EDGE TRIALS: TREATMENTS NOW AVAILABLE FOR NEWLY DIAGNOSED mhspc PATIENTS UPDATE ON RECENT CUTTING-EDGE TRIALS: TREATMENTS NOW AVAILABLE FOR NEWLY DIAGNOSED mhspc PATIENTS Dr. Neal Shore, Carolina Urologic Research Centre, USA Assoc. Prof. Neeraj Agarwal, Huntsman Cancer Institute,

More information

Management of mcrpc: Hormonal therapy and treatment sequence for CRPC

Management of mcrpc: Hormonal therapy and treatment sequence for CRPC Management of mcrpc: Hormonal therapy and treatment sequence for CRPC Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium Credentials

More information

Prostate Cancer UK s Best Practice Pathway

Prostate Cancer UK s Best Practice Pathway Prostate Cancer UK s Best Practice Pathway TREATMENT Updated August 2018 To be updated in vember Active surveillance What is the patient s stage of disease? Low risk localised PSA < 10 ng/ml and Gleason

More information

Management Options in Advanced Prostate Cancer: What is the Role for Sipuleucel-T?

Management Options in Advanced Prostate Cancer: What is the Role for Sipuleucel-T? Clinical Medicine Insights: Oncology Consise Review Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Management Options in Advanced Prostate Cancer: What is

More information

What will change for men with advanced prostate cancer in the next 24 months? ESO Observatory: Perspective on endocrine and chemotherapy agents

What will change for men with advanced prostate cancer in the next 24 months? ESO Observatory: Perspective on endocrine and chemotherapy agents Perspective on endocrine and chemotherapy agents Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy Disclosures Dr.Sternberg has received research funding for

More information

Hormone therapy works best when combined with radiation for locally advanced prostate cancer

Hormone therapy works best when combined with radiation for locally advanced prostate cancer Hormone therapy works best when combined with radiation for locally advanced prostate cancer Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University Introduction Introduction 1/3 of patients

More information

PROSTATE CANCER HORMONE THERAPY AND BEYOND. Przemyslaw Twardowski MD Professor of Oncology Department of Urologic Oncology John Wayne Cancer Institute

PROSTATE CANCER HORMONE THERAPY AND BEYOND. Przemyslaw Twardowski MD Professor of Oncology Department of Urologic Oncology John Wayne Cancer Institute PROSTATE CANCER HORMONE THERAPY AND BEYOND Przemyslaw Twardowski MD Professor of Oncology Department of Urologic Oncology John Wayne Cancer Institute Disclosures I am a Consultant for Bayer and Sanofi-Aventis

More information

Open clinical uro-oncology trials in Canada

Open clinical uro-oncology trials in Canada Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1

More information

Bone-targeted therapies for prostate cancer in Institut Gustave Roussy Villejuif, France

Bone-targeted therapies for prostate cancer in Institut Gustave Roussy Villejuif, France Bone-targeted therapies for prostate cancer in 2012 Pr Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Disclosure Participation to advisory boards or speaker for: Amgen, Astellas-Medivation,

More information

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD CLINICAL TRIALS Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS

More information

Challenges in the management of metastatic prostate cancer

Challenges in the management of metastatic prostate cancer Oncology 323 Challenges in the management of metastatic prostate cancer A significant number of men with prostate cancer will be elderly. Although some of the issues they face will be the same as their

More information

Chemohormonal Therapy For Prostate Cancer. What is old, is new again!

Chemohormonal Therapy For Prostate Cancer. What is old, is new again! Chemohormonal Therapy For Prostate Cancer What is old, is new again! Mount Tremblant January 20, 2017 Kala S. Sridhar MD, MSc, FRCPC Medical Oncologist, Princess Margaret Hospital Head, GU Medical Oncology

More information

Strategic decisions for systemic treatment. metastatic castration resistant prostate cancer (mcrpc)

Strategic decisions for systemic treatment. metastatic castration resistant prostate cancer (mcrpc) Strategic decisions for systemic treatment metastatic castration resistant prostate cancer (mcrpc) SAMO Luzern 14.09.2012 Richard Cathomas Onkologie Kantonsspital Graubünden richard.cathomas@ksgr.ch mcrpc

More information

Bone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital

Bone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital Bone Metastases Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital 1 Outline Pathophysiology Signs & Symptoms Diagnosis Treatment Spinal Cord Compression 2 General Information

More information

SUMMARY. 3. Emerging understanding of mechanisms of resistance to current treatments

SUMMARY. 3. Emerging understanding of mechanisms of resistance to current treatments SUMMARY 1. Discuss the active agents in prostate cancer currently available in Australia 2. Celebrate the growing role for Prostate Medical Oncologists in Multi Disc Teams active treaments overall survival

More information

Oligometastasis. Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie?

Oligometastasis. Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie? Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie? Daniel M. Aebersold 09. Dezember 2016 Oligometastasis JCO, 1995 1 Oligometastasis: Chance for

More information

Management of Acute Oncological emergencies

Management of Acute Oncological emergencies Management of Acute Oncological emergencies Malignant Spinal cord compression (MSCC) Neutropenic sepsis Superior vena caval obstruction Hypercalcemia Hyponatremia Bowel obstruction Brain Metastasis with

More information

Open clinical uro-oncology trials in Canada

Open clinical uro-oncology trials in Canada Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1

More information

Hormone sensitive prostate cancer To add abiraterone or docetaxel? Dr Lisa Pickering

Hormone sensitive prostate cancer To add abiraterone or docetaxel? Dr Lisa Pickering > Hormone sensitive prostate cancer To add abiraterone or docetaxel? Dr Lisa Pickering Disclosures Institutional Research Support/P.I. Employee Consultant Major Stockholder Speakers Bureau Honoraria Scientific

More information

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED

More information

Oncological Treatment of Urological Cancer

Oncological Treatment of Urological Cancer Network Guidance Document Oncological Treatment of Urological Cancer Status: Expiry Date: Version Number: Publication Date: Final March 2014 8 March 2012 Page 1 of 13 Contents Contents... 2 Oncology Provision...

More information

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer AN OPEN-LABEL, MULTICENTER, RANDOMIZED PHASE II

More information

The Latest is the Greatest. Future Directions in the Management of Patients with Bone Metastases from Breast Cancer

The Latest is the Greatest. Future Directions in the Management of Patients with Bone Metastases from Breast Cancer City Wide Medical Oncology Rounds Friday Sept. 21 st, 2007 The Latest is the Greatest Future Directions in the Management of Patients with Bone Metastases from Breast Cancer Mark Clemons Head, Breast Medical

More information

Novel treatment for castration-resistant prostate cancer

Novel treatment for castration-resistant prostate cancer Novel treatment for castration-resistant prostate cancer Cora N. Sternberg, MD, FACP Chair, Department of Medical Oncology San Camillo and Forlanini Hospitals Rome, Italy Treatment options for patients

More information

NAVIGATING THE mcrpc LANDSCAPE: EXPLORING KEY CLINICAL DECISION POINTS

NAVIGATING THE mcrpc LANDSCAPE: EXPLORING KEY CLINICAL DECISION POINTS NAVIGATING THE mcrpc LANDSCAPE: EXPLORING KEY CLINICAL DECISION POINTS Summary of presentations from the Bayer-supported satellite symposium, held at the European Association of Urology (EAU) Congress,

More information

ADT vs chemo + ADT as initial treatment for advanced prostate cancer

ADT vs chemo + ADT as initial treatment for advanced prostate cancer ADT vs chemo + ADT as initial treatment for advanced prostate cancer By Hussein Khaled Prof. Medical Oncology Cairo University Possible Levels of Prostate Cancer At Diagnosis Local-Regional Disease Spread

More information

Prostate Cancer Update 2017

Prostate Cancer Update 2017 Prostate Cancer Update 2017 Arthur L. Burnett, MD, MBA, FACS Patrick C. Walsh Distinguished Professor of Urology The James Buchanan Brady Urological Institute The Johns Hopkins Medical Institutions Baltimore,

More information