Prostate cancer: What to expect the next 12 months

On Friday 15 March, the European School of Oncology held their 6th Prostate Cancer Observatory: innovations and care in the next 12 months, as a kick-off session for EAU19. The point of this session is to feature forecasts in prostate cancer management from multidisciplinary viewpoints on what to expect in the coming year.

The room was packed with hundreds of people, and just entering the room took over 20 minutes, reflective of the attractive format this high-level session has adopted to provide the audience with updated and unbiased "sneak peaks" on the near-future expected outcomes for prostate cancer.

Below is the top-12 of what's on the horizon:

1. This last year brought major changes with respect to the implementation of MRI prior to biopsy, and the guidelines have been changed. The coming year will bring incremental and important refinements to the use of MRI (which underestimates tumour volume by 2.7x).
2. In focal therapy, targeting the largest tumour may not be the best strategy. Secondary tumours may be more relevant. More data is expected this year.
3. A Cochrane Review has determined that pharmacological regular use of PDE5 inhibitors does not improve spontaneous erectile function after prostatectomy; this practice will be stopped.
4. Mesenchymal stem cell injection post-prostatectomy is safe, but placebo-controlled trials will be necessary to determine efficacy in averting erectile dysfunction.
5. Low-intensity shock waves for erectile dysfunction after prostatectomy are promising; 2 trials will be reporting this year.
6. Active surveillance may be considered as a new standard of care for all Gleason 6 cases.
7. Results from the phase 3 ENZAMET trial, led by Dr Christopher Sweeney (Dana-Farber Cancer Institute, USA), is likely to be presented soon. ENZAMET is evaluating the addition of enzalutamide to a LHRH analogue as first-line androgen-deprivation therapy.
8.  A small but pivotal study "A Study of MRI/US Fusion Imaging and Biopsy in Combination With Nanoparticle Directed Focal Therapy for Ablation of Prostate Tissue" will report in December 2019
9. The "Robotic surgery after focal ablation therapy (RAFT study)" is also expected to report this coming December.
10. Hypofractionated radiotherapy for organ-confined prostate cancer will become the new standard of care for many patients, reducing treatment to 1-2 weeks, instead of 8-9 weeks.
11. Genomic stratification will be implemented into clinical practice. For example, men that are carriers of BRCA2 mutations should probably be treated with surgery, and not radiotherapy [1].
12.  The STAMPEDE trial in December 2018 [2] instigated a guideline change: Standard treatment for men newly diagnosed with metastatic prostate cancer is currently drug treatment alone. In 2019, there will be a lot of discussion as to whether we should pharmacologically treat non-metastasised patients as well.

 

1. Castro E, et al. J Clin Oncol. 2019 Feb 20;37(6):490-503.
2. Parker CC et al. Lancet. 2018 Dec 1;392(10162):2353-2366.

Posted on 21 May 201917 May 2024