Advanced Cancer Screening Garnering Attention at AUA

Laird Harrison

May 11, 2018

SAN FRANCISCO — Advances in precision medicine, particularly in tests that help identify aggressive cases of prostate cancer, will be in the spotlight at the upcoming American Urological Association (AUA) 2018 Annual Meeting.

"Precision medicine — guided by genomics, proteomics, microbiomics, and advances in imaging — is the real focus of many of the abstracts," said Manoj Monga, MD, from the Cleveland Clinic, who is AUA secretary.

For example, multiple presentations will examine the use of multiparametric MRI in prostate cancer. In addition to revealing anatomy, MRI reveals information about metabolism, water diffusion, and perfusion, which allows physicians to more accurately characterize the cancer, he told Medscape Medical News.

"Traditionally, clinicians have not employed radiologic imaging until after a biopsy," said Aria Olumi, MD, from Massachusetts General Hospital, who is chair of the AUA research council. "That landscape is changing with MRI."

One study, from researchers at Johns Hopkins in Baltimore, will examine the percentage of prostate cancer patients on active surveillance who could have avoided biopsy if multiparametric MRI was combined with the Prostate Health Index to predict their prostate cancer grade reclassification.

In another study, researchers from centers in Japan and the United States look at the negative predictive value of multiparametric MRI.

Traditionally, clinicians have not employed radiologic imaging until after a biopsy. That landscape is changing with MRI.

Results from a multicenter study will look at whether a protein biomarker, measured with the IsoPSA assay, can distinguish between high- and low-grade cancers.

With the increase in the availability of genomic tests, precision medicine has become more common in the treatment of prostate cancer, as well as in diagnostic and predictive techniques.

A chart review of patients who have undergone multiple genomic assays compares three genomic tests — Decipher, Prolaris, and OncotypeDX — and looks at recommendations for active surveillance from National Comprehensive Cancer Network guidelines.

These advances are not only in prostate cancer, some also apply to bladder cancer and kidney cancer.

For example, treatments for nonmuscle invasive bladder cancer will receive attention at the meeting. "There are new chemotherapy agents and new immunotherapy agents that have shown promise," Olumi told Medscape Medical News.

Among these is VB4-845 (Vicinium, Eleven Biotherapeutics), a recombinant fusion protein produced in Escherichia coli. The agent binds to the epithelial cell adhesion molecule antigen on the surface of carcinoma cells, where it is internalized and induces cell death by blocking protein synthesis, according to the company. Results from a phase 3 study will be presented during a late-breaking abstract session.

Another is CG0070 (Cold Genesys), an oncolytic adenovirus that replicates inside tumor cells, causing lysis and immunogenic cell death. The rupture of the cancer cells can release tumor-derived antigens, along with granulocyte-macrophage colony-stimulating factor, which can stimulate a systemic antitumor immune response from the body's own white blood cells, according to the company.

Benign Prostatic Hyperplasia and Kidney Stones

But not all studies will focus on cancer.

Three-year results will be presented from a study of benign prostatic hyperplasia treated with water vapor thermal therapy (Rezūm, NxThera). This approach uses the condensation of water vapor to release stored thermal energy and denature prostate cell membranes.

Results from a study of an image-guided waterjet resection system (AquaBeam, PROCEPT BioRobotics), in which a high-velocity saline stream is used to resect and remove prostate tissue in patients with benign prostatic hyperplasia, will also be presented.

"I think we're going to see the second wave of these in-office energy-based instruments being used more," Olumi said.

Susceptibility to kidney stones will also be addressed. In addition to genetic factors, the association with potassium in drinking water will be examined in a study from researchers at Stanford University in Palo Alto, California.

The opioid epidemic will also be in the spotlight. Evidence-based guidelines for the prescription of opioids after urologic surgery, developed by a team from Rochester, Minnesota, will be presented. And a retrospective comparison of opioids and ketorolac, a nonsteroidal anti-inflammatory drug, in patients with ureteral stones will be presented by researchers from Chapel Hill, North Carolina.

Monga and Olumi have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Laird Harrison @LairdH

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