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V O L U M E 17, I S S U E N U M B E R 3
TRT Safe Despite History of PCa No increase in disease recurrence observed
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www.renalandurologynews.com
TRT AND ONCOLOGIC OUTCOMES Men with prostate cancer who receive testosterone replacement therapy (TRT) experience biochemical recurrence (BCR) rates after radical treatment and a progression rate on active surveillance comparable to previously reported rates among men not receiving TRT. 12
11.6%
10.6%
10
■ BCR rate after RP
8
BY JODY A. CHARNOW SAN FRANCISCO—Testosterone replacement therapy (TRT) for men with a history of prostate cancer (PCa) does not increase recurrence rates following radical treatment or progression rate after placement on active surveillance, investigators reported at the American Urological Association’s 2018 annual meeting. In a study examining the outcomes of 190 men with PCa (mean age 68 years) who received TRT after diagnosis and/ or treatment for PCa over the previous 5 years, Abraham Morgentaler, MD, of
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Beth Israel Deaconess Medical Center, Director of Men’s Health Boston, and Associate Clinical Professor of Urology at Harvard Medical School in Boston, and colleagues found that biochemical recurrence rates after radical prostatectomy (RP) and radiation therapy, and the progression rate while on active surveillance (AS), were consistent with published rates from other studies. After a mean follow-up of 47 months, the recurrence rates were 11.6% among the 86 men who underwent RP and 4.1% among the 49 men who had
Non-narcotic Drug Superior For Stone Pain BY JODY A. CHARNOW SAN FRANCISCO—Ketorolac is more effective than narcotics in the management of renal colic in the emergency department (ED), yet narcotics remain a common the first-line treatment, according to study findings presented at the American Urological Association’s 2018 annual meeting. Traditionally, renal colic, or stone pain, has been controlled by narcotics in the ED, as there were no good alternatives until the development of ketorolac in the early 1990s, lead investigator Andrew J. Portis, MD, of HealthEast Kidney Stone Institute continued on page 14
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■ BCR rate after RT
4.1%
■ Progression rate on AS
2 0 Key: RP=radical prostatectomy, RT=radiation therapy (external beam or brachytherapy), AS = active surveillance Source: Morgentaler A, Neel DV, Magauran D, Krakowsky Y. Recurrence rates following testosterone therapy in a large clinical cohort of men with prostate cancer. Poster presented at American Urological Association 2018 annual meeting, San Francisco, May 18–21.
either external beam radiation therapy or brachytherapy, Dr Morgentaler’s team reported. None of the 5 men treated with RP followed by salvage radiation had recurrence. The progression rate among the 47 men on AS was 10.6%.
“This is the largest series to date investigating the safety of testosterone therapy in men with prostate cancer,” Dr Morgentaler told Renal & Urology News. “Recurrence rates following prostate cancer treatment with surgery continued on page 14
De Novo Metastatic PCa Ebbs EARLY DETECTION OF prostate cancer (PCa) in the United States has resulted in a decrease in the number of men presenting with metastatic PCa, investigators reported at the European Association of Urology’s 33rd Congress in Copenhagen, Denmark. In an analysis of data from the Surveillance, Epidemiology and End Results (SEER) program, Thomas Helgstrand, MD, PhD, of the Copenhagen Prostate Cancer Center, and colleagues found that the incidence of de novo metastatic PCa declined from 12.0 cases per 100,000 men in 1980–1984 to 4.4 cases per 100,000 men in 2005–2011. The 5-year
PCa-specific mortality rate for the entire cohort was 56.5%. It increased from 54.2% in 1980–1984 to 61% in 2005–2009. The decreasing incidence of de novo metastatic PCa was followed by a decrease in overall PCa-specific mortality within 3 years, the investigators reported. Dr Helgstrand’s team compared the SEER findings with those from a cohort of men in Denmark using the Danish Prostate Cancer Registry (DaPCaR). In contrast to SEER results, the incidence of de novo metastatic PCa in the DaPCaR revealed an increase from 6.7 cases per 100,000 men in continued on page 14
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