Renal & Urology News - Nov/Dec 2019 Issue

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NOV EMBER/DECEMBER 2019

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VOLUME 18, IS SUE NUMBER 6

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www.renalandurologynews.com

Adjuvant RT for PCa Shows No Benefit

© PHANIE / BURGER / MEDICALIMAGES.COM

Findings support delaying radiotherapy until biochemical recurrence after radical prostatectomy

RADIOTHERAPY AFTER RP for high-risk prostate cancer may be unnecessary.

BY JODY A. CHARNOW RADIATION THERAPY (RT) following radical prostatectomy (RP) for highrisk 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. The study, RADICALS-RT, is the largest trial to date looking at postoperative radiotherapy for prostate cancer.

Immunotherapy May Up AKI Risk Early ADT BY NATASHA PERSAUD of sustained AKI occurred a mean Use After RP ACUTE KIDNEY injury (AKI) com- 106 days after checkpoint inhibitor monly occurs in patients taking initiation. Challenged immune checkpoint inhibitors to treat Patients received either a CTLA-4 cancer, a new study shows. In an analysis of 1016 patients who received checkpoint inhibitor therapy during 2011 to 2016 at Massachusetts General Hospital in Boston, 17% experienced any AKI within 12 months of initiating an inhibitor, 8% had sustained AKI lasting 3 days or longer, and 3% had AKI potentially related to immune checkpoint inhibitor use, Meghan Sise, MD, MS, of Massachusetts General Hospital, and colleagues reported in the Clinical Journal of the American Society of Nephrology. The first episode

inhibitor (ipilimumab), PD-1 inhibitor (pembrolizumab, nivolumab) or a PD-L1 inhibitor (atezolizumab, avelumab, durvalumab), with only a few receiving a combination of CTLA-4 or PD-1 (ipilimumab and nivolumab). Among confirmed inhibitor-related AKI cases, 80% of stage 1 AKI occurred in patients receiving PD-1 inhibitors, whereas 56% of stage 3 AKI occurred in patients receiving ipilimumab. Among cases potentially related to immune checkpoint inhibitors, 73% of stage 1 AKI occurred in patients continued on page 8

BY JOHN SCHIESZER FINDINGS FROM a recent study challenge the early use of androgen deprivation therapy (ADT) for men who experience biochemical recurrence of prostate cancer following radical prostatectomy (RP). “We found that the median overall survival and metastasis-free survival from time of diagnosis of prostate cancer is quite long in men with biochemically recurrent prostate cancer and is comparable to the overall survival estimated in contemporary clinical trials,” lead investigator Catherine Handy Marshall, MD, of Johns Hopkins University School of Medicine in Baltimore, told Renal & Urology News. “Early ADT, at time of biochemical relapse, does not clearly prolong overall survival or improve quality of life, and when to start this therapy is still a matter of debate.” Dr Handy Marshall’s team retrospectively studied 2930 men with a median age of 61 years and median follow-up continued on page 8

It enrolled 1396 patients following RP from the United Kingdom, Denmark, Canada, and Ireland. Investigators randomly assigned patients to receive postoperative RT or the standard approach with observation, with RT an option if patients experienced PSA failure, defined as a post-RP PSA level of 0.1 ng/mL or higher or 3 consecutive PSA rises. At a median follow-up of 5 years, biochemical progression-free survival rates were 85% in the RT group and 88% in the observation arm, a difference that was not statistically significant, the investigators reported. The RT group also had a significantly higher proportion of patients who had Radiation Therapy Oncology continued on page 8

IN THIS ISSUE 2

Some RCC surgery cases require follow-up beyond 5 years

4

New study supports use of renal mass biopsies before surgery

10

Q&A: Genetic testing has a role in PCa active surveillance

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Transperineal prostate biopsies found to be safer

15

Bladder cancer linked to higher intake of stewed or roasted meat

20

Kidney stone history predicts worse PCI outcomes

20

Elevated levels of IGF-I and free testosterone up PCa risk

Vitamin K may be a promising therapy for calciphylaxis. PAGE 13


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