By Peter J. Scholz // PCRI Creative Director
Thank you to everyone who made this event possible, and to everyone who took part in this unique experience. Although this second Mid-Year Update was nearly double the size of last year’s event, it was an intimate and focused collaborative experience for everyone who attended. In contrast to the scale of our comprehensive Prostate Cancer Conference that we hold in September —that covers every stage, treatment, side effect, and features breakout sessions and support groups—the Mid-Year Update is intended to help attendees dive deeper into specifically highlighted topics with longer lectures and extended Q+A sessions. This year’s topics were an in-depth exploration of active surveillance and treatment for sexual side effects and dysfunction, both of which are particularly relevant to prostate cancer patients and caregivers.
This year, we were proud to welcome Laurence Klotz, MD, a pioneering doctor, and the forerunner of the medical community’s adoption of active surveillance. His presentation, titled “Active Surveillance: Shrinking the Grey Zone,” covered developments in active surveillance methodology and usage. Some of the topics he covered in his presentation included the PSA screening controversy, causes of over-diagnosis, and the use of multiparametric MRI. He presented results from new clinical studies which followed active surveillance patients over a longer period of time. He illustrated how Gleason 6 cancer doesn’t have the hallmarks of cancer, although it is still technically cancer. He clarified a common misunderstanding about the relation between cancer volume and the likeliness of harboring higher grade disease. To conclude, he presented a new paradigm for screening. Following his lecture, Dr. Mark Moyad and the audience posed questions like:
- How many PSA tests should one take before a biopsy?
- What is the importance of the PCA3 test, and what are the uses and limitations with the advent of mp-MRI?
- Why can the analysis of a biopsy report differ between pathologists?
- What is the value of color Doppler for active surveillance?
- Which genomic tests are useful to predict cancer aggressiveness?
- Should active surveillance patients take metformin or capsaicin and how does it affect prostate cancer?
- How do I find a doctor who utilizes active surveillance?
- What is the significance of high volume 3+3=6 disease?
- How do you determine if the prostate is enlarged without a baseline?
- How do you calculate PSA density?
- How does a DRE compare with color Doppler ultrasound?
- Can African American men consider active surveillance?
- Can men diagnosed with Gleason 6 under 50 years of age consider active surveillance?
- What questions should a patient ask when looking for an MRI center?
Mohit Khera, MD, from Baylor College of Medicine gave a presentation titled “New Approaches in the Treatment of Male and Female Dysfunction: Testosterone Therapy and Other Options.” His lecture covered current treatment options for sexual dysfunction, new treatments and paradigms, female sexual dysfunction, erectile preservation after treatment, and testosterone therapy for men and women. He presented a powerful perspective of treating ED as a couple’s disease. He described in detail how each treatment is used. He provided a clinical perspective on treating the disease and filled common educational gaps. His lecture was full of practical information about how to maximize the effects of treatments. Other notable points in his lecture shed light on sexual rehabilitation after treatment, and the controversy surrounding testosterone supplementation in men who have prostate cancer. He covered issues about the prevalence of ED and how and why it is severely under-diagnosed and under-treated.
His Q+A answered questions about:
- What should I know about drug pricing, generic options, compounding pharmacies, and insurance coverage?
- What is Staxyn and should I consider it as an alternative to common ED drugs?
- Is there a greater risk for heart disease in men taking testosterone?
- What are the side effects of testosterone replacement or supplementation?
- What is the strategy for recovery after the use of hormone therapy?
- How is erectile function influenced by hormone therapy?
- What is the protocol for erectile preservation after surgery, radiation, or hormone therapy?
- What are the specific symptoms of low T?
- How do you distinguish between primary and secondary hypogonadism?
- What are the dangers of high-T?
- What is the potential for loss of penile sensation after radiation?
- What is Clomid and is it safe? What is its availability?
- What is the overall safety of testosterone replacement?
- Is there an optimum time of day to take testosterone cream?
- What is the effect of diurnal variation and dosage of testosterone?
- Can men on active surveillance undergo testosterone replacement/supplementation?
- How does diet and exercise, obesity, and diabetes affect testosterone levels?
- Are there any educational gaps about oral drugs?
- What is venous leak and what are the symptoms?
- What is the influence of alcohol on ED and testosterone levels?
After the lectures, Dr. Scholz briefly discussed five important breakthroughs that occurred in the past year, including the use of adjuvant chemotherapy in prostate cancer and how the use of Taxotere and other drugs at an earlier stage is becoming the standard of care. He covered Dr. Peter Grimm’s comparative studies which showed that seed implants gave the best cure rates for early stage cancer. He discussed the potential use of Optivo, a new immune therapy which has minimal side effects and is currently used in lung cancer and melanoma. He covered another immune therapy that is in trial called Olaparib, which is used in advanced cancer patients who have failed all other drugs. He presented the results from a trial that compared robotic surgery vs. normal surgery.
Our board member, Fabio Almeida, MD, from Phoenix Molecular Institute made a guest appearance and shared information about the development of new imaging agents, which are in development and described the process of undergoing a C11 acetate scan for men with metastatic lesions.
Drs. Scholz and Moyad covered various questions from the audience further expanding on the topicscovered by the featured speakers, but also answered questions about advanced prostate cancer treatments including Provenge immunotherapy in combination with SBRT, and the new drug trial for Prostvac. They discussed the use of the PSA test in relapsed disease, and its use in screening. And finally, they discussed the effects of diet on the immune system when used in tandem with immune therapy.
To end the evening, the attendees viewed a special showing of the hilarious, one-man comedy play: “A Man and His Prostate,” performed by Emmy Award-winning Actor Ed Asner.
Although this educational event was focused and delved deep into important topics, it maintained a lighthearted and entertaining tone. To us at PCRI, it is important that information is provided in an accessible and useable way. The topics were delivered thoughtfully, decisively, and interaction between the attendees and the speakers made the information personal and applicable.