Video: ASCO-GU Prostate Cancer Update | Ask a Prostate Expert
Ask a Prostate Expert | Transcription
Alex: So, Dr. Scholz, we just got back from ASCO GU 2020 which is a huge medical conference for men's health, and what it really comes down to is prostate cancer, and there's a lot of new medical findings that they had in clinical trials. Can you speak to what stood out to you?
Dr. Scholz: Yeah, a couple of things. I mean, one of the things with these conferences is a lot of times they're just small incremental—we know this about hormone therapy, but we don't know is, you know, treatment A or B better or worse. So there was a lot of those sort of refinement studies, but one of the studies (or a couple of studies) that caught my attention were related to the advances that are happening in RNA genetics. We've heard a lot about genetics in, you know, trying things that will predict cancer or there are now studies showing that medications like olaparib and rucaparib can take men that have a mutation called BRCA and help the anticancer effects of that medicine. In other words, if men have a specific genetic mutation, that medicine will work better than when they don't, and so, it's easy to identify these mutations with a mouth swab or a blood test, and that has provided hope to maybe bring a brand new treatment to the prostate cancer world. We have some very good treatments, but we can always use more.
The RNA type genetics, however, in my view, is going to bring a whole new realm of understanding cancer and disease in general, and there were two posters that I would just like to briefly mention. One was—the head author was— Dr. Laurence Klotz of active surveillance fame, and they came up with some RNA signatures that they test in the urine that seem to provide 99% accuracy for men that do and don't have prostate cancer. And 99% accuracy for the men that do have cancer, whether it's a Gleason 6 or lower, or a Gleason 7 and higher (this is what we call the innocuous, harmless types of prostate cancer versus the consequential types that need treatment). So, that is stunning data. I mean, PSAs, as we know, are 30-40% accurate. The other tests like OPKO 4K and SelectMDx are, you know 40%, 50% accurate. That's just not good enough. You need to either have knowledge of the cancer present or not present, or you're gonna need an MRI or need a biopsy. So, if that data pans out that Dr. Klotz produced, that will be a real big game-changer.
Alex: How do you think that'll affect the biopsy process?
Dr. Scholz: Well, if it's that reliable, conceivably, men won't need a biopsy. They may need a biopsy if they have the higher grade forms, but all the men that don't have cancer according to this test or all the men that have the grade 6 form of the cancer, according to this test, won't need a biopsy, which would be fabulous. We're talking about saving 700,000 men being biopsied every year—total game-changer.
That same technology is also being evaluated by a company called MiraDx run by Joanne Weidhaas and she's using microRNA mutation assessments to determine who is likely to get side effects from common therapies like radiation or immune therapy, and there are patterns, genetic patterns, of people that are more likely to get radiation toxicity or more likely to get side effects from the new powerful immune medicines like Keytruda and Opdivo and those sorts of agents. So, that would also be wonderful if before starting treatment we could know in advance who is likely to get side effects and who isn't. And in the ones who are unlikely to get side effects, those people will—we can, you know, embark upon treatment with a real clear conscience and know that they're at least not going to be harmed by the treatment.
So, these things are early in development, but they look really exciting and there's a lot of other stuff at the conference, you know, improvements on MRI, PSMA/PET scans are coming on strong.
Alex: Well, that's some amazing developments. We didn't have that five years ago or even the hope of that five—well, they were studying it five years ago, but to have those types of outcomes, that's going to affect prostate cancer patients in the future in a huge way.
Dr. Scholz: Yeah, it's interesting that prostate cancer in some ways is this sort of neglected cancer because medical oncology as a specialty only is involved in the advanced stages, but on the other hand, with PSA and these genetic tests and then better imaging, the progress seems to be advanced more quickly than it is in the other cancers.
Alex: If you would like to learn more about everything that Dr. Scholz just talked about, you should come to our conference on March 28 in Los Angeles, and that's March 28, 2020, and we're going to be discussing basically microRNA and I believe Joanne Weidhaas is also going to be there and so she'll be able to explain that further as well as imaging and advanced testing and advanced prostate cancer treatments. We hope to see you there.
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