Author Interviews, Biomarkers, Genetic Research, Prostate Cancer / 19.05.2017 Interview with: Bela S. Denes, MD, FACS Senior Director Medical Affairs UROLOGY Genomic Health Inc. Redwood City, CA. 94063 What is the background for this study? Response: This is a prospective community based non-interventional study designed to provide information on the utility of Oncotype GPS in the management of men presenting with a new diagnosis of clinically localized low risk prostate cancer. We sought to understand the impact of incorporating a molecular marker into the shared treatment decision in practices already well versed in Active Surveillance (AS) as measured by persistence on surveillance at 2 years as well as a number of patient reported outcomes. The current publication reports on the results of a one year pre-specified interim analysis. (more…)
Author Interviews, Cost of Health Care, Prostate Cancer / 10.01.2017 Interview with: Tudor Borza, MD, MS Urologic Oncology and Health Service Research Fellow Department of Urology, University of Michigan What is the background for this study? Response: Starting in the late 2000’s studies began to identify overdiagnosis and overtreatment in men with prostate cancer. Because of the indolent nature of some prostate cancers many men who ended up diagnosed and treated would have never had any consequences from their prostate cancer. This led national organizations (like the American Urological Association and the National Comprehensive Cancer Network) to call for decreased prostate cancer screening (using the serum PSA test) and eventually led to the US Preventive Services Task Force to recommend against routine PSA screening, citing that the harms from diagnosis and treatment outweighed the harms from the disease. Over the same specialists treating the disease began to report on the safety of surveillance strategies in select men with prostate cancer. Watchful waiting (delaying any treatment until men become symptomatic from their cancer and then offering palliative treatment) was found to be comparable to initial treatment in men with a limited life expectance, either from advanced age or multiple comorbidities. Similarly, active surveillance (a technique employing intense monitoring with PSA testing, digital rectal exams, repeat biopsies and possible use of MRI or other biomarkers) was introduced with the goal of delaying treatment in some men with low risk cancer until the cancer becomes more aggressive and was shown to have similar outcomes to initial treatment in carefully selected men. We wanted to study the trends in initial prostate cancer treatment in this context of recommendations for decreased screening and recognition of the feasibility of surveillance in certain patients with prostate cancer. (more…)
Author Interviews, NEJM, Prostate Cancer / 21.10.2016 Interview with: Professor Jenny Donovan OBE FMedSci NIHR-SI AcSS FFPHM Director, NIHR CLAHRC West (National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West) at University Hospitals Bristol NHS Trust Lewins Mead, Bristol Professor of Social Medicine School of Social and Community Medicine University of Bristol What is the background for this study? What are the main findings? Response: PSA testing identifies many men with prostate cancer, but they do not all benefit from treatment. Surgery, radiation therapy and various programs of active monitoring/surveillance can be given as treatments for fit men with clinically localized prostate cancer. Previous studies have not compared the most commonly used treatments in terms of mortality, disease progression and patient-reported outcomes. In the ProtecT study, we used a comprehensive set of validated measures, completed by the men at baseline (before diagnosis), at six and 12 months and then annually for six years. The main finding is that each treatment has a particular pattern of side-effects and recovery which needs to be balanced against the findings from the paper reporting the clinical outcomes (Hamdy et al). (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Radiation Therapy / 22.02.2015

Ann Caroline Raldow, M.D. Brigham and Women's Hospital Resident in Radiation Interview with: Ann Caroline Raldow, M.D. Brigham and Women's Hospital Resident in Radiation Oncology Medical Research: What is the background for this study? What are the main findings? Dr. Raldow: Active surveillance (AS) means monitoring the course of prostate cancer (PC) with the expectation to start treatment if the cancer progresses. Men who enter an AS program are able to defer and possibly avoid the side effects of prostate cancer treatment. According to the National Comprehensive Cancer Network (NCCN) guidelines, active surveillance is currently considered as an initial treatment approach for men with low-risk PC and a life expectancy of at least 10 years. However, no direct comparison has been made between favorable intermediate-risk and low-risk PC with regard to PC-specific mortality or all-cause mortality following treatment with high-dose radiation therapy such as brachytherapy, where radioactive seeds are placed inside the prostate to kill the cancer. We therefore assessed whether the risks of prostate cancer-specific mortality and all-cause mortality following brachytherapy were increased in men with favorable intermediate-risk versus low-risk prostate cancer. The study consisted of more than 5,000 men who were treated with brachytherapy at the Prostate Cancer Foundation of Chicago. After a median follow-up of 7.69 years, there were no significant differences in prostate cancer-specific mortality and all-cause mortality between men with low-risk and favorable intermediate-risk prostate cancer, suggesting that men with favorable intermediate-risk prostate may also be candidates for AS. (more…)
Author Interviews, JAMA, Prostate Cancer / 21.02.2015

Karim Chamie MD Department of Urology Ronald Reagan UCLA Medical Center UCLA Medical Center, Santa Interview with: Karim Chamie MD Department of Urology Ronald Reagan UCLA Medical Center UCLA Medical Center, Santa Monica   Medical Research: What is the background for this study? What are the main findings? Response:  Active surveillance has been shown to be safe and effective. There are multiple longitudinal studies that have demonstrated the safety of active surveillance for men with indolent prostate cancer. In this context, we sought out to determine national practice patterns for localized prostate cancer. Moreover, we wanted to identify patient, tumor, and physician factors that influence treatment decision. What we found was that the vast majority of patients undergo radiation therapy, regardless of patient age and health or severity of tumor. Instead, by far the most significant predictor of whether a patient undergoes radiation therapy is whether they have been referred to a radiation oncologist. On the other hand, surgeons significantly incorporate patient age and health and tumor severity when considering radical prostatectomy (surgery). (more…)