The Annual NYC Prostate Cancer Summit has been taking place virtually this year as a four-part webinar series for prostate cancer patients and loved ones. We are pleased to be able to come together online while the pandemic prevents us from gathering in-person. Each part of the FREE virtual series features different topics and speakers, and offers unprecedented access to some of the field’s foremost experts! We hope you’ll join us for this webinar series.
Advances in therapeutics have led to improvements in both survival and quality of life for men with advanced or metastatic prostate cancer. Get the latest information about how physicians can more clearly detect where prostate cancer has traveled in the body and the most cutting-edge therapies for patients. Part 3 – Advanced Prostate Cancer Treatment Updates is taking place on Wednesday, May 12 at 7pm ET. The program is free to attend, but RSVP is required. Register today!
Mark your calendar and sign up for Part 4 – Genetic Links: Family History, Precision Medicine & More on Thursday, July 15th at 7PM ET. Precision medicine is changing the way physicians approach prostate cancer care, using information about the prostate cancer genetics and a patient’s inherited genetic makeup to develop individualized treatment plans. Cutting-edge research advances in prostate cancer biology are shaping treatment breakthroughs and guiding the development of new therapeutics and clinical trials. All prostate cancer patients and family members are welcome.
Prostate-specific membrane antigen (PSMA) is a protein concentrated on the surface of prostate cancer cells with limited expression on other locations in the body. As covered previously on the blog, PSMA can be exploited for both imaging and treatment utilizing either large monoclonal antibodies or small molecule targeting agents.
PSMA-targeting entails attaching a radionuclide (a particle that gives off radiation) to an antibody or small molecule designed to recognize and bind to PSMA. Research into PSMA-targeting has led to promising investigational treatments and transformed how we can detect prostate cancer. In December 2020, the U.S. Food and Drug Administration (FDA) gave limited approval for 68Ga-PSMA11 PET scans for patients with high-risk localized prostate cancer and patients with rising prostate specific antigen (PSA) levels following radiation or surgery. This form of FDA approval allowed for specific facilities in California to use this agent outside of the clinical trial environment. 68Ga-PSMA PET, which has been used elsewhere in the world without strict regulation, allows doctors to better detect recurrent and hidden prostate cancer and consequently, to choose the best type of therapy for each patient.
Weill Cornell has a dedicated team of physicians that study and interpret 68Ga-PSMA PET imaging. Numerous studies have demonstrated that 68Ga-PSMA PET is more effective than traditional scans (such as CT or MRI) in finding metastatic prostate cancer (sites where the cancer has spread elsewhere, including microscopically) and in a small head-to-head study was also better than 18F-fluciclovine (Axumin) PET/CT. There are a number of ongoing trials at Weill Cornell and elsewhere evaluating the use of PSMA targeted imaging, which currently remain the only way to obtain PSMA PET outside of California, with additional approvals of PSMA PET agents expected in the first half of 2021.
At the 2021 Genitourinary (GU) Cancers Symposium, researchers presented a head-to-head comparison of 68Ga-PSMA11 PET vs. MRI in detecting and staging localized prostate cancer (disease mainly confined within the prostate) in 74 patients. The two imaging methods had similar performance, with PSMA PET a little better for tumors outside of the prostate and MRI better for identifying tumor invasion of structures adjacent to the prostate. It may be that the combination of both methods will further enhance prostate cancer staging and a study is currently being done at WCM to evaluate this combination.
Additionally, a number of studies on PSMA-therapeutics were presented at the 2021 Genitourinary Cancers Symposium. There is an ongoing trial investigating PSMA-targeted radionuclide therapy (PSMA-TRT) with radioactive iodine in combination with the prostate cancer drug enzalutamide; radioactive iodine (Iodine-131) is conjugated to the small molecule 1095. An initial study of 10 patients receiving PSMA-directed/TGFβ-insensitive CAR-T cells (immune cells that have been engineered to recognize PSMA) demonstrated safety and efficacy. In this study, 60% of patients experienced PSA decline, ranging from 11.6 to 98.3%, and post-treatment biopsies demonstrated CAR-T cells infiltrating the tumor microenvironment. Furthermore, there is an ongoing clinical trial of a bispecific antibody (REGN5678) that connects PSMA with immune cells, which can subsequently destroy the cancer cell; this bispecific antibody is combined with a medication called cemiplimab that further strengthens the body’s immune response.
There are multiple agents utilizing PSMA small molecules to carry the beta-emitting radionuclide lutetium-177 (177Lu) to PSMA-positive areas in the body (mostly areas of cancer spread). Updated results of a prospective head-to-head comparison of 177Lu-PSMA-617 vs. cabazitaxel (a type of chemotherapy) in 200 patients with advanced prostate cancer were presented at the 2021 Genitourinary Cancers Symposium. In the data initially shared at ASCO 2020, the main objective was met, with more patients receiving 177Lu-PSMA-617 having PSA response compared to cabazitaxel chemotherapy. In the updated report, patients receiving 177Lu-PSMA-617 had longer disease control (both by PSA measurements and scans), with fewer side effects and more improvements in quality-of-life. Recently, VISION, the multicenter phase III clinical trial comparing 177Lu-PSMA-617 + standard of care against standard of care alone in patients with advanced metastatic prostate cancer, has shown that patients receiving 177Lu-PSMA-617 lived longer and had longer disease control. Full results will be presented at an upcoming research conference, and we hope that this study leads to FDA approval in the future.
In general, tumors spread to other parts of the body via the bloodstream. The ability to capture these tumor cells, called circulating tumor cells (CTCs), has led to significant prognostic information along with the ability to study the cells as part of a “liquid biopsy”. When a number of different types of therapy is able to decrease or clear CTCs from the circulation, those therapies generally make patients live longer.
Scans before and after treatment with PSMA-targeted radionuclide therapy (PSMA-TRT).
Weill Cornell researchers examined several sequential prospective clinical trials utilizing various PSMA-TRT agents. In an analysis of 116 patients, 70% treated with PSMA-TRT and with CTC counts before and after therapy had a decline in CTC counts. Some PSMA-targeting agents (i.e. the carrier molecules) may have anti-cancer effects on their own. While it appears that agents labeled with radioactive particles are more effective, some patients treated with anti-PSMA antibody J591 alone had control of CTC counts.
In the medical world—and especially the genitourinary (GU) world – we’re pretty comfortable having candid conversations about what’s going on below the belt. After all, the “genito” half of our name refers to diseases of the genital organs. April is testicular cancer awareness month and there’s no need for the testes to be a taboo topic. Awareness is key to early detection, so here are 8 things you should know about testicular cancer:
It can develop in one or both testicles. Our bodies aren’t always exactly symmetrical and the same can be said for cancer development. Just because cancer develops in one side, it doesn’t guarantee that the other testicle will be affected.
You shouldn’t feel pain. Testicular pain isn’t normal. Visit your primary care physician and inquire about getting an ultrasound to get a better picture of what’s going on. You may also need a referral to a urologist.
Self-examinations are important. Make an effort to get in a regular habit and aim for once a month. The more you’re familiar with what’s normal for you, the easier it will be to spot something that isn’t right. Not all lumps and bumps mean cancer, but it is important to get them evaluated.
Certain men are at increased risk. While testicular cancer can affect males of all ages, most new cases occur in men between the ages of 20-34. Other risk factors include men who were born with undescended testes (when the testes don’t move into the scrotum during development), men with Klinefelter’s syndrome (two or more X chromosomes), men with a family history of testicular cancer and certain familial cancer syndromes (inherited cancer genes).
Testicular cancer has one of the highest cure rates. We have a number of successful ways to treat testicular cancer, including surgery, radiation, and chemotherapy. Seek out a specialist for evaluation if you sense something is wrong as early detection can minimize the amount of treatment needed. A typical initial work up will include an ultrasound and blood tests, and then possibly a CT scan to get a better picture of what’s going on in your body from a variety of different angles. With proper treatment nearly everyone will be cured, including those with cancer that has spread to other parts of the body.
A diagnosis doesn’t mean you can’t have kids. Most men are able to successfully father children following treatment, but there are occasional situations in which prior history, cancer, or the nature of the treatment can prevent it from happening naturally. Some centers (such as ours) are able to extract sperm, which can be utilized for fertilization. Before starting treatment, ask about your options to preserve fertility, including sperm banking.
It doesn’t signal an end to your sex life either. Following treatment, sexual function should be normal.
Some treatments should only be performed at centers of excellence. For example, in today’s treatment era, some men only need removal of the affected testicle. These men can be spared additional surgery, radiation, and/or chemotherapy that might have been administered in the past, but they remain at risk for tumor recurrence that might be missed in less experienced hands. A type of surgery called retroperitoneal lymph node dissection (RPLND) should only be performed by someone with specialized experience in this procedure. Additionally, certain types of chemotherapy regimens are very complicated and require autologous stem cell support (bone marrow transplant) to achieve cure. We happen to offer all of these specialized approaches.
A version of this article was first published on April 30, 2016.
In the medical world—and especially the genitourinary (GU) world – we’re pretty comfortable having candid conversations about what’s going on below the belt. After all, the “genito” half of our name refers to diseases of the genital organs. April is testicular cancer awareness month and there’s no need for the testes to be a taboo topic. Awareness is key to early detection, so here are 8 things you should know about testicular cancer:
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