Genomics, drug sequencing: key areas in high-risk prostate cancer

The role of genomics in identifying patients who will benefit from adjuvant treatments, targeted therapy and drug sequencing combinations is among the key areas that require closer attention from researchers investigating metastatic, high-risk prostate cancer.“Genomics is helping to better risk stratify these men before or after undergoing treatment especially radical prostatectomy (RP). This might also afford better application of adjuvant and/or salvage therapies post-RP,” said Dr. Robert Jeffrey Karnes, a urological-oncology specialist of Mayo Clinic in Rochester, New York (USA).

Karnes, who will be speaking at the upcoming 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) to be held in Lisbon, Portugal, from November 13 to 16, will highlight the role of biomarkers in predicting how metastatic disease will impact the treatment of high-risk patients.

“If one looks at the available clinic-pathologic variables in high-risk, the area under the curve (AUC) for predicting future metastasis is only a little better than 50%. Studies that have used case-control designs (cases those with metastasis balanced or matched to control without post RP) have allowed for such biomarkers to be discovered. Its role in the future might be to predict the likelihood of metastatic disease at diagnosis even with conventional treatments,” explained Karnes.

At the EMUC, prostate cancer is a centrepiece topic that will dominate the four-day meeting which will also tackle treatment strategies that involve current multi-disciplinary approaches in kidney, bladder and testis/penile cancers. Experts in medical oncology, urology and radiology, among others, coming from across Europe and North America are expected to discuss and examine management approaches that are still being debated or whose value may later impact the standard or optimal treatment of urological malignancies.

Specialists are currently grappling with unresolved issues and in metastatic prostate disease, the question on how castration-resistant prostate cancer patients react to new drug combinations and their optimal sequencing are one of the areas that experts and researchers are pursuing in on-going trials.

Asked if he is optimistic regarding a breakthrough in studies related to the diagnostics of prostate cancer, Karnes said: “Perhaps deciding better who needs treatment and, moreover, deciding who could have oligometastatic disease and targeted therapy using better molecular imaging.”

Besides the expected or probable progress in diagnostics, he added that “more effort is needed as to how to best sequence all the "new" drugs for metastatic prostate cancer.”

Multidisciplinary approach

Regarding multidisciplinary approach in uro-oncology, now a well-established strategy in many centres, Karnes noted that there are still areas and issues in multidisciplinary strategies that should be further improved or given extra attention.

One of these, according to Karnes, is the “timing of therapies in castrate-sensitive and castrate-resistant prostate cancer.” More focused studies are also needed with regards the treatment of the primary and/or metastatic disease with "curative" intent therapies.

He also lauded events or platforms like the EMUC for offering the opportunity for specialists to exchange ideas and best practices. “This pushes the envelope and goes beyond "convention," he replied when asked on the benefits of consultative meetings.

Finally, he also underlined the need for more studiers on bladder disease. “There is little progress in drug development or treatment paradigms for advanced bladder cancer, and, moreover, there has been little change, if any, in the survival of T2>=bladder cancer,” Karnes added.For details on registration, abstract submission and the EMUC programme, visit the EMUC website.