James Mohler, MD, professor of oncology, associate director, senior vice president, Translational Research, chief, Inter-Institutional Academics, Roswell Park Comprehensive Cancer Center, discusses what information should be included in a family history, based on the updated National Comprehensive Cancer Network guidelines for genetic testing in prostate cancer. 

In the past, family histories have been limited, explains Mohler. A typical history in an electronic health record would express a positive or negative history, and potentially what relative had cancer, says Mohler.

However, if the patient’s relative had cancer, the family history should include the relative’s age of diagnosis, treatment received, whether they presented with or developed metastatic disease, and if they died from the disease, says Mohler. Moreover, the updated criteria also recommend including hereditary cancer mutations and syndromes, Ashkenazi Jewish status, and race. 

Going forward, these criteria should be implemented in clinical practice to fully capture a patient’s family history, concludes Mohler.

Videos

James Mohler, MD, discusses what information should be included in a family history, based on the updated National Comprehensive Cancer Network guidelines for genetic testing in prostate cancer. 
 

Dr. Mohler on Guidelines for Recording Family History in Prostate Cancer

James Mohler, MD, chair, Department of Urology, associate director, Translational Research, Roswell Park Cancer Institute, discusses the use of androgen-deprivation therapy (ADT) for patients with prostate cancer and how the use is reflected in the NCCN guidelines. Mohler discussed this topic in a talk at the 2016 NCCN Annual Conference.

Mohler says it was interesting for him to go back and try to understand the rationale behind NCCN guidelines regarding ADT in prostate cancer.

Continuous use of ADT has deleterious effects on patients’ morbidity and increases the risk of cardiovascular death. Though it may be easier for a physician to prescribe continuous ADT, Mohler says, intermittent therapy—and the idea that less is better&mdash;is more appropriate.

The NCCN guidelines are carefully crafted around this subject and heeds both good data and missing data, according to Mohler.

View more from the 2016 NCCN Annual Conference

James Mohler, MD, chair, Department of Urology, associate director, Translational Research, Roswell Park Cancer Institute, discusses the use of androgen-deprivation therapy (ADT) for patients with prostate cancer and how the use is reflected in the NCCN guidelines.

Dr. Mohler on Overuse of ADT in Prostate Cancer and NCCN Guidelines

James Mohler, MD, Associate Director and Senior-Vice President for Translational Research, Chair, Department of Urology, Professor of Oncology, Roswell Park Cancer Institute, explains the progress needed to better understand androgen receptors. An older study found that patients with elevated circulating levels of adrenal androgens responded better and longer to ketoconazole. The question is whether or not the same principle can be applied to abiraterone.

Theoretically, Mohler says, an oncologist could biopsy a patient's prostate gland, measure tissue levels of androgens, and determine which anti-androgen agent would work best. As a long-term goal, Mohler sees the need to learn more about how drugs work and how they fail.

James Mohler, MD, Roswell Park Cancer Institute, explains the progress needed to better understand androgen receptors.

Dr. James Mohler on Androgen Levels in Prostate Cancer

James Mohler, MD, Associate Director and Senior-Vice President for Translational Research, Chair, Department of Urology, Professor of Oncology, Roswell Park Cancer Institute, discusses androgen-deprivation therapy (ADT), a standard treatment for men with metastatic prostate cancer.

Mohler believes ADT should only be used to prevent a death from prostate cancer. Before administering ADT, strict calculations should be performed to determine if the cancer is life threatening. Mohler suggests weighing tumor growth rate, tumor volume, health, family history, and age before administering ADT, in order to have a complete knowledge of the risks and benefits associated with treatment.

Additionally, the treatment modality has a substantial impact on the efficacy of ADT. Various methods should be discussed as part of a treatment plan, including whether treatment should be continuous or intermittent, with or without an antiandrogen, or with surgical intervention or an LHRH agonist.

Mohler believes the decision to begin ADT is often rushed, following a prostatectomy or radiation therapy. He believes that in the era of personalized medicine it is important to consider individual characteristics, to determine the most appropriate treatment.

James Mohler, MD, from Roswell Park Cancer Institute, discusses androgen-deprivation therapy, a standard treatment for men with metastatic prostate cancer.

Dr. James Mohler Discusses Androgen-Deprivation Therapy

James Mohler, MD, Associate Director and Senior-Vice President for Translational Research, Chair, Department of Urology, Professor of Oncology, Roswell Park Cancer Institute, discusses the need to develop intermediate endpoints for clinical trials investigating treatments for prostate cancer in order to facilitate the early-stage adoption of new antiandrogen agents, such as abiraterone acetate (Zytiga) and enzalutamide (MDV3100).

Mohler states that the prime reason that newer agents for prostate cancer are being studied for castration-resistant prostate cancer (CRPC) and not earlier stages is because CRPC offers a shorter endpoint, since survival is 18 months on average.

As these drugs are studied earlier in the treatment process it will become increasingly difficult to use survival as an endpoint, Mohler states. In general, men with earlier stages of prostate cancer can live a long time, since the disease is generally slow growing. It is also likely that as the patient progresses they will receive multiple interventions, making it practically impossible to use survival as an endpoint.

Mohler believes that a careful discussion with the FDA on intermediate endpoints needs to take place, so that newer agents can be investigated earlier in the disease.

Dr. James Mohler, from Roswell Park Cancer Institute, Discusses the Need for Intermediate Endpoints for Early Stage Prostate Cancer Trials.

James Mohler, MD

Articles

Dr. Mohler on Guidelines for Recording Family History in Prostate Cancer

Dr. Mohler on Overuse of ADT in Prostate Cancer and NCCN Guidelines

Dr. James Mohler on Androgen Levels in Prostate Cancer

Dr. James Mohler Discusses Androgen-Deprivation Therapy

Dr. Mohler Discusses Prostate Cancer Trial Endpoints