E. David Crawford, MD, professor of surgery and radiation oncology, head of the Section of Urologic Oncology at the University of Colorado Denver School of Medicine, and associate director of the University of Colorado Comprehensive Cancer Center, discusses the evolving role of active surveillance in patients with prostate cancer.

Various perspectives exist regarding active surveillance in prostate cancer, Crawford begins, noting that consensus is emerging around 2 primary objectives. First, a collective push has been made to minimize the number of individuals placed under active surveillance, he states. Secondly, for those under surveillance, a commitment must be made to diligently monitor their condition due to the likelihood that approximately one-third of these patients may harbor a more aggressive condition, Crawford says. Over a 10-year period, a considerable portion of individuals on active surveillance ultimately undergo treatment, he explains.

Discussions to improve active surveillance strategies have treatments to manage prostate enlargement and mitigate its influence in the surveillance process, Crawford expands. There is also consideration for incorporating additional markers to better monitor individuals on active surveillance programs, he notes. Traditionally, these programs involved annual biopsies, but there is a shifting trend away from this practice, Crawford explains. He says frequent biopsies may not always be necessary; instead, certain triggers, such as a rise in PSA levels or the emergence of new urinary symptoms, could prompt the need for biopsies according to established guidelines, he adds.

National Comprehensive Cancer Network Guidelines suggest that individuals falling within certain grade groups, typically 1 or occasionally 2, should be considered for active surveillance, Crawford continues. This recommendation is relatively recent and acknowledges that the approach to monitoring individuals on active surveillance can be more flexible and personalized based on specific triggers and individual circumstances, he explains. Therefore, the decision-making in terms of how individuals are monitored during active surveillance can vary based on clinical judgment and patient-specific factors, Crawford concludes.

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E. David Crawford, MD, discusses the evolving role of active surveillance in patients with prostate cancer.


Dr Crawford on the Evolving Role of Active Surveillance in Prostate Cancer

Jeffrey Crawford, MD, professor of medicine at Duke University Medical Center in Durham, North Carolina, discusses the efforts underway to better manage cancer-related cachexia, a degenerative syndrome that results in the loss of muscle mass, known as sarcopenia.

Crawford explains that cancer-related cachexia can be caused by both the metabolic demands of the tumor and the treatment provided. Cancer cachexia is characterized by progressive weight loss, muscle atrophy, decreased performance status, fatigue, weakness, and an inability to work or perform daily tasks.

Crawford warns that even though cancer cachexia and weight loss are related they are not always the same. In some cases, patients who seem healthy may still have significant loss in muscles mass. Cachexia can happen prior to therapy, from the cancer alone, resulting in a significant reduction in quality of life.

There currently is not an approved regimen to manage cancer cachexia; however, a host of clinical trials are underway investigating new methods, such as ghrelin antagonists to stimulate appetite and improve weight gain. Additionally, Crawford notes that phase III trials are currently studying novel selective androgen-receptor modulators (SARMs) to treat cancer cachexia.

Dr. Jeffrey Crawford from Duke University Medical Center Discusses Managing Cancer-Related Cachexia

Dr. Crawford Discusses Managing Cancer Cachexia

Jeffrey Crawford, MD, professor of medicine at Duke University Medical Center in Durham, North Carolina, discusses the importance of managing febrile neutropenia, which can often occur after the first cycle of many anticancer therapies.

	Crawford explains that the risk for developing febrile neutropenia is highest in the first cycle of treatment. Additionally, it is difficult to measure an individual's risks until the first cycle is administered. There are guidelines to suggest risk, but individual factors such as liver and renal function, age, and prior treatments make determining risk difficult.

	Complications of febrile neutropenia may lead to hospitalization, intravenous antibiotics, and a significant degree of mortality, according to a presentation by Crawford at the 2012 MASCC International Symposium. Febrile neutropenia remains the largest cause of death connected to an adverse reaction.

	Crawford stresses that it is important for providers and those taking care of patients to be cognizant of the risks of febrile neutropenia when beginning treatment, especially when administering a full dose of chemotherapy.

	The ASCO guidelines note a need to administer preventive pharmaceuticals if the level of risk is over 20%. Crawford believes that preemptive medications should be considered in the first-cycle for those at risk.

Jeffrey Crawford, MD, from Duke University Medical Center, on Managing Febrile Neutropenia.

Jeffrey Crawford, MD

Articles

Dr Crawford on the Evolving Role of Active Surveillance in Prostate Cancer

Dr. Crawford Discusses Managing Cancer Cachexia

Dr. Crawford on Managing Febrile Neutropenia