Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the efficacy and feasibility of using a GNRH antagonist rather than an agonist as hormonal therapy for men with prostate cancer.

It can be challenging to use the FDA-approved GNRH antagonist degarelix as a treatment of prostate cancer because it involves monthly injections, Cooperberg explains. This has been shown to be a barrier in practice, as patients are less likely to travel great distances on a monthly basis. However, some patients may start with an agonist before being transferred to an antagonist if they did not achieve a castrate level of testosterone.

The relevance of preventing micro-testosterone surges with an antagonist is unclear, Cooperberg suggests. In fact, for most patients starting on a hormonal therapy who have a detectable prostate-specific antigen or limited-burden metastatic disease, Cooperberg questions the significance of testosterone flare. Outside of this item, analyses have suggested that fewer cardiac or metabolic side effefts are seen with an antagonist compared with an agonist, but further studies need to be conducted to validate these findings, Cooperberg suggests.

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Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the efficacy of using an antagonist with hormone therapy in prostate cancer.

Dr. Cooperberg on Using Antagonists for Hormonal Therapy in Prostate Cancer

Matthew Cooperberg, MD, MPH, Assistant Professor of Urology; Epidemiology & Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, describes the future and historical impact of screening in prostate cancer.

There is a great deal of excitement over the multitude of new agents recently approved to treat advanced prostate cancer. Additionally, Cooperberg points out, markers are being researched to help identify patients who will benefit the most from these treatments. However, future advances are contingent on effectively screening patients, Cooperberg believes.

Completely abandoning screening will have a disastrous impact on survival rates, Cooperberg suggests. Furthermore, despite salient progress made in advanced disease, discontinuing screening could undo the progress made in the past 10-15 years. As a result, screening only those who are likely to benefit, in order to achieve optimal results, could enhance screening without completely doing away with the approach.

Matthew Cooperberg, MD, MPH, from the UCSF Helen Diller Family Comprehensive Cancer Center, describes the future and historical impact of screening in prostate cancer.

Dr. Cooperberg on the Impact of Prostate Cancer Screening

Matthew Cooperberg, MD, MPH, Assistant Professor of Urology; Epidemiology & Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses the imminent stage migration that is likely to occur as new therapies become available expressly for metastatic prostate cancer.

The boundary between M0 (no metastasis) and M1 (metastatic) prostate cancer is arbitrary and depends heavily on the methods used to detect metastasis. In fact, Cooperberg stresses, most patients with M0 prostate cancer likely have microscopic metastasis that cannot be detected by standard bone scans.

These stages have remained unchanged to date because therapeutic options were limited. However, recent advances have brought an abundance of effective treatments into this space, providing incentive to pursue more advanced diagnostic approaches, such as fluorine-based PET scans.

This stage migration will not be without consequences, Cooperberg notes. While the agent sipuleucel-T (Provenge) has a fixed cost, other treatments can be given for an open-ended timeframe. Beginning these therapies earlier, and ultimately providing them for a longer period of time, may dramatically impact costs.

Matthew Cooperberg, MD, MPH, from the University of California, San Francisco, discusses the imminent stage migration that is likely to occur as new therapies become available expressly for metastatic prostate cancer.

Dr. Cooperberg on Prostate Cancer Stage Migration

Matthew Cooperberg, MD, MPH, Assistant Professor of Urology; Epidemiology & Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses the earlier administration of treatment with sipuleucel-T (Provenge) for men with prostate cancer.

Cooperberg believes that immunotherapies, such as sipuleucel-T, are best administered earlier in the treatment paradigm when the immune system is stronger and less cancer cells are present.

To examine this, a study conducted at the University of California, San Francisco looked at the neoadjuvant administration of sipuleucel-T. The primary endpoints for this study were immune parameters that related to immune activation by sipuleucel-T. Cooperberg believes that from a mechanistic standpoint, sipuleucel-T may be most effective when given as a neoadjuvant therapy in prostate cancer.

View coverage from the 2013 GU Cancers Symposium

Matthew Cooperberg, MD, MPH, from the University of California, San Francisco, discusses the earlier administration of treatment with sipuleucel-T for men with prostate cancer.

Matthew Cooperberg, MD

Articles

Dr. Cooperberg on Using Antagonists for Hormonal Therapy in Prostate Cancer

Dr. Cooperberg on the Impact of Prostate Cancer Screening

Dr. Cooperberg on Prostate Cancer Stage Migration

Dr. Cooperberg on Earlier Treatment With Sipuleucel-T