Sam S. Chang, MD, MBA, professor in the Department of Urology and Patricia and Rodes Hart Professor of Urologic Surgery at Vanderbilt University Medical Center, discusses the importance of quality of life (QOL) in prostate cancer.

From a prostate cancer standpoint, physicians at Vanderbilt University Medical Center are focused on improving QOL and learning more about patient-reported outcomes, says Chang. There is so much more to be understood with regard to how patients are doing before, during, and after treatment. That information must be taken into account. Physicians have aleady started to do a better job at counseling patients on what outcomes will look like with the different therapies that can be employed for their cancer. Those things make a difference and have been very exciting within the space, concludes Chang.

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Sam S. Chang, MD, MBA, discusses the importance of quality of life in prostate cancer.

Dr. Chang on Efforts to Improve Quality of Life in Prostate Cancer

Sam S. Chang, MD, MBA, professor in the Department of Urology and Patricia and Rodes Hart Professor of Urologic Surgery at Vanderbilt University Medical Center, discusses remaining questions regarding molecular testing in prostate cancer.

Surgeons are faced with many challenges despite the fact that a variety of tests are currently available for prostate cancer, says Chang. Simple questions, such as determining which tests to order and how to order them can be difficult to answer. Furthermore, once the results come back, knowing what to do with the test results is another challenge.

This is a big educational barrier that will need to be overcome and part of that is because testing continues to rapidly evolve. It is important to understand that these components of testing need to be considered. These questions will be addressed in the National Comprehensive Cancer Network guidelines as well as in the upcoming American Urological Association guidelines with regard to testing in patients with advanced prostate cancer. Beyond advanced, metastatic, or castration-resistant disease, considering genetic testing in high-risk localized disease also needs to be better understood. Determining specifically how the testing will be best used in this setting is a bigger question that still needs to be addressed, concludes Chang.

Sam S. Chang, MD, MBA, discusses remaining questions regarding molecular testing in prostate cancer.

Dr. Chang on Questions Regarding Molecular Testing in Prostate Cancer

Sam S. Chang, MD, MBA, professor, Department of Urology, Patricia and Rodes Hart Endowed Chair of Urologic Surgery, Vanderbilt University Medical Center, discusses adjuvant versus salvage radiation in patients with nonmetastatic high-risk prostate cancer.

Some data suggest that early salvage therapy is superior to late salvage therapy, says Chang. Moreover, it is understood that late salvage therapy is worse than adjuvant therapy. Both intervention strategies are associated with treatment-related complications, says Chang.

Performing upfront genetic testing may shed light on a patient’s recurrence risk. In addition to understanding a patient’s genetic profile, it’ll be important to determine whether adjuvant therapy is better than salvage therapy and when to initiate salvage therapy, explains Chang. 

Ultimately, combining surgery, radiation therapy, and systemic therapy may be the optimal strategy for these patients, concludes Chang.

Sam S. Chang, MD, MBA, discusses adjuvant versus salvage radiation in patients with nonmetastatic high-risk prostate cancer.

Dr. Chang on Adjuvant Versus Salvage Radiation in High-Risk Prostate Cancer

Sam S. Chang, MD, MBA, professor, Department of Urology, Patricia and Rodes Hart Endowed Chair of Urologic Surgery, Vanderbilt University Medical Center, discusses the evolution of surgical techniques in prostate cancer.

In prostate cancer, surgery has shifted toward the use of robotic approaches. Now, the question is whether the field should focus on focal therapy versus continued whole-gland treatment, such as whole-gland radiation or radical prostatectomy, says Chang. If oncologic outcomes are the same with less-invasive focal therapies, patients could be spared unnecessary adverse events. 

In terms of surgical radical prostatectomy, subtle changes have been made, such as using a single port. There is also a move toward retzius-sparing surgery, which is done in an attempt to improve continence rates, explains Chang. The procedure has resulted in encouraging results with regard to early urinary control and early continence. Moreover, these changes have the potential to improve quality of life, concludes Chang.

Sam S. Chang, MD, MBA, discusses the evolution of surgical techniques in prostate cancer.

Dr. Chang on the Evolution of Surgical Techniques in Prostate Cancer

Sam S. Chang, MD, MBA, professor, Department of Urology, Patricia and Rodes Hart Endowed Chair of Urologic Surgery, Vanderbilt University Medical Center, discusses the shift toward personalized therapy in prostate cancer.

In the phase III PROfound trial, the PARP inhibitor olaparib (Lynparza)led to an improvement in radiographic progression-free survivalversus enzalutamide (Xtandi) or abiraterone acetate (Zytiga) in men with metastatic castration-resistant prostate cancer with homologous recombination repair gene alterations. Though, the benefit was more pronounced in patients with 

Historically, genetic testing has not played a large role in the treatment of patients with prostate cancer, explains Chang. Urologists typically focused on tumor grade and Gleason score rather than molecular alterations. Now, genetic testing could inform systemic therapy options for patients, concludes Chang.

Sam S. Chang, MD, MBA, discusses the shift toward personalized therapy in prostate cancer.
 

Sam S. Chang, MD, MBA

Articles

Dr. Chang on Efforts to Improve Quality of Life in Prostate Cancer

Dr. Chang on Questions Regarding Molecular Testing in Prostate Cancer

Dr. Chang on Adjuvant Versus Salvage Radiation in High-Risk Prostate Cancer

Dr. Chang on the Evolution of Surgical Techniques in Prostate Cancer

Dr. Chang on the Use of PARP Inhibitors in Prostate Cancer