Happy New Year. Welcome 2014!

Happy New Years to all...This is my personal assessment of the year in PCa...

For prostate cancer patients, 2014 comes with a lot of promise.  But just reviewing 2013 leaves us with a lot of hope in the treatment of prostate cancer.

• In early May the American Urologic Association (AUA) issued new guidelines for PSA screening for prostate cancer.  The guidelines came with much controversy and lots of opposition by the patient community.  Those opposing the guidelines were not particularly thrilled we the call for less screening and the rationale for the various statements.  They also stated that the 40% drop in the prostate cancer mortality rates since the PSA era was instituted was solely and mostly responsible.  Those for the new guidelines acknowledged over diagnosis and over treatment as huge issues today that impact not only patient quality of life but also industry related expenditure.  Many urologists even have called for population based "screening" all men starting in the "40's" for a baseline PSA test to determine if "pre-cancerous" risk factors are present.  In any case, the screening controversy has been heavily affected in recent years due to the US Preventive Services Task Force issued a Grade D recommendation to end all PSA based screening for prostate cancer in 2010.  And with the new year, don't expect anything to change
• 15 Year update from the Prostate Cancer Prevention Trial (PCPT).  In one of the most significant trials over the last two decades Finasteride (Proscar) has been tested to see if it could be useful in preventing prostate cancer.  And while earlier reports indicate that finasteride WAS successful ate reducing the detection of prostate cancer, there was concern that the active arm of that trial was showing a higher rate of high risk cancers.  In the 2013 report, IM Thompson et al, report that the reduction in the detection of prostate cancers was 30% and that there was no significant different between the control arm and the active arm in terms of survival.  That is a terrific result from a very well controlled long term trial.  And since the make up of the reduction was largely in the low risk group this significantly can impact over diagnosis and over treatment statistics.  The problem?  How do we accurately target the appropriate patients to be on finasteride?  It certainly is not a one size fits all drug.
• Xofigo hits the streets 2013. The ALSYMPCA trial was stopped early after Radium-223 dichloride showed life extending capability in men with mCRPC  Yet another new therapy since 2004 that extends life.  In fact up until 2004 there were no life extending care options released in PCa.  But as Oliver Sartor reported at ASCO 2013 (Click Here). recent years have given men plenty of hope.  And since even just 2010 the great new findings in pill formed and also in intravenous therapies have extended life in well controlled trials. Thus we await the findings for ARN-509, XL-184, TAK-700, Prostvac-VF, etc.  If all does as planned for these drugs then 2014 and beyond will prove to be another good year...
• CHAARTED to make a dent in patient charts.  Earlier use of docetaxel in men with metastatic prostate cancer is showing definitive survival benefits in the CHAARTED trial done by ECOG-ACRIN.  Sweeny et al report that men with extensive metastatic disease are better suited to starting chemotherapy with their hormonal ablation regimen.  The data that will be released at GU ASCO in February is highly anticipated.  But it is expected to give us a possible new standard of care for men with extensive mets but it is unclear the effect on men with few lesions.  CHAARTED also impacts current clinical trials examine earlier settings for drugs such as enzalutamide, abiraterone, orteronal, etc.  
• Moving ahead in 2014 are many trials testing various settings of application in the newer drugs.  Also we look at a lot of exploration of genetic research to better define approaches to treatment and research.  Translational medicine can be heavily impacted in 2014 by findings in 2013 already but as new data continues to come in 2014 has no boundaries on how it will impact the treatment of prostate cancer.
  

A special thank you to my friends and colleagues at ASCO and SWOG for their help in my growth in 2013.  I have learned a lot about the scientific approaches in research and in understanding the lay of the land in the complications of screening and treatment of prostate cancer.  It's truly an honor working with these groups in 2014 and beyond.  

Again, Happy New Years and welcome to this site!

Tony