Please note: If you registered for a webinar in this series, you are pre-registered for upcoming webinars and you do not need to register again.
In 2021, an active partnership was established between the International Cardio-Oncology Society (IC-OS), the Canadian Urological Association (CUA), and the European Association of Urology (EAU) to produce a series of online educational events addressing the cardiovascular impact related to prostate cancer treatment.
Building on this foundation, this partnership extended to include an educational program in 2022 that addresses practical clinical decision making, with CV disease in mind, utilizing a multidisciplinary approach in the treatment of prostate cancer worldwide. These events (two of this year’s four events) are now available for viewing and for earning CME credits.
These events (two of this year’s four events) are now available for viewing and for earning CME credits.
Moderators: Dr. Tia Higano, Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia, Canada, and Dr. Derya Tilki, Professor of Urology, Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
The webinar series began with: How do I advise my patient of the best choice individually? Dr. Neil Fleshner, Chair and Professor at the Division of Urology, University of Toronto, Canada, presented an excellent overview of the basics of prostate cancer, including the anatomic considerations, the epidemiology, concepts of early detection, and the principle of biopsy grading, as well as advancements in the treatment of localized disease.
Next, Role of androgen deprivation therapy (ADT) as adjuvant therapy in radiation treatment (RTX) with curative intention: Dr. Paul Nguyen, Professor, Radiation Oncology, Harvard Medical School, USA, summarized the major studies regarding ADT and RTX.
He highlighted that in low-risk patients, ADT may not be needed, but in high-risk patients it is a must in conjunction with RTX. Also, the length of ADT required may not be as long as was previously prescribed. Additionally, he noted that ADT may raise the risk of CV events, but perhaps only in those with established CVD at the outset. Lastly, Which screening tests and initial treatments are needed to prevent CVD progression? Dr. Chris Plummer, Consultant Cardiologist at Newcastle’s Freeman Hospital, UK, provided an excellent overview of how significant the CV risks (especially hyperlipidemia, hypertension and diabetes) may be in patients with prostate cancer, and what subsequent treatments may exacerbate CV disease. Importantly, most men are not on appropriate CV disease prevention therapy, and the use of statins is clearly associated with better outcomes. It is uncertain at present if aspirin may have a salutary effect on CV disease in these patients.
Dr Ricardo Rendon, MD, Professor, Department of Urology, Dalhousie University, Canada, who highlighted what is the standard for ADT in 2022 based on a number of important clinical trials. Recent trials including DART and SPPORT provide important insight such as: the length of ADT may be best limited to 18 months. A meta-analysis suggests that delaying RTX to do neoadjuvant ADT was not helpful. The EMPIRE-1 trial introduced the concept that novel imaging tools were beneficial for decision making.
Next, The role of different hormonal-based therapies in Prostate Cancer: Alicia Morgans, MD Genitourinary Medical Oncologist and the Medical Director of the Survivorship Program at Dana-Farber Cancer Institute, USA, did a beautiful summary of all the medical options for prostate cancer in contemporary practice. This included: who should get ADT, for how long, and when is intensification of hormonal therapy with androgen receptor blockers the standard of practice currently. Lastly, Summarizing the CV toxicities for prostate cancer therapies (including the PRONOUNCE trial): Dr Renato Lopes, MD, Professor of Medicine, Member in the Duke Clinical Research Institute, USA, closed out this session with an outstanding overview of what exactly is the Class 1 evidence to date (which is limited to about 10% of guideline recommendations) and how are these CV events defined in standard oncology trials. He went on to explain the careful adjudication of CV events as part of the PRONOUNCE study, and he then described how this outstanding multidisciplinary trial has set the standard for cooperation for future research. In conclusion, he postulated that the lower than expected CVD event rate observed in this trial where patients with pre-existing CVD receiving ADT all had access to ongoing treatment by a cardiologist should inspire multidisciplinary standard of care for prostate cancer.