n°134 | October 8, 2020
In this issue:

Knowledge of erectile dysfunction alarmingly low

New European survey finds that one in four affected don’t talk about it
6 Oct 2020

Patients feel vulnerable and sidelined under COVID

New survey of patient groups reveals major concerns about safety
29 Sep 2020
Prostate Research and Treatments

Androgen Deprivation Therapy and Risk of Dementia Among Patients With PCa

It remains unclear whether androgen deprivation therapy (ADT) is associated with subsequent dementia risk in patients with prostate cancer. There are limited data regarding dementia risk across ADT types. The objective of the study was to examine the association between all-cause dementia, including Alzheimer disease (AD), and different ADT types in patients with prostate cancer.

Does the risk of dementia vary by type of androgen deprivation therapy among patients with prostate cancer? Findings in this cohort study of patients with newly diagnosed prostate cancer between 2008 and 2015 suggest that antiandrogen monotherapy use was associated with an increased dementia risk compared with patients who did not receive androgen deprivation therapy.

Note: This cohort study used linked data from the Taiwan National Cancer Registry, the National Health Insurance Research Database, and the Taiwan National Death Registry. A cohort of 23 651 patients with newly diagnosed prostate cancer between January 1, 2008, and December 31, 2015, was identified and followed up from 1 year after diagnosis until December 31, 2017. Data analysis was performed between January 2019 and May 2020.

Read more by clicking here.

Subcutaneous Fat and mCRPC Treatment Response

In a study of men with metastatic Castration-Resistant Prostate Cancer (mCRPC) receiving chemotherapy and maximal androgen ablation, those who had an objective response to treatment had a significantly higher subcutaneous adipose tissue index (under-the-skin fatty tissue) than those who did not. In accordance with data presented to the ESMO Virtual Congress in September 2020.

This was a small study of 58 men led by Dr Andrew Hahn of the University of Texas. Patients receiving chemotherapy with maximal androgen ablation and who also have significantly more fat under their skin (subcutaneous) were seen to have a much better response to their treatment. What may surprise some readers is that visceral fat tissue or BMI or skeletal muscle mass were not significantly associated with the response. In the report, published by Renal & Urology News, there is also reference to a larger 2018 study which seemed to suggest a similar connection.

For further information click here.

Trends in Use and Comparison of Different Radiation Therapies, for the Management of Localized, Intermediate-Risk Prostate Cancer

Brachytherapy (BT) and dose-escalated external beam radiotherapy (DE-EBRT) have longstanding use in the treatment of patients with localized prostate cancer (PCa), stereotactic body radiation therapy (SBRT) is an emerging option owing to cost effectiveness, patient convenience, and noninferior tumour control and acute toxic effects. SBRT. The increase in radiation options and lack of comparative evidence present challenges in guiding patient-centred care. A new paper in JAMA using the US National Cancer Database, compared use and outcomes between SBRT, BT, and EBRT for the treatment of patients with intermediate risk PCa.

From 2004 to 2014, SBRT use grew from insignificant levels to 10.6% and DE-EBRT use steadily increased from almost half to 62.0% with a corresponding decline in BT use which almost halved to 27.4%. This cohort study is a preliminary evaluation comparing outcomes of patients with intermediate-risk PCa, with results suggesting no difference in long-term survival between patients treated with SBRT, EBRT, or BT.

For further information read the abstract here.

ESMO 2020 Virtual Conference Highlights for Prostate Patients

ESMO 2020 was the most recent medical congress in Europe to go virtual. A number of topics of interest to prostate cancer patients featured, if you want to read the Abstracts on any of these articles or the video interview click on the hypertext link:

Prof. Margel presented the results of the imaging-based screening of 188 germline BRCA1/2 carriers (presentation ID LBA 22). An age-stratified PSA protocol was combined with mpMRI. A total of 8.5% had prostate cancer, with 44% intermediate to high risk. In patients >55, PSA was an acceptable way to triage before MRI.

Dr. Dai addressed local therapy for the prostate in patients with oligometastatic (=<5 bone or extrapelvic node lesions) disease (presentation ID 618 MO). In a prospective randomized controlled trial, ADT (N=100) only was compared to ADT + surgery (N=85) or radiation (N=15). The progression-free survival after radiation therapy favoured the ADT + local therapy group (33 vs 19%) after 28 months.

Dr. Tran (AU), who also gave a video interview to us, presented the results of a phase-1 study of a novel PSMA-targeted, bispecific T-cell engager immunotherapy (BiTE®) for metastatic CRPC (presentation ID 6090). In patients with different previous lines of therapy, PSA response was observed in 69% of the patients, with an acceptable safety profile.

Prof. James (GB) presented the long-term results of upfront abiraterone therapy in 1003 M+ patients during the Stampede trial (presentation ID 6110). Median overall survival was higher in the ADT + abiraterone group compared to ADT alone (6.6 versus 3.8 years), while the effects were independent from the risk group stratification according to the LATITUDE criteria.


Europa Uomo News

EUPROMS study additional data presented

The latest results of the analysis of the Quality of Life Survey (EUPROMS) have emerged following the work of the analysts in Erasmus University, Rotterdam. After the presentation of the early results at the ESOU conference in Dublin in January this year the Board asked Prof. Monique Roobol and her team to analyse the data further with their epidemiological and statistical expertise. This work has been proceeding since February.

Our Chairman, André Deschamps, was able to present much of this new data to the Virtual EAU Congress in July and a further follow-up at the ESMO Virtual Congress in September. The Board decided to make available the data in a format which is intended to be read by patient rather than clinical experts. As an initial step this form of presentation was opened for comment to the Europa Uomo membership and again delivered by André Deschamps to a virtual conference of members and guests at the beginning of this month. Each section was the subject of discussion and valuable feedback provided.

Further work on this presentation material for patients will continue in the coming months with a view to preparation of an on-line and printed version of the data in due course.

Items of Interest

Karen Benn RIP

Tributes have poured in for Karen Benn, deputy CEO and head of public affairs at Europa Donna, who died on 4 September. Karen was one of the longest serving officers at Europa Donna, the European Breast Cancer Coalition that unites advocacy in Europe, having joined in 2003 after working in the business sector for a number of large companies. Since then she has been instrumental in raising the profile of breast cancer advocacy, care and research, in particular at the highest levels in the European Union, paving the way for advocates of other cancers.

Stella Kyriakides, EU commissioner for heath and food safety, and past Europa Donna president, led the tributes, saying it is “almost impossible to describe the immense contribution and impact Karen had in the world of breast cancer advocacy”. She described “her warmth, her ability to emotionally connect with women from every country and background… I will always remember the long discussions we had together on how to make the world a better place for women diagnosed, on the importance of using our voices, of being the voices for others, of building on science and principles.”

In a letter to the advocacy community, Europa Donna CEO, Susan Knox, who worked with Karen throughout her time at the organisation, writes that she made “an enormous contribution to Europa Donna, carrying out projects in a wide variety of areas, from policy at the European Parliament to research projects with BIG [Breast International Group] and the European Commission, to managing our advocacy training course for many years.

“Karen accepted all challenges, and was willing to do everything necessary to improve breast services for women across Europe. She was constantly learning and increasing her knowledge on policy, European laws that could impact women with breast cancer, and scientific advances that could be important to women diagnosed with the disease.”

On the policy front, Karen started work at Europa Donna at a critical point, when the European Parliament adopted its first resolution on breast cancer. Translating this commitment to concrete outputs has been a major task given changes in parliament and the European Commission, and Karen helped launch projects such as the European Commission Initiative on Breast Cancer (ECIBC), extend the resolution to European Council level, and produce written declarations, with commitments to universal breast units and accreditation, screening, and the needs of patients with metastatic breast cancer.

Fatima Cardoso, director of the breast unit at the Champalimaud Clinical Center in Lisbon, and chair of the Advanced Breast Cancer (ABC) conference, said: “Karen was a wonderful person and advocate. She had skills that are not very common in the advocacy world, as an expert in policy issues, and so was a very strong asset for patients, Europa Donna and all the breast cancer field. She was instrumental in the lobbying work done at the European Commission and European Parliament. Karen also collaborated from the beginning with the ABC conference and guidelines effort, as well as with the ABC Global Alliance. She will be greatly missed by all of us in the field.”

Karen was well known to Cancer World and its parent body, the European School of Oncology (ESO). She contributed to ESO’s masterclasses on patient advocacy, talking about how to influence European policy and bring together many stakeholders; how to participate in research; and developing leadership skills. These events were just a few of her many engagements, which also included many major conferences such as ABC and the European Breast Cancer Conference, events at the European Parliament, and the EU’s joint actions on cancer.

Karen was also on the steering committee of Horizon 2020 research projects, and was equally at home working with academic colleagues as with policymakers and advocates. As she said: “It’s important to evaluate potential research projects carefully to ensure that the trial/study answers an important question of interest and of use, and that advocates are involved from the outset and have adequate resources for their involvement.”

One paper on which she is co-author is the European Breast Cancer Council manifesto on genetic risk testing, and colleagues appreciated her input that ensured the article was up to date on legal aspects. Detailed knowledge of pan-European law and regulation was also to the fore in another recent contribution at policy level, on work and cancer, which included research by Europa Donna, as reported in Cancer World.

One reason Karen joined Europa Donna was a strong family history of breast cancer, and she herself developed early and then metastatic breast cancer (MBC) while at the organisation. As Susan Knox adds, she even wanted to use her own experience and knowledge of MBC to conduct workshops at Europa Donna’s most recent MBC advocacy conference in 2019.

Susan concludes, “Karen’s wit, beauty, and dedication to breast cancer advocacy will be greatly missed, but never forgotten. Her life and career serve as an example of what an advocate can be and what an advocate can accomplish on behalf of others. I think that is what she would want us to remember the most.”

Karen was a native of Dublin, Ireland, and a ceremony will be held there.

[Article by Marc Beishon – courtesy of Cancer World]


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