William K. Kelly, DO
Developments in screening and localized treatment for prostate cancer are two components that have been part of the prostate cancer field’s transformation, explains William K. Kelly, DO, adding that treatment of these patients must involve a multidisciplinary approach. “Prostate cancer is not 1 disease; it is [made up of] multiple diseases and it takes multiple people to treat a patient,” Kelly said.
With regard to active surveillance, the United States Preventative Services Task Force (USPSTF) released draft recommendations in April 2017 that physicians should have decision-making conversations with their patients aged 55 to 69 regarding the benefits and risks of prostate cancer screening. This differs from the USPSTF’s previous opinion, which was against routine prostate-specific antigen (PSA) screening for the disease.
Novel imaging approaches, such as prostate-specific membrane antigen (PSMA)-PET scans, could revolutionize the paradigm, he says, to track microscopic disease in a particular area as the technology has high-detection sensitivity rates.
In an interview during the 2018 OncLive®
State of the Science SummitTM
on Prostate Cancer, Kelly, professor, director, Division of Solid Tumor Oncology, Thomas Jefferson University Hospital, discussed the evolving imaging techniques and emerging therapeutic approaches in prostate cancer.
OncLive: What are some notable advancements in prostate cancer?
: It starts off with localized disease; we are really starting to rethink what we can do with [that setting]. In the meeting, Dr Edouard Trabulsi introduced the fact that, even in patients with locally advanced disease, there is a role for local control of tumor. We forgot that before because, in all of the other tumor types, we have maximized local control of the tumor.
Years ago, we swung away from that. Anybody who had a locally advanced prostate cancer we shied away from [doing] local disease control on them. There is a swing backwards—even in those patients who had micrometastatic disease. We are now doing surgery in those patients because it does give optimal local control. However, it also brings up the multimodality approach that is approaching with prostate cancer.
Looking at localized prostate cancer, what are your thoughts on the use of active surveillance, and especially how the USPSTF took a step back and then a step forward with its recommendations?
When you see a task force go back and forth, that means there are limited data to guide them; there are not black-and-white data, it’s really gray. There are a lot of things that go into a decision about active surveillance—not only about the tumor type, but it is based on anywhere from the pathology to the genomics to other characteristics. We have to also include the patient preferences because they actually drive [the decision]. We need to understand patient preferences and their comorbidities.