Listen to the Special Cancer.Net Podcast: 2008 Genitourinary Cancers Symposium Highlights, with Howard Sandler, MD, MS, adapted from this feature.

Leading experts in genitourinary (GU) cancers met in San Francisco at the first bi-annual Genitourinary Cancers Symposium to present and discuss new research related to prevention, screening, and treatment. GU cancers include cancers of the prostate, kidney, bladder, and testis. Cosponsors of the symposium included the American Society of Clinical Oncology (ASCO), the American Society for Therapeutic Radiology and Oncology (ASTRO), and the Society of Urologic Oncology (SUO). PLWC talked with Howard M. Sandler, MD, MS, to learn more about this meeting and the research presented.

Q: What makes this symposium unique?

A: The Genitourinary Cancers Symposium is exceptional because of the multidisciplinary nature of the program. From the onset, the program was designed with the help of the representative organizations of the specialists who care for patients with cancers of the genitourinary tract: medical oncologists, radiation oncologists, and urological surgeons who specialize in cancer management. The meeting agenda and the selection of the scientific presentations were performed by multidisciplinary boards of specialists and, as a result, we have a symposium that has created substantial interest throughout the genitourinary cancer field.

Q: One study presented at the meeting shows that radiation therapy for men with recurrent prostate cancer after a radical prostatectomy (removal of the whole prostate gland) improved survival by more than 60%. What does this mean for these patients?

A: In some cases, there is evidence of prostate cancer recurrence following a radical prostatectomy. This evidence takes the form of an elevated prostate-specific antigen (PSA) test when one would expect the value to be near zero. The noted study evaluated the potential benefit to patients from the addition of salvage radiation therapy, where radiation treatments are delivered to the pelvic region in an effort to kill residual prostate cancer. The data presented show that when radiation therapy is given promptly upon the detection of an elevated PSA level, the treatment results in a reduction in prostate cancer deaths, which is encouraging for patients who develop an elevated PSA level after surgery. This study should further encourage patients and physicians to seek prompt care.

Q: What are we learning about the role of treatment for older men with early-stage prostate cancer?

A: Since prostate cancer may grow slowly in some situations, it is conceivable that not all patients need immediate treatment. In a large review of patients who were diagnosed with prostate cancer in the 1990s and were followed without surgery or radiation therapy, the risk of dying 10 years after diagnosis from low or moderately aggressive prostate cancer - based upon the biopsy appearance - was only 3% to 6%. For more aggressive disease, the risk was higher, at 17%. Data like these suggest that patients who are older and have a limited life expectancy might be monitored for cancer growth rather than undergo surgery or radiation therapy.

Q: Another study shows that 15% of patients with renal cell carcinoma (the most common type of kidney cancer) or gastrointestinal stromal tumor (GIST) who were treated with sunitinib (Sutent) experienced heart failure. What should these patients taking this medication know?

A: Targeted therapies, such as sunitinib, have generated tremendous enthusiasm as a treatment for advanced kidney cancer, which was previously considered highly resistant to therapy. However, it has become recognized that sunitinib, which is an oral drug and easy to administer, may cause heart side effects in some patients. Researchers at Stanford note that reversible heart changes had been noted in large sunitinib studies, but that in their own experience, 15% of patients had symptomatic heart failure, and that in some cases it was apparently irreversible even after sunitinib was discontinued. This rate of symptomatic heart issues was higher than previously reported and indicates that patients should be monitored carefully when taking this drug.

Q: Other research suggests that some groups of patients who have small kidney tumors are more likely to undergo a radical nephrectomy (complete surgical removal of the kidney) than a partial nephrectomy, despite the risk of impaired kidney function with radical nephrectomy, and the equal effectiveness of the two approaches. What does this mean for these patients?

A: Partial nephrectomy has been accepted as standard surgical management of selected kidney cancers. Partial kidney removal allows patients to maximize their overall kidney function, which can be important in the long run. Using a large national database, a group of researchers noted that the use of partial nephrectomy varied depending on the patient group. Younger patients and men were more likely to undergo the partial kidney removal procedure. The authors speculate that younger patients are easier to manage in the immediate postoperative period, but note that older patients, with compromised kidney function, could also benefit from kidney preservation. The authors of the study also note that toward the end of the seven-year study period, more patients were receiving partial nephrectomy, which is encouraging.

Dr. Sandler is Professor and Senior Associate Chair in the Department of Radiation Oncology at the University of Michigan. He is a member of ASCO's Cancer Communications Committee.

More Information

Genitourinary Cancer Advances: News from the 2008 Genitourinary Cancers Symposium