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Prostate Cancer Highlights From ESMO 2020

Dr Johann S. de Bono, of The Institute of Cancer Research in London, reviews key studies on prostate cancer presented at the 2020 ESMO Virtual Congress, including the phase 3 PROfound trial, which led to the approval of the PARP inhibitor olaparib for patients with metastatic prostate cancer.

He also discusses updated results of the STAMPEDE phase 3 trial of abiraterone plus ADT and the IPATential150 study of the AKT inhibitor ipatasertib plus abiraterone for patients with advanced prostate cancer.

Finally, he reviews several emerging new immunotherapies for prostate cancer that are showing promise in early clinical trials.

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Risky Breast Lumps; Bone Testing Lags in Prostate Cancer; Cancer Breathalyzer?

Benign breast lesions detected after a woman’s initial screening mammogram are more likely to become malignant. (European Breast Cancer Conference)

Younger adults who have never smoked are the group with the biggest increase in use of electronic cigarettes. (American Cancer Society, American Journal of Preventive Medicine)

The FDA issued draft guidance aimed at getting more premenopausal women enrolled in clinical trials of new drugs and biologic agents for breast cancer.

Only one-fourth of men with prostate cancer had testing for bone health and integrity after androgen deprivation therapy, which causes loss of bone mineral. (Journal of the National Comprehensive Cancer Network)

Updated results from a randomized trial supported single-agent nivolumab (Opdivo), as opposed to nivolumab-ipilimumab (Yervoy) combination therapy, as adjuvant therapy for resected melanoma, and adding nivolumab to neoadjuvant chemotherapy significantly improved pathologic complete response in resectable non-small cell lung cancer, Bristol Myers Squibb announced in separate statements.

Amgen announced that its investigational KRAS inhibitor sotorasib met the primary endpoint of objective response in a phase II clinical trial of previously treated advanced non-small cell lung cancer.

Minority patients with cancer, as compared with white patients, show increased risk of coronavirus infection, higher rates of hospitalization for COVID-19, and lower use of telehealth during the ongoing pandemic. (ASCO Quality Care Symposium)

Introduction of a pay-for-performance program in oncology practices increased prescriptions for cancer drugs supported by high-quality clinical evidence without significantly increasing the total cost of cancer care. (Penn Medicine, Journal of Clinical Oncology)

More than 100 patient organizations worldwide have formed the World Patients Alliance to increase patient involvement in shaping healthcare policy.

Surgery for benign breast disease does not interfere with breastfeeding. (American College of Surgeons)

Within a week after infusion of CAR T-cell therapy, changes in circulating DNA may identify which patients with large B-cell lymphoma will benefit from the treatment. (University of Texas MD Anderson Cancer Center)

Immune checkpoint inhibitors used to treat multiple types of cancer may aggravate systemic inflammation that drives the development of coronary atherosclerosis. (JACC: CardioOncology)

A rapid and inexpensive breath test showed promise for head and neck cancer. (Flinders University, British Journal of Cancer)

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    Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow

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Does Medicare cover prostate cancer care? Screening, tests and more

Medicare provides its beneficiaries with many different options for helping with the costs of prostate cancer care.

If someone is scheduled for a prostate cancer screening or has recently received a prostate cancer diagnosis, they may be thinking about which treatments, supplies, services, and prescription drugs Medicare may cover.

In this article, we will look at the Medicare coverage available for both the prevention and treatment of prostate cancer. We will also look at general costs, out-of-pocket expenses, and more.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

The prostate is a small, spongy gland approximately the size of a ping-pong ball. It is located deep inside a person’s groin, sitting between the penis and the rectum.

The prostate is important for reproduction because it provides the seminal fluid, which mixes with sperm. Seminal fluid assists the sperm with transport and survival.

If something goes wrong with prostate cells, cancer may develop. Prostate cancer starts when a normal prostate cell shows irregular growth. One of the principal treatments is hormone therapy, which involves lowering a person’s hormone levels with drugs.

Different parts of Medicare cover different treatments and services, depending on their setting.

Medicare Part A

Part A, which is inpatient hospital insurance, covers:

  • inpatient hospital admissions, including cancer treatments a person receives during their stay
  • skilled nursing facility care following a 3-day hospital stay
  • home healthcare, such as rehabilitation services for speech-language, physical therapy, or skilled nursing care
  • hospice care
  • blood work
  • eligible clinical trials

It may be important to note that there are times when hospital stays can be considered outpatient. This may affect Medicare benefits, so if a person is unsure, they may ask the medical staff to clarify.

Medicare Part B

Part B covers outpatient care, including:

  • some preventive services for those who are considered at-risk for cancer
  • doctor visits
  • many intravenous chemotherapy drugs when administered in a doctor’s office
  • radiation treatments performed in a clinic
  • diagnostic tests such as x-rays and CT scans
  • durable medical equipment (DME) such as wheelchairs and walkers
  • outpatient surgical procedures
  • mental health services that are received in a clinic, doctor’s office, therapist’s office, or hospital outpatient department
  • certain preventive and screening services
  • some clinical trials

In some cases, Medicare will also cover the cost of a second opinion for non-emergency surgery, and a third opinion if the first and second opinions differ.

Screenings

Medicare covers prostate cancer screenings for the early detection of prostate cancer. Procedures covered include a digital rectal exam

Hold Off Radiotherapy After Prostate Cancer Surgery

Most men who undergo radical prostatectomy can skip adjuvant radiotherapy and can be followed with observation alone. They can undergo early salvage radiotherapy if the disease shows sign of progressing, say experts reporting results from three similar clinical trials.

This approach would allow most men to avoid radiotherapy and its side effects altogether, the investigators emphasize.

The studies were published online September 28 in The Lancet and The Lancet Oncology.

“There is a strong case now that observation should be the standard approach after surgery and [that] radiotherapy should only be used if the cancer comes back,” commented Chris Parker, MD, the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom.

“Results suggest that radiotherapy is equally effective whether it is given to all men shortly after surgery or given later to those men with recurrent disease,” he said in a statement.

Parker was lead investigator on the largest of the studies, the phase 3 RADICALS-RT trial, published in The Lancet. Preliminary results were reported at a meeting last year. Similar results from two other trials were published in The Lancet Oncology. A preplanned meta-analysis of the three trials was published in The Lancet.

Despite a number of limitations to each of the studies, they represent “an important step forward” and support the use of early salvage radiotherapy for many patients following radical prostatectomy, write experts in an accompanying comment. The editorialists are Derya Tilki, MD, University Hospital Hamburg-Eppendorf, Hamburg, Germany, and Anthony D’Amico, MD, Brigham and Women’s Hospital and the Dana Farber Cancer Institute, Boston, Massachusetts.

However, the editorialists question whether the results apply to all men who have undergone a radical prostatectomy.

One possible exception are men at high risk for progression, such as patients with a Gleason score of 8 to 10 or whose tumor is of grade pT3b or higher. Such patients made up fewer than 20% of participants in the three clinical trials. For high-risk patients, the editorialists think it would be “prudent” to consider adjuvant radiotherapy rather than early salvage therapy.

Results From RADICALS-RT

The RADICALS-RT trial involved 1396 patients who were followed for a median of 4.9 years. Participants had to have at least one risk factor for biochemical progression. These factors included disease of pathologic T-stage 3 or 4, a Gleason score of 7 to 10, positive margins, or a preoperative prostate-specific antigen (PSA) level ≥10 ng/mL.

Half of the men were randomly assigned to receive adjuvant radiotherapy (delivered within 6 months of study enrollment for 90% of patients). One quarter of this group also received either neoadjuvant or adjuvant hormone therapy, the investigators note.

The other half were followed with observation and received salvage radiotherapy group only if they showed biochemical progression within 8 years following randomization.

There was no evidence of a difference in biochemical progression-free survival (bPFS) between the adjuvant and salvage groups, Parker and colleagues report. At 5 years, bPFS rates were 85% for men in the adjuvant radiotherapy group and 88%