AUAUniversity

PARPi: Genetic Testing in Advanced Prostate Cancer - When and Who to Test (2023)

CME Available: https://auau.auanet.org/node/39603

Release Date: December, 2023

Expiration Date: December, 2024

LEARNING OBJECTIVES:

At the conclusion of this activity, the learner will be able to:

1. Review recommended criteria for genetic testing of prostate cancer patients, currently available gene panels, and options for testing these men.

2. Explain the importance of testing for germline and somatic mutations and their implications for utilizing PARPi.

3. Describe work flows for genetic testing and utilization of genetic counselors.

4. Describe the genetic counseling process and the importance of pre-test counseling to discuss the benefits, limitations, and potential implications of germline testing for patients and their families.

ACKNOWLEDGEMENT

This educational activity is supported by an independent educational grant from Pfizer, Inc.

Infectious Complications Following Prostate Biopsy: Strategies for Reducing Infections and Reducing Health Care Costs

CME Available: https://auau.auanet.org/node/39485

Release Date: December, 2023

Expiration Date: December, 2024

LEARNING OBJECTIVES

At the conclusion of this activity, participants will be able to:

1. Describe health care costs associated with prostate biopsy infections.

2. Identify the steps where modifications in technique can reduce the risk of complications.

3. Apply modified technique at various steps of the procedures to mitigate the risk of complications.

ACKNOWLEDGEMENT

Project Firstline is a national collaborative led by the U.S. Centers for Disease Control and Prevention (CDC) to provide infection control training and education to frontline health care workers and public health personnel. AMA has partnered with Project Firstline, as supported through Cooperative Agreement CDC-RFA-CK20-2003.  The American Urological Association is proud to collaborate with AMA and Project Firstline in this educational activity.  CDC is an agency within the Department of Health and Human Services (HHS). The contents of this event do not necessarily represent the policies of CDC or HHS and should not be considered an endorsement by the Federal Government.

The AUA Expert Exchange Podcast: Discussions in Managing GU Cancer:

Germline Testing in GU Cancers – How I Do It

CME Available: https://auau.auanet.org/node/39544

Release Date: December, 2023

Expiration Date: December, 2024

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from: 

AstraZeneca

Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC 

Lantheus Medical Imaging

Merck & Co., Inc.

LEARNING OBJECTIVES:

At the conclusion of this activity, participants will be able to:

1. Differentiate between germline and somatic testing in the context of GU cancers, understanding the fundamental differences in the types of genetic alterations detected and their implications for patients and their families.

2. Describe the genetic counseling process and the importance of pre-test counseling to discuss the benefits, limitations, and potential implications of germline testing.

3. Evaluate the clinical significance and impact of germline testing results on treatment decisions, surveillance recommendations, and family management.

The AUA Expert Exchange Podcast: Discussions in Managing GU Cancer:

Treatment Intensification for Advanced Prostate Cancer

CME Available: https://auau.auanet.org/node/39486

Release Date: November, 2023

Expiration Date: November, 2024

LEARNING OBJECTIVES:

At the conclusion of these activities, participants will be able to:

1. Identify the latest developments in hormone therapy for advanced prostate cancer, including the use of novel treatments and combinations.

2. Discuss the concept of doublet and triplet therapy in advanced prostate cancer and its rationale in enhancing treatment efficacy.

3. Consider the challenges and future directions in implementing doublet and triplet therapy in clinical practice, including cost, accessibility, and patient selection.

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from: 

Astellas and Pfizer, Inc.

AstraZeneca

Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC

Lantheus Medical Imaging

Merck & Co., Inc.

REFERENCES:

Freedland SJ, et al. Enzalutamide and Quality of Life in Biochemically Recurrent Prostate Cancer. NEJM Evidence. 2023.

Smith MR, et al. Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer. N Engl J Med 2022.

Fizazi K, et al. Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design. Lancet. 2022.

Clarke NW, et al. Abiraterone and Olaparib for Metastatic Castration-Resistant Prostate Cancer. NEJM Evidence. 2022

Chi KN, et al. Niraparib and Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer. J Clin Oncol. 2023.

Agarwal N, et al. Talazoparib plus enzalutamide in men with first-line metastatic castration-resistant prostate cancer (TALAPRO-2): a randomised, placebo-controlled, phase 3 trial. Lancet. 2023.

PARPi: Precision Medicine in Advanced Prostate Cancer (2023)

CME Available: https://auau.auanet.org/node/39597

Release Date: November, 2023

Expiration Date: November, 2024

At the conclusion of this activity, the learner will be able to:

1. Describe the mechanism of action of PARP inhibitors and the differences among drugs in this class.

2. Describe the role of PARPi treatment alone and in combination with other cancer based therapies.

3. Discuss existing clinical trial data assessing the efficacy of PARPi in advanced prostate cancer and ongoing late phase trials for PARP inhibitors.

4. Recognize the need for a multidisciplinary team to provide care for patients with advanced prostate cancer.

ACKNOWLEDGEMENT

This educational activity is supported by an independent educational grant from:

Pfizer, Inc.

Prostate Cancer Treatment Intensification

Moderator: Dr. Jay D. Raman

Guest: Dr. Michael S. Cookson

Acknowledgement: This podcast was funded by and in collaboration with AZ. All opinions are that of the faculty and do not necessarily reflect those of AstraZeneca.

Release Date: 11/8/2023

Expiration Date: 11/8/2024

Update Series (2023) Lesson 33: A Critical Appraisal of the 2021 AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction

Now in its 42nd installment, the AUA Update Series is renowned for delivering high-quality lessons to practicing urologists, fellows and residents. All content is developed by internationally recognized experts in urology, making the AUA Update Series the most professional and sought-after self-study program available. Improve your practice and patient care by staying abreast of the latest treatments and surgical techniques in urology.

For more information, please visit the AUA Update Series on the AUAUniversity: auau.auanet.org/update23

Disparities in Care and Barriers to Access for Patients with Advanced Prostate Cancer

CME Available: https://auau.auanet.org/node/39088

Release Date: October, 2023

Expiration Date: October, 2024

At the conclusion of these activities, participants will be able to:

1. Recognize current patterns of use for systemic therapies in patients with advanced prostate cancer.

2. Identify disparities in access to care with respect to advanced prostate cancer treatment (ie. race, geography, socioeconomics).

3. Understand opportunities to improve quality and compliance with ADT treatment across different treatment populations.

4. Appreciate financial challenges that may be associated with current therapy options for advanced prostate cancer.

5. Apply treatment approaches that improve patient adherence to ADT including use of oral and parenteral therapies.

ACKNOWLEDGEMENTS:

This series is supported by independent educational grants from:

Myovant Sciences LTD

Pfizer, Inc.

REFERENCES:

Benjamin, D.J., Shrestha, A., Fellman, D. et al. Hormonal treatment for newly diagnosed metastatic prostate cancer: a population-based study from the California cancer registry. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00732-9

Cortese BD, Dusetzina SB, Al Hussein Al Awamlh B, Penson DF, Chang SS, Barocas DA, Luckenbaugh AN, Scarpato KR, Moses KA, Talwar R. Estimating the Impact of the Inflation Reduction Act on the Out-of-Pocket Costs for Medicare Beneficiaries With Advanced Prostate Cancer. Urol Pract. 2023 Sep;10(5):476-483. doi: 10.1097/UPJ.0000000000000425. Epub 2023 Jul 3. PMID: 37409930.

Systemic Therapies for Advanced Prostate Cancer – Short and Long-Term Side Effects

CME Available: https://auau.auanet.org/node/39087

Release Date: October, 2023

Expiration Date: October, 2024

At the conclusion of these activities, participants will be able to:

1. Characterize current treatment paradigm for systemic therapies in managing advanced prostate cancer including doublet and triple therapy.

2. Identify short and long-term side effects of ADT and novel hormonal treatments for advanced prostate cancer including cardiovascular, bone health, and metabolic risk.

3. Recognize strategies to monitor and manage side effects of ADT and novel hormonal treatments.

4. Understand adverse effects of newer agents for advanced prostate cancer including PARP inhibitors, immunotherapy, and theranostics.

5. Review management options for adverse effects of newer agents for advanced prostate cancer.

This series is supported by independent educational grants from: 

Myovant Sciences LTD

Pfizer, Inc.

REFERENCES:

1. Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA 2011;306:2359-2366.

2. NCCN Guidelines for prostate cancer. Version 4.2023. www.nccn.org

3. Lowrance W, Dreicer R, Jarrard DF, et al. Updates to advanced prostate cancer: AUA/SUO guideline (2023). J Urol. 2023;209(6):1082-1090.

Genetic Testing and Stone Disease

Co-host: Kyle Wood, MD

Population analysis demonstrated that genetic conditions resulting in stone disease are magnitudes higher than those seen in clinical cohorts, suggesting underdiagnosis. Urologist play a unique role as we often times have many touch points with these patient given their presentation for stone disease. With the advancement of treatments, specifically in primary hyperoxaluria, it is essential that urologist play a more active role in the earlier diagnosis of patients. Genetic testing has become readily available at lower cost and much of the perceived barriers to genetic testing are addressed by current available programs.

Outline:

1. The contribution of genetics to kidney stone disease

2. Specific studies using genetic testing

3. Primary Hyperoxaluria as an example

4. Current Genetic Testing and Ease

5. The role of the Urologist

References:

- Hill AJ, Basourakos SP, Lewicki P, et al. Incidence of kidney stones in the United States: The Continuous National Health and Nutrition Examination Survey. J Urol. 2022;207(4):851-856.

- Singh P, Harris PC, Sas DJ, Lieske JC. The genetics of kidney stone disease and nephrocalcinosis. Nat Rev Nephrol. 2022;18(4):224-240.

- Goldfarb DS, Fischer ME, Keich Y, Goldberg J. A twin study of genetic and dietary influences on nephrolithiasis: a report from the Vietnam Era Twin (VET) Registry. Kidney Int. 2005;67(3):1053-1061.

- Daga A, Majmundar AJ, Braun DA, et al. Whole exome sequencing frequently detects a monogenic cause in early onset nephrolithiasis and nephrocalcinosis. Kidney Int. 2018;93(1):204-213.

- Braun DA, Lawson JA, Gee HY, et al. Prevalence of monogenic causes in pediatric patients with nephrolithiasis or nephrocalcinosis. Clin J Am Soc Nephrol. 2016;11(4):664-672.

- Halbritter J, Baum M, Hynes AM, et al. Fourteen monogenic genes account for 15% of nephrolithiasis/nephrocalcinosis. J Am Soc Nephrol. 2015;26(3):543-551.

- Knoers N, Antignac C, Bergmann C, et al. Genetic testing in the diagnosis of chronic kidney disease: recommendations for clinical practice. Nephrol Dial Transplant. 2022;37(2):239-254.

- Groothoff JW, Metry E, Deesker L, et al. Clinical practice recommendations for primary hyperoxaluria: an expert consensus statement from ERKNet and OxalEurope. Nat Rev Nephrol. 2023;19(3):194-211.

- van der Hoeven SM, van Woerden CS, Groothoff JW. Primary hyperoxaluria type 1, a too often missed diagnosis and potentially treatable cause of end-stage renal disease in adults: results of the Dutch cohort. Nephrol Dial Transplant. 2012;27(10):3855-3862.

- Hopp K, Cogal AG, Bergstralh EJ, et al. Phenotype-genotype correlations and estimated carrier frequencies of primary hyperoxaluria. J Am Soc Nephrol. 2015;26(10):2559-2570.

- Garrelfs SF, Frishberg Y, Hulton SA, et al. Lumasiran, an RNAi therapeutic for primary hyperoxaluria type 1. N Engl J Med. 2021;384(13):1216-1226.

- Baum MA, Langman C, Cochat P, et al. PHYOX2: a pivotal randomized study of nedosiran in primary hyperoxaluria type 1 or 2. Kidney Int. 2023;103(1):207-217.

- Soliman NA, Nabhan MM, Abdelrahman SM, et al. Clinical spectrum of primary hyperoxaluria type 1: Experience of a tertiary center. Nephrol Ther. 2017;13(3):176-182.

- Schonauer R, Scherer L, Nemitz-Kliemchen M, et al. Systematic assessment of monogenic etiology in adult-onset kidney stone formers undergoing urological intervention-evidence for genetic pretest probability. Am J Med Genet C Semin Med Genet. 2022;190(3):279-288.