PSMA: a game changer in the diagnosis and treatment of advanced prostate cancer.

Although management of advanced prostate cancer is evolving, a lot of work remains to be done for patients who have exhausted all options. Molecular targeting of prostate specific membrane antigen (PSMA) is valuable not only for diagnostic but also for therapeutic reasons. PSMA is thus considered to be useful in a theranostic approach. PSMA scans are upcoming diagnostic modalities which detect metastatic lesions that are missed by conventional imaging modalities. PSMA ligand therapy is also an upcoming treatment modality that has been proven to be beneficial with minimal toxicity in patients with advanced prostate cancer that have progressed on prior therapy. In this review article, we summarize the current knowledge regarding PSMA diagnostics and PSMA ligand therapies and discuss their implication in the treatment of advanced prostate cancer.

Triple-arm androgen blockade for advanced prostate cancer: a review.

Prostate cancer is estimated to be the second most common malignancy in men in the USA in 2020 and represents the second highest mortality from cancer behind lung and bronchial neoplasms. Management of advanced prostate cancer is evolving. Medical androgen deprivation therapy is currently a cornerstone of therapy for prostate cancer; however molecular mechanisms of resistance have emerged leading to castration-resistant prostate cancer that is proliferation of prostate cancer in the setting of low testosterone (< 50 ng/dl). The benefit of double androgen blockade like ADT plus abiraterone acetate or androgen receptor blockers is proven in many clinical trials; however multiple mechanisms of resistance still exist. In theory, another layer of androgen blockade will prevent, or at least slow, prostate cancer proliferation. This direction of thought has recently been explored with multiple clinical trials. In this review article, we summarize the current knowledge regarding androgen resistance, newer androgen inhibition therapies, and the implications of a triple-arm anti-androgen blockade in advanced prostate cancer.

A Needle in the Haystack: A Rare Case of Spontaneous Tumor Lysis in Newly Diagnosed Chronic Lymphocytic Leukemia Unmasked by Acute Renal Failure.

Tumor lysis syndrome (TLS) is the phenomenon of metabolic derangements that typically follows the initiation of cytotoxic chemotherapy. Metabolic disturbances include hyperphosphatemia, hyperkalemia, hyperuricemia and hypocalcemia. Hematological malignancies are associated with spontaneous TLS (STLS), which is cell lysis in the absence of chemotherapy. STLS is extremely rare in chronic lymphocytic leukemia (CLL). This has been documented only once in the medical literature, making this an extraordinarily uncommon case. We present here a 68-year-old male with a history of benign prostatic hyperplasia (BPH) who is admitted for a two-week history of abdominal pain and three days of anuria, despite adequate fluid intake. Laboratory values yielded a greatly elevated leukocyte count with a lymphocytic predominance and smudge cells. Potassium, phosphorus, and uric acid were also significantly increased. EKG revealed peaked T-waves. Flow cytometry confirmed the presence of an abnormal B-cell population consistent with B-cell chronic lymphocytic leukemia, with the following markers: CD19+, CD20+, CD23+, CD5+, CD10-. He was diagnosed with CLL and treated with aggressive fluid resuscitation, allopurinol and rasburicase. The patient had another similar episode within one month. His CLL fluorescence in-situ hybridization (FISH) showed complex cytogenetics with unmutated IgVH and he was subsequently started on ibrutinib.

Evaluating the Industry Relationships of Presenting Physicians at the American Neurotological Society Spring Meetings.

OBJECTIVE: 1) Evaluate the accuracy of financial disclosures reporting by research presenters and moderators at the American Neurotology Society Spring meetings between 2014 and 2016. 2) Tabulate the reported monetary value of undisclosed financial relationships. 3) Determine the degree of compliance to the standards put forth by the Accreditation Council for Continuing Medical Education. STUDY DESIGN: Cross-sectional analysis. SETTING: N/A. PATIENTS: N/A. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: The number of undisclosed payments, the accuracy of reporting, and the value of undisclosed payments were measured to test the hypothesis. RESULTS: At the 2014 American Neurotology Society Spring Meeting, the organizers maintained a median amount of $950 and $6,525.89 for the presenters. 2015 showed a median amount of undisclosed payment of $7,134.74 for organizers and $12,256.46 for presenters. Likewise, 2016 showed a median of $4,165.14 in undisclosed payment for the organizers and $12,031.70 for the presenters. CONCLUSIONS: It is promising to see improvement in disclosure rates as organizers and presenters are effectively complying with the requirements set by Accreditation Council for Continuing Medical Education. However, there is a substantial difference in disclosures by the presenters group compared with the organizers. The presenters had more undisclosed financial relationships than the organizers and although, not all undisclosed financial relationships are actual conflict of interest, it is safer and better practice to avoid the potential for undisclosed conflict of interest altogether. Presenters should be encouraged to fully disclose all relationships in the manner that organizers are required to do so.