Re: Nicolas Mottet, Roderick C.N. van den Bergh, Erik Briers, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021;79:243-62: Comorbidity Measurement in Patients with Prostate Cancer

Identification of a high-risk immunogenic prostate cancer patient subset as candidates for T-cell engager immunotherapy and the introduction of a novel albumin-fused anti-CD3 × anti-PSMA bispecific design

BACKGROUND

Cancer immunotherapies such as bispecific T-cell engagers have seen limited adoption in prostate cancer (PC), possibly due to differing levels of cancer receptor expression and effector T-cell infiltration between patients and inherent defects in T-cell engager design.

METHODS

CD8⁺ T-cell infiltration and PSMA expression were determined by RNA sequencing of primary PC tissue samples from 126 patients with localised PC and 17 patients with metastatic PC. Prognostic value was assessed through clinical parameters, including CAPRA-S risk score. A panel of albumin-fused anti-CD3 ×  anti-PSMA T-cell engagers with different neonatal Fc receptor (FcRn) affinity were characterised by flow cytometry, Bio-Layer Interferometry and functional cellular assays.

RESULTS

A subset of patients with localised (30/126 = 24%) and metastatic (10/17 = 59%) PC showed both high PSMA expression and high CD8⁺ T-cell enrichment. The High/High phenotype in localised PC associated with a clinically high-risk cancer subtype, confirmed in an external patient cohort (n = 550, PRAD/TCGA). The T-cell engagers exhibited tunable FcRn-driven cellular recycling, CD3 and PSMA cellular engagement, T-cell activation and PSMA level-dependent cellular cytotoxicity.

CONCLUSION

This work presents an albumin-fused bispecific T-cell engager with programmable FcRn engagement and identifies a high-risk PC patient subset as candidates for treatment with the T-cell engager class of immuno-oncology biologics.

Prolonged Response with Enzalutamide in a Prostate Cancer Patient on Hemodialysis

Current therapies in oncology that offer a longer and better quality of life are leading to more cases where cancer and chronic diseases coexist. Enzalutamide, a second-generation anti-androgen agent, was approved by the US Food and Drug Administration (FDA) in 2012 for the treatment of metastatic castration-resistant prostate cancer (mCRPC). There is no series with many patients on the use of enzalutamide in patients with end-stage renal disease (ESRD). We present a patient diagnosed with mCRPC who was followed up with enzalutamide treatment for about 5 years after progression with docetaxel and who was on hemodialysis 3 days a week.

Diagnostic evaluation and incorporation of PSA density and the prostate imaging and data reporting system (PIRADS) version 2 classification in risk-nomograms for prostate cancer

PURPOSE

The diagnostic approach for prostate cancer still depends on PSA and DRE.

OBJECTIVES

to evaluate the diagnostic validity of PSA-Density and PIRADSv2 as diagnostic tests regarding biopsy results, and to design nomograms that include all diagnostic variables for malignancy, significant tumor (ST) and high-grade tumor.

METHODS

Cross-sectional study which included men with PSA ≥ 4 ng/ml and/or suspicious DRE, PIRADSv2 ≥ 3 lesions on multiparametric MRI and prostate biopsy. The gold standard test was the maximum ISUP of the targeted biopsy per patient (malignancy: ISUP ≥ 1, ST: ISUP ≥ 2, high-grade tumor: ISUP ≥ 4). Association and logistic regression tests were used and diagnostic validity parameters using PSA-Density and PIRADSv2 classification was analyzed. Nomograms were designed for malignancy, ST, and high-grade tumor using the best model selection procedure from all possible equations.

RESULTS

336 men with median age, PSA and PSA-Density of 67.7 years (IQR:12.6), 6.3 ng/ml (IQR:3.3) and 0.12 ng/ml/cc (IQR:0.10), respectively; 63 index lesions were PIRADS3, 204 PIRADS4, and 69 PIRADS5. 65.8% and 37.8% were malignant and ST, respectively. The significant positive association highlighted between malignancy and ST with age, DRE, PSA-Density and PIRADSv2. PSA-Density and PIRADSv2 ≥ 3 presented the highest sensitivity to detect malignancy, and their combination showed sensitivity nearly 95% (AUC:0.803). Nomograms for malignancy and ST included the variables age, DRE, PSA-Density, and PIRADSv2 with a sensitivity closely 91% (AUC:0.833), and a specificity of almost 85% for ST, exposing risk < 5% for ST when PSA-Density is < 0.15, not suspicious DRE and PIRADS3.

CONCLUSION

PSA-Density and PIRADSv2 classification in risk nomograms can provide highly relevant information to increase the accuracy in the diagnosis of PC and ST.

An Immune-Related lncRNA Signature to Predict the Biochemical Recurrence and Immune Landscape in Prostate Cancer

Purpose

This study aims to construct an immune-related signature to provide comprehensive insights into the immune landscape of prostate cancer, which can predict biochemical recurrence (BCR) and clinical treatment.

Methods

Based on The Cancer Genome Atlas (TCGA) dataset, a signature constructed by DEirlncRNAs pairs was determined. The receiver operating characteristic curve analysis, Kaplan-Meier analysis, nomogram, and decision curve analysis were used to analyze it. Then, immunophenoscore (IPS), immune cell infiltration, tumor mutation burden (TMB), and immune function were investigated. Finally, we evaluated the role of the signature in medical treatment.

Results

A signature constructed by 10 valid DEirlncRNAs pairs was identified in the training set and validated well in the testing and entire set. The signature was a reliable and independent prognostic indicator to predict the BCR of prostate cancer, which was better than the clinicopathological characteristics. After dividing the patients into low- and high-risk groups by median value, we found that the high-risk group had shorter BCR-free time and higher TMB levels. Furthermore, the high-risk group was negatively associated with plasma B cells and CD+8 T cells. IPS and immune functions, such as immune checkpoints and human leukocyte antigen, were significantly different between the two groups. Low-risk group was more sensitive to endocrine therapy and immunotherapy, while high-risk group was more inclined to targeted drugs. Both groups had their own sensitive chemotherapy.

Conclusion

We established a novel signature to predict BCR and validated its role in the immune landscape of prostate cancer, which could help patients receive personalized medical treatment.

Epithelial-Mesenchymal Transition in Docetaxel-Resistant Prostate Cancer

Castration-resistant prostate cancer (CRPCa) is an advanced stage of prostate cancer in which a tumour progresses even under androgen deprivation. Treatment alternatives for CRPCa remain very limited and mostly rely on docetaxel-based chemotherapy. Despite being shown to increase patients’ overall survival, docetaxel’s clinical efficacy is impaired by development of chemoresistance. Most patients do not respond to docetaxel treatment and even those initially responsive ultimately develop resistance. Recently, chemoresistance was found to be closely related to epithelial-mesenchymal transition (EMT), a process in which epithelial cells transition into a mesenchymal phenotype. In fact, EMT markers are overexpressed in prostate cancer and are correlated to a higher Gleason score. For this reason, new therapeutic strategies are being studied to inhibit this process in several cancers. However, the clinical usefulness of targeting EMT as a way to overcome docetaxel resistance in CRPCa is still questionable and suffers from some significant limitations. This review briefly summarises the most common mechanisms of EMT-induced chemoresistance and evaluates its use as a new approach to overcome docetaxel resistance in CRPCa.