Immune response to prostate-specific antigen, live birth rate adversely affected by increasing paternal age, comparison of treatment modalities for benign prostatic hyperplasia, understanding psychosocial and supportive needs following cystectomy
Researchers at the Icahn School of Medicine at Mount Sinai presented several landmark studies at the 2014 American Urological Association (AUA) annual meeting in Orlando, FL, including data on an immune response in prostate cancer tumors, effects of paternal age on stimulated insemination live birth rates, issues of sexual function after cystectomy and a comparison of modalities for the treatment of benign prostatic hyperplasia (BPH).
Meeting attendees were able to view a live 3-dimensional video feed of a robotic prostatectomy performed by Ashutosh K. Tewari, MBBS, MCh, Chairman, Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, who has performed over 5,500 robotic prostatectomies and is one of the world's foremost researchers and surgeons in this field.
Highlights of Mount Sinai research at AUA:
Sipuleucel-T-Induced Antigen Spread: Immune Response to Prostate-Specific Antigen Correlates with Improved Overall Survival Rates
Sipuleucel-T is an autologous cellular immunotherapy indicated for the treatment of asymptomatic metastatic castration resistant prostate cancer by inducing an immune response against prostatic acid phosphotase (PAP). Researchers including Simon J Hall, MD, Director of the Barbara and Maurice Deane Prostate Health and Research Center, Associate Professor, Urology, Icahn School of Medicine at Mount Sinai, sought to determine whether this treatment induced an immune response to other potential prostate cancer antigens such as PSA after treatment with sipuleucel-T and if this response was associated with enhanced overall survival. A total of 512 men were evaluated with 341 receiving sipuleucel-T and 171 in the control group. A subset of men treated with sipuleucel-T generated immune responses to several known prostate cancer antigens including PSA, PSMA and human kallikrien-2. In the case of PSA, a significant improvement in survival was noted for patients who generated antibodies against this antigen.
"The study data demonstrated that a subset of patients (30%) vaccinated against one specific antigen, PAP, develop immune response to other antigens; this antigen spread is associated with a profound enhancement of survival. This study thus demonstrates some of the complexities of immunotherapy in patients and serves as a backdrop for further studies to enhance anticancer immune therapies," said Dr. Hall.
This multi-center study included collaboration with Johns Hopkins University School of Medicine, Baltimore, MD; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of California, San Francisco, CA; Indiana University Simon Cancer Center, Indianapolis, IN; and University of Washington School of Medicine, Seattle, WA. Grant funding for this study was provided by the Dendreon Corporation, Seattle, WA.
Stimulated Intrauterine Insemination Live Birth Rates are Adversely Affected by Increasing Paternal Age
It is well established that increasing maternal age leads to a higher risk of infertility, miscarriage, and chromosomal defects in offspring. A research team at Icahn School of Medicine at Mount Sinai, led by Natan Bar-Chama, MD, Associate Professor, Urology and Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai sought to answer whether paternal age had a negative impact on the ability to reproduce and the rate of successful outcomes using stimulated intrauterine insemination (IUI). In the largest study of its kind, researchers retrospectively reviewed 18,806 IUI cycles from a single center from 2003-2011. Success rates were defined as live births rates. The mean maternal age in the cohort was 36.4 years and the mean paternal age was 38.4 years. The cumulative live birth rate was 23%. After adjusting for standard predictors of life birth, researchers observed a 20% decline in live births per decade of advanced paternal age.
"This study the largest of its kind to date, clearly demonstrates that advanced paternal age negatively impacts fertility outcomes in couples undergoing the most common form of assisted reproductive technologies; stimulated intrauterine inseminations," said Dr. Bar-Chama. "This effect is important for us to discuss with the couples we care for and will enable us to better counsel patients undergoing this reproductive treatment."
Comparison of Transurethral Resection of Prostate, Plasma Button™ Transurethral Vaporization of Prostate, Greenlight™ 180-W XPS Photoselective Vaporization of Prostate, and VersaPulse® 100-W Holmium Laser Ablation of Prostate
Benign prostatic hyperplasia (BPH) is a non-cancerous increase in the size and number of cells that make up the prostate. There are several surgical modalities used at Mount Sinai in the treatment of BPH. Michael A. Palese, MD, Director of Minimally Invasive Surgery, Associate Professor, Urology, Icahn School of Medicine at Mount Sinai, will lead one of the first comparisons of all four minimally invasive modalities for the treatment of BPH at a single institution.
"Our findings will help us select the optimal treatment for each patient. This research will provide a standard of care for the surgical treatment of BPH," said Dr. Palese.
Research on Addressing Needs of Patients Undergoing Cystectomy and Urinary Diversion
Understanding the unmet needs of cancer patients and survivors is a critical step in providing high quality care. Researchers at Icahn School of Medicine at Mount Sinai are conducting a study to examine the informational, psychosocial, and supportive care needs of patients with bladder cancer who have undergone cystectomy and urinary diversion across the disease trajectory (i.e. at time of diagnosis, following cystectomy, and during survivorship). Under the direction of Nihal Mohamed, PhD, Assistant Professor, Department of Urology, this research will provide vital insight to the patient's full spectrum of needs and information that will guide further enhancements of supportive care resources available for bladder cancer patients and survivors.
"Understanding the needs of our patients is pivotal to improving health outcomes and achieving patients' and families' satisfaction," said Mohamed.
A second study led by Nihal Mohamed, PhD, evaluates the impact of radical cystectomy on patients' quality of life, with a special focus on the sexual and urinary function. This research will help clinicians to better understand the emotional and psychosomatic aspects that influence patients' quality of life following radical cystectomy.