The past 20 years have witnessed a wide range of changes affecting the treatment of patients with prostate cancer. Classification of disease, genomic profiling, chemotherapy regimens, and surgical improvements have improved outcomes for patients and provided clinicians with numerous options for treatment. “It’s been amazing to see the advances that have really revolutionized the field of prostate cancer care,” said Nicholas J. Vogelzang, MD, FASCO, FACP, associate chair of the Genitourinary (GU) Committee for US Oncology Research and vice chair of the GU Committee for SWOG, a worldwide network of investigators who design clinical trials.

, Vogelzang, who is also a medical oncologist with Comprehensive Cancer Centers of Nevada, Las Vegas, and a 2018 Giants of Cancer Care

 awardee, discussed groundbreaking developments that have transformed the treatment of prostate cancer, as well as current issues in urology.

The ability to subdivide prostate cancer into types of disease has made matching patients with treatments easier, and refinements in testing have facilitated this, Vogelzang said. Genomic tests, especially, have improved patient selection, although much remains to be understood about the significance of genetic biomarkers and how they should be addressed.

Refinements in hypofractionation, involving higher doses of radiotherapy over a shorter period, and robotic surgery, which provides for minimally invasive work with the dexterity of a human hand, are 2 enormous advances in the field of prostate care. “Radiation has shown us that shorter hypofractionation can be safely and effectively given, shaving weeks off what used to be an 8 or more-week treatment course, which now can be given in just 5 weeks and, in some cases, as little as 5 days. It is a major shift toward more efficient treatment for patients who need radiation,” Vogelzang said.

Improved screening has saved many men the hardships of unnecessary treatment, although confusing standards have complicated the picture. Much remains to be understood about the role of prostate-specific antigen (PSA) testing. Screening recommendations from the US Preventive Services Task Force have at times caused more hardship, not less, Vogelzang said. More refinement of these guidelines is needed, particularly for African American men, who are in a high-risk category, he said.

The emergence of androgen pathway drugs that stall hormone production, a source of fuel for cancer, represents a major advance over the past 10 years.

Chemotherapy in metastatic and hormone-sensitive disease was initially thought to be ineffective, but that has largely proved untrue, Vogelzang said. In addition, “it seems there is a benefit to chemotherapy in earlier stages of prostate cancer, although that is hotly debated and not yet finalized.”

With all these developments, the treatment of prostate cancer and, more broadly, all urologic cancers has become an intensely complex medical science demanding a high degree of specialization and training, Vogelzang said. For this reason, he is leery of the trend toward bringing immunotherapy and targeted therapy into urologic practices, unless these doctors have the resources and expertise necessary to fully grasp the essentials of such advances. That said, exciting developments are emerging in clinical trials that should interest urologists. One of these is the use of radioligand therapy with 177Lu-PSMA-617 in the VISION trial (NCT03511664) for the treatment of metastatic castration-resistant prostate cancer, Vogelzang noted. In addition, the approval of darolutamide augments the palette of androgen antagonists, although this shows little advantage over existing drugs in its class, and the challenge for oncologists will be to correctly select from this group, he said.

 What have been the major changes in the treatment of prostate cancer in recent decades?

: I think the most important thing is the breaking down of prostate cancer into multiple subsets of disease by either genetic or histologic subsets. The most helpful has always been the Gleason score, and that’s always been around, but I don’t think people appreciated how important the Gleason score was when it was developed.

The second major advance was the introduction of genomic profiles. Essentially, what they do is further subdivide prostate cancer. If you look at a patient with Gleason scale grade 2 or grade 1 prostate cancer, and then you do a genetic panel, suddenly you find their cancer has a worse genetic profile. These tests have been helpful and are becoming widely used.

Next is 3 Tesla [3T] magnetic resonance imaging [MRI], which has given us a whole new window into the world of prostate cancer. You can now see the lump or mass and determine whether it is in the prostate or outside and see its size. [The 3T MRI] has really given a big impetus to the field of active surveillance; if you have a patient with a grade 1 Gleason score and the MRI shows no cancer, that is a very good thing. Some clinicians still do the genomic profiling to make it even clearer. There are hundreds of thousands of men who have been saved the toxicity of radiation or surgery because of these tests. Now, many times, the insurance companies are still not paying for these tests, so that is still a barrier, but they have made a big impact on a broad population of patients.

Number 4 is the genetics of the cancer itself—looking at the specific genetics of 

, all these various genes—and right now we don’t have exact knowledge as to what they mean. But these data are very helpful when patients have metastatic disease; it can be treated with PARP inhibitors. This has implications also for the family. We have these great stories where a genetic abnormality is picked up, and we tell the patients to go talk to their family, and lo and behold, someone in the family is given a diagnosis of early-stage breast cancer or discovers an early malignancy like a melanoma.

In addition to the advantages of hypofractionation, there have been improvements in surgery. Surgery has really moved, to a large extent, to the robot. Robotic surgery has made life much easier for the patient, and although it’s more expensive, it has reduced the length of stay, reduced the need for blood transfusions, reduced postoperation complications, and, across a wide variety of operative indications, improved outcomes for patients.

The treatments for metastatic disease have focused on the androgen receptor pathway. The past 10 years have brought us abiraterone [Zytiga], enzalutamide [Xtandi], and now apalutamide [Erleada]. These drugs are highly effective, and they are based on the discovery that prostate cancer was being driven by its own perpetual motion machine, producing its own male hormones.

We have known for many years that prostate cancer is dependent upon male hormones, dating back to the Nobel Prize [in Physiology or Medicine] given to Charles Huggins [in 1966], but we did not know that prostate cancer was making its own food.

More than 20 years ago, there was broad pessimism about the role of chemotherapy in prostate cancer. In fact, in 1988 a number of papers were written saying that chemotherapy had no role in the treatment of prostate cancer. Well those papers were completely incorrect, and chemotherapy, particularly the taxane-based therapies, docetaxel and cabazitaxel [Jevtana], has a role in the treatment of metastatic disease. Docetaxel also has a role in the treatment of hormone-sensitive disease.

Chemotherapy’s role in prostate cancer is not as defined as the role of adjuvant chemotherapy in breast cancer or colon cancer, but work is under way, and it seems there is a benefit to chemotherapy in earlier stages of prostate cancer, although that is hotly debated and not yet finalized.

Another big advance has been in the treatment of hormone-sensitive prostate cancer. [Results of] the CHAARTED study [NCT00309985] showed that chemotherapy [docetaxel] when added to leuprolide [Lupron] or an LHRH [luteinizing hormone-releasing hormone] agonist improved overall survival in men in certain highrisk categories. Then came STAMPEDE [NCT00268476], and those results showed the same, as well as showing that [the combination] worked in all subsets of hormonesensitive disease, not just a high volume. And then a French study, which was previously thought to be negative, called GETUG-13 [NCT00104676] was reanalyzed and did in fact show the same trend, namely a trend in favor of chemotherapy for high-volume disease. These moved chemotherapy earlier into the treatment.

[These data] have presented patients with sometimes very difficult choices. Do they take chemotherapy, which is short but has toxicity, or pills, which are very expensive and have to be given for long periods of time?

Results of one important study showed that cabazitaxel compared with docetaxel was equally effective and less toxic. A lower dose [of cabazitaxel] could be given, and in fact, cabazitaxel doesn’t cause hair loss, which is a quality- of-life issue.

Where are we missing things? We’re missing in patients who become refractory to taxanes and who become refractory to enzalutamide and abiraterone. We did have 1 glimmer of hope in more advanced disease with radium 223 [Xofigo]. Radium 223 showed a survival advantage for that population, so it is a major life extender and improves quality of life. And we do have drugs beyond the hormones, the pills, and the chemotherapy, and those include sipuleucel-T [Provenge].

How reliable are current standards for PSA testing?

PSA is an enormous help in both early- and late-stage disease. The unfortunate problem is that it is not able to distinguish among grade groups 1 to 5, so there was widespread testing. Many people underwent surgery and radiation, somewhat needlessly. The US Preventive Services Task Force discouraged the use of PSA for prostate cancer screening [in 2012], and that was a complete overreaction and led to an increase in the rate of prostate cancer cases diagnosed in advance stages, a decrease in the use of surgery and radiation, and an increase in death rates.

The US Preventive Health Services Task Force then said you should discuss testing with a patient, but at least they said you should test. They did not [address testing in] African American patients, who have a much more aggressive type of cancer and a higher rate of grade group 5 or 4. I don’t think we have solved the problem of what is the right test at the right time for the right patient.

Are urology practices the right setting for delivery of immunotherapy and targeted therapy?

This is a field for specialists; it’s not a field for generalists. More and more, at our practice in Nevada, the urologists are referring patients with prostate [cancer to us] right away. Just as breast cancer has moved toward specialization, there are now specialists in prostate cancer. And that trend will only continue.

Our group has 2 full-time medical oncologists out of 34 who focus mostly on prostate cancer and other GU cancers. That same trend is occurring in urology. One difficulty is that urologists also have to perform robotic prostatectomies, so some urology groups have focused on the surgeon becoming the only robot specialist. Other groups, if they are large enough, have added a doctor or two for the nonsurgical approach, and that is laudable, but many times it pulls that urologist in many different directions. He or she is then meant to be a surgeon specializing in robotic surgery, spending many hours in the operating room, in addition to dealing with all the complexities of hormone therapy, chemotherapy, and immunotherapy. And I don’t know whether that’s feasible, honestly.

I view the field as breaking down into highly specialized urologic surgeons who perform robotic [procedures] almost exclusively and then a subset of urologists who deal with advanced metastatic disease. I think these fault lines are only going to continue to be accentuated and some urologists are going to try to do a little bit of both and be more like general medical oncologists. They may find themselves not fully prepared for the complexities that they’re [going to] face.

What developments should urologists pay attention to right now?

I think the VISION trial [NCT03511664] is most exciting.

There is also a series of new radioactive substances. Lutetium-177 for prostate cancer is the first, and there are others coming down the pike, but they’re years away. So right now, we have just radium, and, hopefully, we’ll have lutetium-177, and those will be the maximum that we can expect in the near term.

Articles

Nicholas J. Vogelzang, MD, FASCO, FACP, discusses groundbreaking developments that have transformed the treatment of prostate cancer, as well as current issues in urology.

Vogelzang Highlights Decades of Innovation in Prostate Cancer

For close to 62 years, I have managed to stay healthy enough to keep clear of being on the receiving end in the operating theater. My hopes were to be that rare individual who went through life never having to see the sharp end of a Bard-Parker scalpel. That fantasy is about to come to an abrupt end, as I am scheduled to undergo a total hip replacement to eliminate this unrelenting pain that has plagued me now for 5 weeks, despite many temporizing maneuvers. Through it all, I have gained some valuable insights I thought worth sharing.

In both medical school and my first 2 years of general surgical practice pre-urology, I never had an orthopedic rotation. I knew the musculoskeletal system and the anatomy, had learned enough to talk competently with the ortho residents when evaluating patients during my emergency department rotations, but had never learned, per se, how patients present with early-stage disease. Now looking through the retrospectoscope with 20/20 vision, I more than likely had been having very early symptoms of osteoarthritis over the past 2 years but never comprehended it. Because I was not experiencing pain, I attributed the “tightness” in my hip to not stretching my hip flexors. Had I recognized that some of these early symptoms were true indications of progressive disease, been more proactive, and not waited for pain to determine when to finally seek treatment, I might have staved off for a few more years the destruction of my joint, although I certainly would have averted these 5 weeks of misery and inactivity. This is exactly the sin we commit when evaluating our patients with advanced prostate cancer. We disregard or minimize minor symptoms, attributing them to “other” causes and wait for patient-reported pain to signal the time for action. The result is often a critical delay in the diagnosis of metastatic disease and possibly the loss of that window for certain treatments to be efficacious.

In preparation for my procedure, I became a patient and a consumer for the first time. Once I'd made the decision to move forward and proceed with surgery, imagine my dismay when forced to give the exact same information to 3 distinct factions that would be integral to my case: the surgeon, the anesthesiologist, and the hospital. Yes, I was able to provide the information over the phone or in a centralized setting. But despite the billions of dollars spent in the conversion to a digital healthcare record over the past couple of decades, I found the process of repeatedly exchanging information highly frustrating. How much have we truly advanced if it seems that even basic information is not shared or transportable? Perhaps I expect too much.

But along this journey from diagnosis to treatment decision making, a couple of things happened that validated what many of us have advocated in the management of our patients with cancer.

Like many of us in the field, and given the quasi-acute onset of my symptoms, I was able to bypass the normal process for consultation. I called an orthopedic colleague to work me in for an immediate office visit, an evaluation, and a working diagnosis. After unsuccessful attempts to eradicate my pain, the recommendation was for hip arthroplasty via an anterior approach. Being the consummate consumer, I sought a second opinion from another colleague in a different practice, who concurred. To my satisfaction, both encouraged me to see a third provider—another colleague. This was a former student and a partner in yet a third, distinct practice who had performed a much higher volume of anterior replacements than anyone in the city.

After consultation and, dare I say, “shared decision making,” I accepted the fait accompli of needing a bionic hip. I was then routed into a joint replacement “center of excellence.” In my opinion, this moniker is thrown around quite loosely, and practices and hospitals slap it on just about anything in a ploy to attract patients. However, from the moment I initiated the process, the care provided truly was comprehensive, dedicated to an optimal outcome, and a model for all of us to follow. I was assigned a nurse navigator, who coordinated my imaging and lab work and scheduled my operating room (OR) time and subsequent physical therapy appointments. In addition, she arranged meetings with physical therapy, occupational therapy, anesthesia, their dedicated hospitalist, and my surgeon’s physician assistant, who provided the bulk of the education, both what to do and expect pre- and post op. But perhaps more important, they have a 10-room OR that is dedicated to joint replacements with dedicated anesthesia staff, as well as a post-op floor. Dear to my heart, they asked me to participate in their health economics and outcomes research study, which is tracking all their patients and looking at multiple parameters. This all took place in a window of 4 hours, 7 days prior to surgery!

I am hoping the denouement will fulfill my expectations for a quick return to normal activity. But seeing this process now firsthand, it appears that once again, we as urologists can learn from our colleagues in other specialties how to advance and optimize care. Clearly, the volume of patients we manage could benefit from this model of efficiency, which could be realized if we allow physicians and partners to manage what they are passionate about. We should not be afraid to defer to those with expertise or to make patient-centered outcomes and protocols the centerpiece of how we deliver care.

My hopes were to be that rare individual who went through life never having to see the sharp end of a Bard-Parker scalpel. That fantasy is about to come to an abrupt end.

When Physician Becomes Patient, Valuable Lessons Emerge

Sipuleucel-T (Provenge) received an FDA approval in 2010 and a subsequent CMS coverage decision in 2011. At Lancaster Urology in Pennsylvania, we began infusing sipuleucel-T in 2011, and at the 7-year mark, we conducted a review to evaluate these first years of therapy. We had complete information on 94 patients.

Sipuleucel-T is for first-line therapy for men with metastatic castration-resistant prostate cancer (mCRPC) who are asymptomatic or have minimal symptoms, and it is now incorporated into treatment guidelines issued by the American Urological Association, European Association of Urology, and National Comprehensive Cancer Network.

 excluded men with visceral metastasis, although the guidelines now recommend sipuleucel-T for this population. Many papers have been written since the agent’s 2010 approval, but the patient cohorts have tended to be small. In addition, papers have tried to address the plethora of new treatments and how they might be best sequenced, layered, and used cost-effectively.

 This review was undertaken to see how our practice has addressed all this information in the management of men with mCRPC. In addition, we hoped to gain insights into our survival outcomes.

Table 1. Survivorship Following Treatment With Sipuleucel-T

We reviewed all patients treated with sipuleucel-T over a 7-year period at a busy community urology practice. The patients were categorized by year of sipuleucel-T treatment, prostate-specific antigen (PSA) at time of therapy, subsequent therapies, and overall survival. As 

 illustrates, most of these men were alive at the time of this review. The median age was 74. Roughly 70% of men with a PSA <22.1 were alive at the time of this review.

The majority received sipuleucel-T in the past 4 years, partly because of an improved understanding of the optimal patient for this therapy (

). Although survival appears shorter in recent years, the majority of men treated since 2016 were alive at the time of this review (

). The patients were placed into PSA quartiles, as previously described from the original trials.

 Again, the majority of men in the favorable lowest quartile remained alive at the time of this review.

Finally, we addressed the addition of other therapies and their impact on overall survival. Most men went on to receive additional therapies. At the time of this review, several patients were still on their first or second therapy following sipuleucel-T.

Table 3. Survival Results According to PSA Quartiles

The incorporation of sipuleucel-T in the management of mCRCP has gradually changed in our practice since the agent received FDA approval, and its use continues to rise. Because we are seeing stage migration in prostate cancer, as are others,

 we feel the incidence of metastatic prostate cancer will continue to increase. The first article to better address the timing of sipuleucel- T came from Schellhammer et al.

 The authors looked at the original pivotal trials with sipuleucel-T and found that the PSA level at treatment was exceedingly important. They sorted patients into quartiles based on PSA at the time of sipuleucel-T administration. The hazard ratio for those patients with a PSA <22.1 (the lowest quartile) was a striking 0.51 compared with a PSA >134 (highest quartile) hazard ratio of 0.84. This translated into a median survival improvement of 13 months for the lowest quartile. In addition, performance status, increased tumor burden, and PSA doubling time appear to predict for more rapid deterioration after sipluleucel-T.

 Thus, we have moved to earlier administration of sipuleucel-T in regard to PSA at time of administration, more prolonged PSA doubling times, and better performance status. These 3 factors are helpful in identifying the ideal patient for immunotherapy with sipuleucel-T. It is encouraging that we are seeing longer survivals post administration of sipuleucel- T, as this lends credence to these measures for patient selection.

The majority of patients receiving sipuleucel-T have also gone on to 1 or more therapies. Both timing and layering have continued to evolve,

 but this has not been without setbacks. The first trials combining radium-223 (Xofigo) and abiraterone (Zytiga) versus radium-223 alone were halted and led to a warning from the manufacturer against combination therapy after an increase in bone fractures and deaths was noted in the combination arm of the study.

 Multiple studies have been completed and are ongoing looking at combination therapy with sipuleucel-T. Small et al looked at the combination with abiraterone and found no evidence of vaccine production interference as measured by cumulative antigen presenting cells number and total nucleated cell counts. Additional endpoints included in vivo peripheral immune responses to sipuleucel-T (T-cell responses, T-cell proliferation, humoral responses, and antigen spread) suggested no interference from concurrent use of abiraterone acetate plus prednisone.

 Scholz et al have looked at adding additional immunotherapy with ipilimumab with some success.

 Finally, Antonarakis et al have looked at administration of sipuleucel-T prior to androgen deprivation therapy in men. with biochemically recurrent prostate cancer who are at high risk for metastasis.

Present guidelines suggest the sequential use of agents post sipuleucel-T. Our experience with sequential therapy has been very positive, with most patients having received multiple therapies. Many of our patients have received sipuleucel-T in the past 3 years and are only on their first or second subsequent therapies, and we assume most will receive second and third, even fourth, lines of therapy. We have already noted that patients who receive multiple lines of therapy seem to have the longest survival. We hope to see ongoing extensions in survival as we move to the ideal patient for sipuleucel-T and better understand how to sequence the multiple options now available. Most likely, this will continue to rapidly evolve with the multitude of new agents being tested in castration-resistant cancer.

The management of mCRPC continues to evolve. As we continue to add new agents, new ideas about the sequencing and of layering of therapies will undoubtedly develop. We have seen our early findings with sipuleucel-T appear consistent with what other authors have reported. We are seeing median survivals for patients with mCRPC extending well beyond the results of multiple single-agent clinical trials

We continue to follow the current guidelines, placing sipuleucel-T first in the treatment algorithm in asymptomatic patients with mCRPC. We believe we have been successful in identifying the optimal patient for immunotherapy. The use of additional layers of therapy is now routine and most likely will continue to evolve, hopefully, with the addition of new novel agents.

NCCN Clinical Practice Guidelines in Oncology—Prostate Cancer. Version 2.2019. National Comprehensive Cancer Network website. nccn.org/ professionals/physician_gls/pdf/prostate_blocks.pdf. Updated April 24, 2019. Accessed July 24, 2019.

Castration-resistant prostate cancer (2018). American Urological Association website. auanet.org/guidelines/prostate-cancer-castration-resistant- guideline. Published 2013. Updated 2018. Accessed July 24, 2018.

Cornford P, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIUG guidelines on prostate cancer. part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. 

. 2017;71(4);630-642. doi: 10.1016/j.eururo.2016.08.002.

Kantoff P, Higano CS, Shore ND, et al; IMPACT Study Investigators. Sipuleucel- T immunotherapy for castration-resistant prostate cancer. 

. 2010;363(5):411-422. doi: 10.1056/NEJMoa1001294.

Crawford ED, Petrylak DP, Shore N, et al; Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR II) Group. The role of therapeutic layering in optimizing treatment for patients with castration-resistant prostate cancer (prostate cancer radiographic assessments for detection of advanced recurrence II). 

. 2017;104:150- 159. doi: 10.1016/j.urology.2016.12.033.

Zheng H, Chen J, Qiu W, et al. Safety and efficacy of first-line treatments for chemotherapy-naïve metastatic castration-resistant prostate cancer: a systematic review and indirect comparison. 

. 2017;3941217. doi: 10.1155/2017/3941217.

Grochtdreis T, König HH, Dobruschkin A, von Amsberg G, Dams J. A cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: a systematic review. 

. 2018;13(12):e0208063. doi: 10.1371/journal.pone.0208063.

Nuhn P, De Bono J, Fizazi K, et al. Update on systemic prostate cancer therapies: management of metastatic castration-resistant prostate cancer in the era of precision oncology. 

. 2019;75(1):88-99. doi: 10.1016/j. eururo.2018.03.028.

Schellhammer P, Chodak G, Whitmore JB, Sims R, Frohlich MW, Kantoff PW. Lower baseline prostate-specific antigen is associated with a greater overall survival benefit from sipuleucel-T in the Immunotherapy for Prostate Adenocarcinoma Treatment (IMPACT) trial. 

. 2013;81(6):1297- 1302. doi: 10.1016/j.urology.2013.01.061.

Caram M, Estes J, Griggs JJ, Lin P, Mukherjee B. Temporal and geographic variation in the systemic treatment of advanced prostate cancer. 

. 2018;18(1):258. doi: 10.1186/s12885-018-4166-3.

Reese AC, Wessel SR, Fisher SG, Mydlo JH. Evidence of prostate cancer “reverse stage migration” toward more advanced disease at diagnosis; data from the Pennsylvania Cancer Registry. 

. 2016;34(8):335. e21-8. doi: 10.1016/j.urolonc.2016.03.014.

Wei XX, Perry J, Chang E, et al. Clinical variables associated with overall survival in metastatic castration-resistant prostate cancer patients with sipuleucel-T immunotherapy. 

. 2018;16(3):184-190.e2. doi: 10.1016/j.clgc.2017.12.004.

Bilen M, Hess K, Subudhi SK, et al. Clinical predictors of survival in patients with castration-resistant prostate cancer receiving sipuleucel-T cellular immunotherapy. 

. 2017;80(3):583- 589. doi: 10.1007/s00280-017-3391-9.

Smith M, Parker C, Tombal BF, et al. ERA223: a phase 3 trial of radium-223 dichloride in combination with abiraterone and prednisone in the treatment of asymptomatic or mildly symptomatic chemotherapy-naïve patients with bone dominant metastatic castration-resistant prostate cancer. 

. 2017;34(suppl 15). doi: 10.1200/JCO.2016.34.15_suppl.TPS5088.

Small E, Lance R, Gardner TA, et al. A randomized phase II trial of sipuleucel- T with concurrent versus sequential abiraterone acetate plus prednisone in metastatic castration-resistant prostate cancer. 

. 2015;21(17):3862-3869. doi: 10.1158/1078-0432.CCR-15-0079.

Scholz M, Yep S, Chancey M, et al. Phase I clinical trial of sipuleucel-T combined with escalating doses of ipiluminab in progressive metastatic castrate-resistant prostate cancer. 

. 2017;6:11-16. doi: 10.2147/ITT.S122497.

Antonarakis ES, Kibel AS, Yu EY, et al; STAND Investigators. Sequencing of sipuleucel-T and androgen deprivation therapy in men with hormone-sensitive biochemically recurrent prostate cancer: a phase II randomized trial. 

. 2017;23(10):2451-2459. doi: 10.1158/1078-0432. CCR-16-1780.

Sipuleucel-T received an FDA approval in 2010 and a subsequent CMS coverage decision in 2011. At Lancaster Urology in Pennsylvania, we began infusing sipuleucel-T in 2011, and at the 7-year mark, we conducted a review to evaluate these first years of therapy.

August 2019 | Oncology Live Urologists in Cancer Care®

Vogelzang Highlights Decades of Innovation in Prostate Cancer

When Physician Becomes Patient, Valuable Lessons Emerge

Where Sipuleucel-T Fits in the Treatment of mCRPC