Issue #5
april, 2023


The Pulse of Oncology Compass

the last prostate
cancer taboos

How the Diagnosis Changed the Life of Actor/Model Urs Althaus
Prof. Dr. Mattei:
Operation Da Vinci
The Promise of
Radioligand Therapy
PD Dr. med. Omlin:
Sensitize Society

Focus Shifts in Metastatic Prostate Cancer Research – Stay Tuned!

«Having now added prostate cancer to the Oncology Compass platform will be helpful for oncologists everywhere.»
For decades, the only meaningful treatment for metastatic prostate cancer consisted of androgen deprivation. While initially very effective, the response was lost within a fairly short period of time leading to metastatic castration-resistant prostate cancer (mCRPC) and no treatment was available afterwards.

First meaningful progress was achieved by administration of docetaxel chemotherapy around 20 years ago. Over the coming years, the main research focus was on the mCRPC setting with the introduction of several effective and overall survival (OS) prolonging drugs including the androgen receptor pathway inhibitors (ARPI) abiraterone and enzalutamide, cabazitaxel chemotherapy and the radionuclide radium 223.

But soon, the focus shifted again towards metastatic hormone-sensitive disease (mHSPC) demonstrating huge OS benefits for early use of docetaxel and ARPI therapy. The excitement in the community was palpable and the benefit for patients could easily be seen in the daily clinic. However, despite all the benefit, mHSPC invariably changes into mCRPC and having used up some of the best options already, further treatment becomes difficult.

Now – in 2023 – we’re back to improvements in the mCRPC setting again, fortunately! Radioligand therapy with LuPSMA demonstrates OS benefit in different mCRPC settings and more recently PARP inhibitors appear to be beneficial not only to BRCA mutated patients. But more progress is needed to help improve the outcome for patients with mCRPC and we have to stay tuned for the next focus shift in prostate cancer.
PD Dr. med. Richard Cathomas
Co-head of Oncology/Hematology at the Kantonsspital Graubünden
The Taboo of Prostate Cancer: Threatened Masculinity
by Roland Schäfli
Head of Content at Capptoo AG
On his 60th birthday he said in an interview: «I believe in fate.» At that time he had no idea cancer was waiting around the corner. What lesson had fate planned for Urs Althaus? Today, at 66, he says in an interview with «Digest»: «Prostate cancer changed me.»
Althaus spent a large part of these 66 years in an industry of external appearances: as a model for Armani and Calvin Klein. As an agent for supermodels such as Kate Moss and Diane Kruger. As an action actor too, in testosterone-bursting films like «War Bus». Whoever wants to stay on top in this industry cultivates an image of vitality and health. «A word like cancer sticks with you,» Urs Althaus knows, «and an illness reduces the market value.» Illnesses are hushed up. Men keep prostate problems to themselves.

His managers also recommended not making the prostate surgery public. «Now I said to myself, offers for roles as hunky lovers won’t come anymore anyway, and if my story helps someone, then I’ll tell it.»
Swiss-born Urs Althaus, seen here modeling for Calvin Klein, was the first top black dressman. © Arthur Elgort
An accidental discovery
At the annual examination, his family doctor determined a PSA (Prostate-Specific Antigen) value of 6.4 ng/ml,  with a value above 4 ng/ml generally being considered to be elevated and to be clarified. However, the grey area is large. The urology examination at the canton hospital in Altdorf found no signs of cancer. The next examination, however, already showed a PSA value of 11.1 ng/ml – and this time the result was clear: prostate cancer. The Uro-Oncology Center at LUKS (Lucerne Cantonal Hospital), the cantonal hospital in Lucerne, is highly specialized in the treatment of prostate neoplasms.
«I didn’t want an operation»
Althaus often likes to let his gaze glance over Lake Uri, which for him has always been a primal force and is the origin of many Swiss legends. He grew up in Altdorf as the illegitimate child of a Swiss woman and a Nigerian medical student. He has returned to these roots after many busy years of wandering. As he aimlessly followed the shore on the day of his diagnosis, the mystical lake was churned up by the foehn. The irony suddenly became clear to the him: «I had survived my drug addiction. I hadn’t contracted AIDS in the years I’d been dating  men, while many of my friends died from it. Twice I’ve been seriously beaten up by neo-Nazis. And now I should die of cancer?».

According to current knowledge, lifestyle has an influence on the chances of surviving prostate cancer: smoking, eating and drinking habits. He didn’t think about that. «I didn’t want to regret anything.»

If the cancer cells could spread, it would usually be to the bones or lymph nodes. Fatally, he thought to himself: We all have to die. He had already lived the lives of three men, experienced all the ups and downs. «My record was balanced. That’s why I didn’t want to undergo surgery at first, nor did I want to expose myself to chemotherapy and radiotherapy.»
Today, Urs Althaus is also involved as a speaker for special endorsements and as a campaign ambassador. © Simon Michel
Man’s ego
Although he knew little about this cancer type and didn’t google it, he was aware that men fear the operation because it changes their sex life. And that it would not leave the man’s ego untouched. At a young age he played for FC Zurich (which would lead to the role of footballer Aristoteles in the still popular Italian cult film), and «if you stepped naked into the shower with the other men, then it was really important to compare to see if everything was in the right place.»
Because of such reservations, he asked his urologist flat out, how long he could survive without surgery.
Decision for radical prostatectomy
It took Urs Althaus a week to give his consent. He also came to the conclusion that the entire prostate should be removed. In a radical prostatectomy, the entire prostate and the surrounding lymph nodes are surgically removed – which leads to infertility. Nerves and blood vessels that supply the penis are important for the ability to have an erection are close to the prostate, which is why affected men are usually no longer able to have a spontaneous erection.

«My partner Esti and I talked quite openly about these consequences. She left the decision to me. Luckily all the doctors had a sense of humor, so we kept coming back to not interfering with the length of my weenie.»
Even more uncertainties
When setting the surgery date, the actor argued that it should take into account the starting date of the TV series «Oktoberfest: Beer & Blood» in June: so could he go under the knife in May? At LUKS he was told straight out: «We have a waiting list. If you want special treatment, you’d better have surgery in Dubai.»

Surprisingly, the desired date suddenly became a possibility, another operation got cancelled. «How spontaneous are you, Mr. Althaus?» He was very spontaneous – as long as he could still take up his invitation to Zurich’s Sechseläuten, because it only comes once in a lifetime! He knew LUKS from an earlier occasion: He was on the operating table with severe facial injuries, beaten up by racists. A double fracture of the jaw, the tongue sewn twice – a difficult operation, yet it maintained his ability to talk.

Now he re-entered LUKS at 6 o’clock in the morning, with the Sechseläuten under his belt. But instead of the expected urologist, a doctor appeared who introduced himself to him in broad Valaisian dialect as Agostino Mattei. «I’d like to exploit the rare opportunity to operate on Urs Althaus myself,» he explained. «Since Uri and Valais get along well, I immediately agreed,» Althaus recalls this first encounter.
Breakthrough part  in 1986’ as a monk whose murder is investigated by Sean Connery. «The Name of the Rose»  grossed 77 millions worldwide. © Althaus Medien
«You are healed»
The next time he saw Mattei during the chief physician’s visit, he was surrounded by half a dozen doctors who respectfully addressed him as «Herr Professor». «It was only then that it dawned on me that I was lucky enough to have been operated on by a luminary in this field and a pioneer of the robot-assisted keyhole-surgery!»

The chief physician of the urology clinic was able to explain to him that the operation went well: «He thought I was still too young to lose my fertility.» And so he told his patient that he had removed all of the cancer – 17 different cancer foci – but not the entire prostate, which meant that chemotherapy and radiation therapy were no longer necessary.

After five days he was discharged from the hospital. He was able to start filming the German TV-series in Prague.
«My managers advised me not to publicize the cancer. They also didn’t want to take any risks with the insurance, it was an expensive production.»
The shame of incontinence
During the filming he had to wear diapers. «I only confided in the makeup artist.» What does that do to a man’s pride? «A very central question,» Althaus thinks, because «as a black man you always have this image of potency, we are often asked whether we are really that well endowed. We are – wrongly – considered stereotypes of sexuality.» That's a cliché that Urs Althaus would have liked to have done without all his life – and that now weighed on him even more.

«No one should know about my surgery. I didn’t want people to see me in this condition.»

Every second man subsequently has problems with incontinence. But even this was spared him in the long term.

When he was still on the cat walks for top designers, he was a role model with a flawless body. Now he turned down an offer for a part in a good film because there was a nude scene in the script.
Black men’s sexuality was always an issue, especially back in his days on the catwalk. © Althaus Medien
The new insight
Finally, he noticed that friends confided in him about their prostate. Very secretly, never in front of their partner. «I realized it’s a taboo subject that isn’t talked about publicly. I now belonged, so to speak, to the circle of initiates.»

The rethinking took time. He never set out to break taboos. But he never avoided them either. «I, the Negro» is the provocative title of his bestselling biography. But he was also the first black model on the cover of the renowned US magazine «GQ». Speaking on behalf of minorities led to engagements as a spokesperson for Special Endorsements. A journalist from an Italian newspaper, covering the launch of his biography in Italian, asked him in confidence if the rumors were true. «I didn’t peddle it, but I didn’t try to hide it either. He asked me to be allowed to write about it – in Italy the masculinity obsession would prevent any discussion about prostate cancer prevention. But even in my home country, Switzerland, people only talk about it behind closed doors.»
In 1977, he became the first black model on the cover of the renowned US magazine «GQ». © Althaus Medien
«The New Urs»
Yes, his sex life is affected, he openly admits today. Follow-up treatment could correct that, but Althaus dismisses it. «I live in a wonderful relationship built on love and friendship. Activating my sex life is not important enough to me.» He is considered cancer-free, and he is grateful for that.

Of course, the limitations in sex sometimes gnaw at a man's ego (at present, the text ends here). With the right partner, Althaus continues, that's not a problem. «I found myself,» Urs Althaus sums up positively and smiles mysteriously. For the first time in his eventful life, he is calm himself. «My environment tells me that too. This is a whole new Urs! I think my operation got rid of some old baggage.»
His autobiography made the bestseller list and was recently translated into Italian. © Althaus Medien
Meet the Doctor who operated Urs Althaus
«Meeting the Prostate Cancer is a Discovery Every Time»
by Roland Schäfli
Head of Content at Capptoo AG
Prof. Dr. med. Agostino Mattei operated on Urs Althaus on April 10, 2019 (see Feature story). @ LUKS
Prof. Dr. med. Agostino Mattei, Head of Urology at Lucerne Cantonal Hospital (LUKS)

… is a Course Director at the European Association of Urology and the American Association of Urology;

... was appointed Fellow of the European Society of Urology in Paris in 2003;

... introduced robotic surgery at LUKS in 2008 and was active as a consultant and trainer in the introduction of robotic surgery at the Kantonsspital St.Gallen and the University Hospital Lausanne (CHUV);

... is known for the robot-assisted lymph node resection in the technique «monoblock».
Prof. Dr. Mattei, the LUKS is considered one of the leading clinics in Switzerland with more than 8000 procedures per year. How many prostate cancer surgeries are performed on average per year, and how many do you personally perform as head of urology?
On average, we perform 150 to 200 radical prostate removals. Four experienced surgeons perform the procedures, of which I conduct about a third myself and help with about another quarter. I am consulted in about 100 cases a year when a patient has a complex initial situation.
Can you give an example of such complexity?
For example, in a young patient with advanced disease, if the cancer grows around the sphincter and is to be removed radically, but the functions such as continence and spontaneous erection are to be preserved, our more experienced colleagues support the intervention of younger surgeons in this more complex part. This is the advantage we have in a broad-based clinic like LUKS.
Thanks to this focus, the center can concentrate fully on the personal situation of each patient. To what extent is a patient’s life situation ultimately decisive for the choice of treatment?
For now, I must emphasize that surgery is not the only therapy for prostate cancer. Wherever possible, we remain cautious. We also take advantage of the opportunity to accompany younger patients through active surveillance for the time being when the cancer is in its early stages. During this time, we do not initiate any therapy until it is no longer possible to wait. In addition, we exploit all options such as external radiation with hormone therapy, or brachytherapy, in which the radiation source is inside the body. The cancer can also be destroyed with HIFU treatment, with ultrasound. Each therapy has the goal of neutralizing the cancerous prostate while preserving continence and possibly sexual function.
Accordingly, there are patients who are more suitable for certain treatments than others. How can individual wishes be addressed?
For each patient, we first do tailoring, considering the disease, stage, age, general condition and, last but not least, the patient’s wishes. The most frequently heard wish is, of course: to become cancer-free, while preserving the functions, for life.
Would you agree with the notion that the chances of survival of prostate cancer depend not only on the tumor stage, but also on lifestyle?
No. The causes of prostate cancer remain unknown. We know the risk factors: age, familial accumulation, and we know that men of black ethnicity are more likely to get sick.
To make surgery by autonomous robots possible in the future, data must be collected. © iStock
You operated Urs Althaus on April 10, 2019. Radical prostatectomy was planned. As he told us, you could remove all the cancer cells, but at the same time preserve his sexual function and continence. How can such a decision be made during surgery?
The preliminary investigations showed a constellation in which sexual function was worth preserving. But each operation is an individual case. The prostate is hidden in the small pelvis, we approach minimally invasive with the «keyhole» technique. It is a discovery for me every time we finally have the cancerous organ in front of us. Only then when we get there, we can determine whether a preservation of the structures around the prostate is feasible.

To radically remove it and at the same time preserving its environment is a constant balancing act between too little and too much.
«In these few hours, the future is decided for the patient, both oncologically and functionally.»
You operated Urs Althaus with the robot-assisted surgical system Da Vinci. You are considered one of the earliest proponents of robot assistance and have introduced this to LUKS as well as to the Kantonsspital St.Gallen and Lausanne. Did you initially have to dispel the reservations of your colleagues?
Of course, but nobody talks about that anymore. Nobody makes phone calls with a Nokia anymore (laughs).
How do you see the possibilities of AI and robotics in surgery developing?
The surgeon still controls the robot, but I imagine that one day it will operate autonomously. To do this, as much big data as possible must be collected, the movements of the best surgeons must be programmed. I would certainly not stand in the way of this development. I also do not believe that future therapy will remain surgical. The multimodal treatment concept is present and future.
Lucerne Cantonal Hospital (LUKS)
The Uro-Oncology Center at LUKS is highly specialized in the treatment of neoplasms of the prostate. For the success of the treatment, the center is well-known for its close interdisciplinary cooperation. Specialists from various disciplines coordinate diagnostics and therapy right from the start. In particular, Prof. Dr. Agostino Mattei emphasizes the tumor board: «Together we agree on a therapy proposal that refers to the special circumstances of each individual patient.»

The Promise of Radioligand Therapy

by Kristina Olujic
Medical Writer at Capptoo AG

According to a new study, radioligand therapy helps improve current prostate cancer treatment. The PSMAfore phase III trial showed that lutetium (Lu177) vipivotide tetraxetan provides a statistically significant and clinically meaningful radiographic progression-free survival benefit (rPFS) in patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC).

The uniqueness of this radioligand therapy is in the combination of a PSMA-targeting ligand and a Lu177 radionuclide. The treatment binds to the transmembrane protein PSMA, which is expressed on prostate cancer cells, and enters the cell via endocytosis. Then Lu177 emits radiation that damages DNA leading to the cancer cells’ deaths.

The PSMAfore phase III trial investigated whether radioligand therapy, lutetium Lu177 vipivotide tetraxetan, improves rPFS compared to a change in androgen receptor-directed therapy (ARDT) in mCRPC patients who were not treated with taxane-based chemotherapy.

The study’s results demonstrated that this radioligand treatment significantly improved rPFS in patients with PSMA-mCRPC compared to a change in ARPI with no unexpected safety outcomes. Based on these findings, Lu177 vipivotide tetraxetan is the first PSMA-targeted radioligand therapy that showed clinical benefit in this prostate cancer patient population.

These findings confirm the value of radioligand therapy in the treatment of prostate cancer. The results will be discussed with the FDA for regulatory approval and presented at upcoming medical conferences.
© Novartis
Shreeram Aradhye, M.D., President, Global Drug Development and Chief Medical Officer at Novartis

«With the announcement of these positive topline phase III results, Lu177 vipivotide tetraxetan becomes the first PSMA-targeted radioligand therapy to demonstrate significant and clinically meaningful benefits for people living with this type of prostate cancer who have not received taxane-based chemotherapy.

We look forward to discussing the data with healthcare authorities in order to bring this innovative new early treatment option to many more prostate cancer patients sooner after their diagnosis.»

Will AI transform how we treat Prostate Cancer?

by Serg Valencia
Medical Writer
A researcher behind the initial study from which the FDA-approved algorithm evolved:
Dr. Peter Choyke of the National Cancer Institute. © National Cancer Institute
A prostate cancer detection and diagnosis algorithm is cleared by the FDA. How does AI aid in prostate cancer diagnosis? The researcher behind the initial study summarizes.
On July 8th, 2022, the FDA approved an AI-driven algorithm called ProstatIDTM. ProstateIDTM is a software Computer-Aided Detection (CADe), and Diagnosis (CADx) system, that integrates artificial intelligence with conventional MRI scanning. The algorithm detects suspected malignant tumours and assesses the prostate gland volume. The software evaluates visible and undetectable features to the human eye, including brightness and greyscale, pixel-by-pixel texture, 3D voxel texture, and infinite feature weighting testing and validation. The FDA treats AI algorithms as 'Software as a Medical Device', but their guidelines remain a matter of study and adjustment.

In a pioneering study, researchers trained the CADx algorithm, the same algorithm later enhanced to power ProstatIDTM to help interpret MRI results, resulting in more consistent readings and improved accuracy, even among less experienced readers. Two clinical studies involving 25 radiologists in the United States showed that computer-aided detection significantly improved the accuracy of radiologic interpretation. Researchers found that CAD helped detect more prostate cancer cases, an area under the curve (AUC) of 0.935. They reduced the number of false positives, thus saving healthcare providers time and money and possibly saving lives by detecting prostate cancer early.

A researcher behind the initial study from which the FDA-approved algorithm evolved doesn’t think AI tools are intended to replace the medical judgement of radiologists, as he views artificial intelligence as a tool to dispense with human error and empower clinicians to make better decisions.

Here are the words of Peter L. Choyke, M.D., F.A.C.R., chief of the Molecular Imaging Branch at NCI’s Center for Cancer Research: «The radiologist is still free to interpret the MRI the way he or she sees fit but is also free to incorporate the AI’s ‘opinion’ into the interpretation. This should help make interpretations of MRIs more consistent and more reliable by decreasing the human element.»
Emerging AI Technologies Enhance the Precision of Prostate Cancer Detection and Treatment

Artificial intelligence (AI) seems to be taking over the planet in various fields. The AI industry works on developing technology that mimics the human intellect in complex cognitive tasks, such as solving novel problems, making high-stakes decisions, learning from experience, and language comprehension.

A branch of AI, Machine Learning, is particularly interesting for medicine as it focuses on using algorithms to sift through mountains of data searching for meaningful patterns. Prostate cancer research hasn't escaped the magnetic pull of artificial intelligence. Since 2017, over a thousand clinical studies have been published investigating AI's potential benefits in the diagnosis and treatment of prostate cancer.
Personalised interventions
Personalised medicine methods are particularly important in prostate cancer therapy.

Radiation therapy techniques like intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are game-changers as they deliver high doses of radiation to cancerous tissues while minimising the radiation exposure of nearby vital organs. But the power of these therapeutic interventions depends on creating a personalised treatment plan for each patient, a labour-intensive process requiring trial and error while optimising for a more effective plan.

Researchers conducted a study in which they tested machine learning algorithms to automate the plan selection process and predict the radiation exposure levels of vital organs for new patients based on previous treatment data. During the validation phase, 92% and 96% of dosimetric endpoints were within the error boundaries for the bladder and rectum. The mean sum of absolute residuals for the bladder and rectum were 0.034 ± 0.028 and 0.046 ± 0.021, respectively, indicating that the deep learning technology effectively generated accurate treatment plans for prostate cancer radiotherapy.
The meanings of these findings
During their lifetime, one in eight men will be diagnosed with prostate cancer. Early detection is crucial in diseases like prostate cancer, which can develop silently without many symptoms.

The routine use in clinical practice of imaging technologies such as ultrasound, Multiparametric-magnetic resonance imaging (mp-MRI), MRI-US fusion imaging, and PET have resulted in a vast database of cancer studies that can be harnessed to diagnose and treat prostate cancer more effectively.

Artificial intelligence's true power lies in enhancing rather than replacing human capabilities.

Machine learning and artificial intelligence can have a clinical impact by extracting hidden information from routinely available data to equip medical professionals battling prostate cancer with insights to make better decisions and develop more precise diagnostic and therapeutical interventions.

In 2023, human expertise is needed more than ever in the fight against cancer. Artificial intelligence can be a valuable complement.

Life-extending Drug: UK Leads the Way

by Kristina Olujic
Medical Writer at Capptoo AG

The National Health Service (NHS) in England will be the first in Europe to provide Darolutamide, a new life-extending drug, to patients with advanced prostate cancer that has spread to other parts of the body. This promising treatment will be available to approximately 9,000 men with one of the most aggressive types of prostate cancer.

In England, approximately 47,000 people are diagnosed each year with prostate cancer, the most common cancer in men. Almost 9,000 of them deal with advanced prostate cancer.

Darolutamide treatment blocks prostate cancer tumour growth and proliferation by inhibiting androgen receptors. According to studies, previously untreated patients who received darolutamide have a one-third greater chance of living longer.

The ARASENS phase III trial assessed whether a combination of darolutamide, androgen-deprivation therapy (ADT), and docetaxel would improve survival among patients with metastatic, hormone-sensitive prostate cancer.

The results showed that the risk of death was significantly lower, by 32.5%, among patients treated with darolutamide with no increase in adverse events. Therefore, the trial provided clear and compelling evidence that overall survival was significantly longer in patients who received combination therapy with darolutamide.

These findings support the use of darolutamide in combination with ADT and docetaxel for treating patients with metastatic, hormone-sensitive prostate cancer, with NHS England fast-tracking this treatment and being the first in Europe to make it available for this patient population.
© Hospital Times
Amanda Pritchard, Chief Executive of NHS England

«The NHS is continuing to lead the way in securing the best possible treatments for patients – this is the latest in a long list of cutting-edge drugs that we have secured to help people to live longer with cancer, making a huge, life-changing difference to patients and their families across the country.»
Aurelius Omlin: «Society Definitely Needs to be Sensitized More»
by Roland Schäfli
Head of Content at Capptoo AG
PD Dr. med. Aurelius Omlin, FMH specialist in medical oncology, Uro-oncology Center Zurich, Chairman of the Uro-Oncology Center at Klinik Hirslanden and Onkozentrum Zurich. © Onkozentrum Zürich
It has been 20 years since Aurelius Omlin started working in the treatment of prostate cancer after completing his studies. In an interview with «Digest», he talks about his experiences – and expectations for the future.
Prostate cancer is the most common cancer in men. How does the number of cases increase in relation to demographic development and aging?
It’s true, prostate cancer is the most common malignant cancer diagnosis in men. In Switzerland, the average age at the time of diagnosis is 70 years. According to the Federal Statistical Office, the rate of new cases increased sharply between 1990 and 2009 (+43%) and has been falling since then. The mortality rate has decreased continuously since 1990 (-50% between 1990 and 2019). The decrease in the incidence rate is probably related to the fact that there is no general recommendation for screening of men aged 50 to 70 years, based on the results of large screening studies. However, as a result, an increase in prostate cancer mortality was observed again, for example in the United States. However, prostate cancer screening will come back into focus. The EU intends to establish a prostate cancer screening program for men aged 50 to 70 by 2025.
How does the use of new methods for early detection affect the chances of recovery?
The prognosis for prostate cancer – no different than for other types of cancer – depends on the stage of the disease at diagnosis. The early detection of prostate cancer was controversial for many years, as it led to overdiagnosis and overtreatment in some of the men affected if the PSA level was elevated. In the meantime, however, MRI diagnostics have become the standard for an elevated PSA and before a possible biopsy.

With this approach, fewer insignificant carcinomas are found – i.e. those that often do not require therapy. On the other hand, the diagnostic reliability of the biopsy is improved, so that follow-up biopsies can often be avoided. At the UOZ, only MRI ultrasound (TRUS) fusion biopsy is used. All newly diagnosed cases of prostate cancer are also discussed at the interdisciplinary tumor board, after which an individualized treatment recommendation is made.
How important do you think is maintaining the ability to ejaculate and potency for most men?
We would say that the vast majority of men would like to maintain potency and continence as best as possible. If a significant, localized prostate carcinoma is detected, the established curative methods (radical prostatectomy or local radiotherapy and hormone therapy) are associated with a certain risk of incontinence or erectile dysfunction. Careful counselling of the men concerned is important here, so that the best possible method can be used for each individual case.
Do you think that society’s awareness of prostate cancer has increased in general, or is there a need for further education?
There is definitely a need for more awareness, especially when comparing it to breast cancer, the most common malignancy in women, which is as common as prostate cancer. Thanks to the Movember Foundation, the month November has been established as Prostate Cancer Month, with many campaigns and increased media attention for the topic, which understandably falls into a certain taboo area, since continence and potency are two very sensitive subject areas that men generally do not like to talk about.
Movember is a charity tackling men’s health on a global scale. Members address some of the biggest health issues faced by men, with prostate cancer high on their list. © Movember Foundation
What other warning signs besides difficulties urinating and incontinence – if noticeable at all – should a man look out for?
Early prostate cancer is usually not noticeable. Therefore, the PSA determination from the age of 50 is often the first indication of an abnormality. Men who have family members with prostate cancer (father, brother, uncle, grandfather) should start regular check-ups at the age of 45.
Current studies indicate that triple therapy could become a new standard for metastatic hormone-sensitive prostate cancer. Do you agree that using a specific chemotherapy drug and an androgen receptor signaling blocker can increase survival benefits?
Since 2015, eight large, randomized phase III studies have shown that in the metastatic, hormone-sensitive situation, combination therapy significantly improves survival and many other secondary endpoints compared to monotherapy. The latest data comes from the PEACE-1 and ARASENS studies: they compared the combination of hormone therapy and chemotherapy with the combination of hormone therapy plus chemotherapy plus new endocrine therapy. Comparison with other studies is always tricky, but the so-called triplet therapy has shown excellent results and is one of the standard options. Here, too, individual assessment and counselling is essential because many factors influence the individual therapy decision.
Indications of decisive changes on adjuvant therapy: expectations are high about gene expression profile diagnostics on tumor tissue. © Uro-Oncology Center Klinik Hirslanden
Changes are also evident in adjuvant therapy: follow-up treatment with radiation and hormone therapy. How do you see the perspective of this development?
This area is in a state of upheaval because, as an alternative to adjuvant treatment, early salvage therapy can only be discussed once a PSA increase has been confirmed. The sensitive determination of the PSA value and modern imaging with PSMA PET can improve early salvage therapy. However, we still know very little about which patients benefit more from adjuvant therapy after the wound has healed and continence has been established. There is hope that gene expression profile diagnostics on tumor tissue can help formulate an individual recommendation in the future.
«The affected men can do a lot themselves to reduce the side effects.»
In the treatment of advanced prostate cancer, «hormone therapy» (testosterone suppression) is usually the basis of treatment. How can the side effects on male hormone production be reduced?
This is a very important point and the affected men can do a lot themselves to reduce the side effects. Training (resistance and endurance excercise), healthy nutrition and good monitoring and control of all cardiovascular risk factors are important. Individual advice is also important here, in particular for measures against erectile dysfunction or psychological topics.
«The vast majority of men would like to maintain potency and continence as best as possible.»
What treatments and diagnostic options are on the horizon – and which ones are you personally particularly excited about?
When I started work after graduating in 2003, there was no therapy for the treatment of men with advanced prostate cancer apart from hormone therapy that was proven to improve the chances of survival. In the last 20 years, however, many effective and well-tolerated therapies have been tested and approved based on a relevant survival benefit, in particular chemotherapeutic agents, new endocrine therapies, radionuclide and radioligand therapies, as well as targeted therapies (PARP and checkpoint inhibitors). This allows patients in the advanced situation to live much longer, but we need to do more research because these therapies do not work for everyone affected and not for everyone for the same length of time.

Hope rests on the development of new, targeted therapies, including possibly immunotherapies, monitoring methods with modern imaging (PSMA PET) or liquid biopsy in order to be able to identify and intervene in the early stages of resistance developments.
© Uro-Oncology Center Klinik Hirslanden
Uro-Oncology Center Klinik Hirslanden
At the German Cancer Society (DKG)-certified Uro-Oncology Center (UOZ) Klinik Hirslanden in Zurich, the entire spectrum of prostate cancer treatment is offered, from the assessment of elevated PSA to the treatment of benign prostate hyperplasia and localized prostate cancer treatment.

The number of primary cases (i.e. new diagnoses of prostate cancer – localized or metastatic) is around 400 per year. Prostatectomy at the UOZ is only carried out with the da Vinci robot, since the urologists operating here have specialized in this method, with about 280 prostatectomies performed each year.
User Data

Platform Stats in Q1 2023

15 Scientific Leaders
selected practice-relevant publications for lung, renal, gastro-esophageal and melanoma cancer.

TOP 3 filter criteria in Q1:


Total active users on the Platform

We are proud that Oncology Compass is becoming an increasingly important tool for oncologists.
Website Visitors
Avg. Session
3:14 min
Avg. Session Duration per Registered User
3:56 min
Pages per Session per Registered User
Insights: website visitors
users by DEVICES
device category
total users
Users by place of work
Need specific audience data?
Our data analysts will do their best to make it happen.
Contact Marija Galić for more info.
Top 10 countries where visitors come from
1. United States
2. Switzerland
3. Netherlands
4. India
5. Germany
6. United Kingdom
7. Belgium
8. China
9. Italy
10. Austria
users by age *
age group
1. 25-34
2. 18-24
3. 35-44
4. 45-54
5. 65+
6. 55-64
Users by gender *
* for the rest of visitors, the gender and age are unknown, they choose not to share it.

Our July Issue Will Focus on Multiple Myeloma

How did you like this issue? go to the survey →
Oncology Compass is a service of Capptoo for physicians. The information contained therein reflects the independent opinion, expertise and experience of the scientific board. This view is not necessarily that of Capptoo.

Please note:

We have no influence on the selection of publications referenced on the Oncology Compass website.

Information related to any product(s) may not be consistent with the prescribing information.
Generously sponsored by
initiated by
owned by
Roland Schäfli
Head of Content
Anne Jäkel
Senior Medical Writer
Dejan Dragasevic
Tanja Palm
Marija Galic
Social Media
Oksana Gerasimenko
Ana Najcer
OC Coordination
and Administration
Cover photo © Simon Michel

Published by: Capptoo AG, Churerstrasse 92i, 8808 Pfäffikon SZ, Switzerland.

Any text and design are the property of Capptoo AG. Any other use of the materials is prohibited unless Capptoo has previously agreed.

© All rights reserved, including the right to reproduce this magazine or portions thereof in any form whatsoever. For information, address the publisher.