Issues in diagnosing and treating prostate cancer particularly in patients with resistant or metastatic disease were discussed in several sessions at the 3rd EAU Baltic Meeting in Tallinn, Estonia, with experts saying that although there are new and emerging options a careful selection is crucial to achieve better quality of life for patients.
In the session “Current management for metastatic castration-resistant prostate cancer (mCRPC),” Professors F. Jankevicius (LT) and P. Mulders (NL) looked into patient selection, new alternatives and sequencing of drug treatment, with both noting that although there are newer options in drugs the different modes of action make the current treatment landscape more complex for physicians to select the best regimen course.
Examining the benefits and outcomes of drugs such as abiraterone, prednisone and enzalutamide, to name a few, Mulders said the challenge is to identify the proper sequence and combination.
“Which sequence and which combination and when? These are the questions…We need a prospective trial with these drugs (abiraterone, enzalutamide) and we have to make a choice,” he said.
Jankevicius looked into the aspects of choosing the right treatment for CRPC patients and said previous response to therapies, co-morbidities, potential toxicities and patient choice are some of the points that doctors should look into before deciding on a course of action.
“In the absence of prospective data, the modest potential benefits of a continuing castration outweigh the minimal risk of treatment,” Jankevicius said.
Mulders also gave an overview on the current drug landscape for CRPC and mentioned the role of chemotherapy (docetaxel/cabazitaxel), immunotherapy Sipuleucel T, hormonal therapies (such as abiraterone), and Radium 223. He said that with regards progression in mCRPC, it is very important to look at the patient’s performance status,
Mulders: “When you treat patients in a sequential way you need to look at three parameters and not only the patient’s PSA…you have to measure also the clinical, biological and radiological aspects.”
“More active drugs are available, and there are different modes of action (MoA) with the sequencing of the same MoA unsuccessful,” said Mulders in his closing remarks. “We need more information from prospective, randomized studies and molecular targeting.”