October 2010 - Issues regarding the hormonal therapy of prostate cancer were discussed in the second plenary session at the 10th Central European Meeting (CEM) held yesterday in Bratislava, Slovakia. Chaired by M, Sosnowski and V. Student, the session featured Per-Anders Abrahamsson, George Thalman and R. Zachoval as speakers.
Prof. Per-Anders Abrahamsson spoke on the pros and cons of androgen deprivation., addressing the issue of what is new in androgen therapy (ADT) Abrahamsson discussed new agents, new concerns about efficacy of intracellular testosterone suppression, better selection of indications and better understanding of side effects.
"It’s time to promote a holistic view of ADT," said Abrahamsson as he examined concerns such as hidden toxicities and the need for a more 'global' patient approach. He said that for patients who really needed ADT, they should take precautionary measures such as regular physical exercise, stop smoking, improving their diet, undergoing a cardiovascular evaluation, monitoring glycerin and serum lipids, and the use of cholesterol-lowering agents, amongst others.
In his take-home messages regarding intermittent androgen therapy (IAD), Abrahamsson highlighted the following:
- Evidence from clinical trials is poor (only one mature phase 3 trial so far
- More questions than answers, such as patient selection, when to stop or resume the therapy, what kind of therapy, etc..
- IAD remains an experimental approach (according to EAU Guidelines)
Meanhile, Thalmann addressed the issue of managing bone metastasis in urological diseases, looking at skeletal complications , the prognostic factors in cancer with bone metastases and the traditional treatment approaches to urological bone metastases such as radiotherapy, hormonal therapy in prostate cancer, analgesic, orthopedic interventions, chemotherapy, radionucleotides and drugs.
In his concluding remarks, Thalmann said bone metastases are a source of considerable morbidity and that given the possibilities that physicians have, no patient should suffer, He also mentioned the issue of employing focal therapy vis-à-vis systemic therapy.
Roman Zachoval, on the other hand, tackled the challenges regarding hormonal therapy in castrate resistant prostate cancer (CRPC) and discussed various potential therapeutic options in CRPC.