Is the Gleason score the driver for the treatment decision-making of patients with castration-resistant prostate cancer in the new era of the anti-androgenic therapies?

Overview: With the surge in therapeutic options for castration-resistant prostate cancer (CRPC) comes increasingly complicated treatment decision making, highlighting the need for biomarkers that can identify appropriate patients for specific treatments and accurately assess disease response. Here we discuss existing and potential prognostic, predictive, and surrogate biomarkers in CRPC.

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Mobile Audio Recording Technology to Promote Informed Decision Making in Advanced Prostate Cancer

JCO Oncology Practice ◽

10.1200/op.21.00480 ◽

2021 ◽

Author(s):

Daniel H. Kwon ◽

Sneha Karthikeyan ◽

Alison Chang ◽

Hala T. Borno ◽

Vadim S. Koshkin ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Treatment Decision ◽

Decisional Conflict ◽

Informed Decision ◽

Informed Decision Making ◽

Castration Resistant Prostate Cancer ◽

Software Application ◽

Castration Resistant ◽

Patient Reported

PURPOSE Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale–informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.

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Expert recommendations on the management of patients with metastatic castration-resistant prostate cancer who progress after CHAARTED or LATITUDE

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920920067 ◽

2020 ◽

Vol 12 ◽

pp. 175883592092006

Author(s):

Javier Puente ◽

Urbano Anido ◽

Miguel Ángel Climent ◽

Enrique Gonzalez-Billalabeitia ◽

Nuria Lainez ◽

...

Keyword(s):

Prostate Cancer ◽

Treatment Decision ◽

Individual Case ◽

Delphi Process ◽

Nominal Group ◽

Castration Resistant Prostate Cancer ◽

Level Of Evidence ◽

Treatment Decision Making ◽

Castration Resistant ◽

American Society

Objective: Our aim was to provide practical recommendations on the management of patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after docetaxel plus androgen-deprivation therapy (ADT) or abiraterone plus ADT. Methods: Systematic literature review (SLR), nominal group meeting, and Delphi process. A panel of 12 experts was established who defined the scope, users, and sections of the document. We performed an SLR in order to assess the efficacy and safety of available drugs in patients with mCRPC. Abstracts from the American Society of Oncology and European Society for Medical Oncology meetings were also examined. The results were discussed during an expert meeting in which 14 recommendations were generated. The level of agreement with the recommendations was also tested by 13 additional experts following the Delphi process. Recommendations were voted by means of scores ranging from 0 (total disagreement) to 10 (total agreement). We defined agreement when at least 70% of the experts voted ⩾7. Next, we assigned a level of evidence and grade to the recommendation using the Oxford Centre for Evidence-based Medicine Levels of Evidence, following which the final document was drafted. Results: The literature search did not find any articles meeting the inclusion criteria. Finally, 13 out of 14 recommendations were accepted after two Delphi rounds (two were modified after the first round). They pertain to general and individual case-based treatment recommendations. Conclusions: In mCRPC patients who have progressed after docetaxel or abiraterone plus ADT in the metastatic hormone-sensitive prostate cancer setting, these recommendations may support treatment decision-making, due to the lack of evidence or other globally accepted sequencing algorithms.

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Abstract LB-435: Treatment decision-making for clinically localized Gleason score 6 prostate cancer: What younger men choose and why

10.1158/1538-7445.am10-lb-435 ◽

2010 ◽

Author(s):

Abhinav Sidana ◽

Bruce Trock ◽

Zhaoyong Feng ◽

David Hernandez ◽

Jonathan Epstein

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Gleason Score ◽

Treatment Decision ◽

Treatment Decision Making ◽

Younger Men

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Association of time from definitive therapy (DT) to start of androgen deprivation therapy (ADT) for metastatic disease and survival outcomes in men with new metastatic hormone-sensitive prostate cancer (mHSPC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.265 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 265-265

Author(s):

David Michael Gill ◽

David D. Stenehjem ◽

Heather H. Cheng ◽

Elizabeth Riley Kessler ◽

Andrew W. Hahn ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Risk Stratification ◽

Gleason Score ◽

Univariate Analysis ◽

Treatment Decision ◽

Localized Prostate Cancer ◽

Prior History ◽

Treatment Decision Making ◽

Definitive Therapy

265 Background: Few objective criteria are considered for risk stratification for treatment decision making in men with new mHSPC. Time between DT for localized disease, and start of ADT for new mHSPC may predict response to ADT, and prognosticate outcomes in this setting. Methods: In this multicenter study, men with newly diagnosed mHSPC with prior history of definite therapy for localized prostate cancer were included. Kaplan-Meier and Cox proportional hazard methods assessed time to castration resistance (CRPC) and overall survival (OS) from initiation of ADT, and correlated with the time elapsed from DT to initiation of ADT for new mHSPC. Results: A total of 112 men with new mHSPC initiating ADT, with prior definitive therapy were eligible (all median: age 68 yrs, Gleason score 7, PSA 14 ng/ml, ECOG 0, median time from DT to start of ADT for new mHSPC 54 months). In the univariate analysis, time from DT to start of ADT of < 60 months vs ≥ 60 months significantly correlated with duration of response to ADT and outcomes (Table). After adjustment for Gleason score and log PSA, time from DT to start of ADT for new mHSPC (<60 vs ≥60 months) remained an independent and a significant predictor of time to CRPC (HR 1.92 95% CI 1.02-3.90, p=0.044), and showed trends towards predicting OS (HR 1.77 95% CI 0.60-6.19, p=0.33). Conclusions: Time from DT for localized prostate cancer to initiation of ADT for new mHSPC independently predicts response to ADT, and may aid in risk stratification for treatment decision making in men with new mHSPC. These hypothesis-generating data require validation in a larger cohort. [Table: see text]

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