Relevance: Prostate cancer (PC) is one of the most common
malignant neoplasms in the male population. The widespread
introduction of modern diagnostic methods and the determination of prostate-specific antigen (PSA) levels have increased
the number of detected cases of localized and locally advanced
PC forms. However, in some patients treated with radical
methods and long-term androgen deprivation therapy (ADT),
the disease continues to progress in the form of an increase in
PSA levels with castration testosterone values and with no distant metastases. Such a course of the disease is referred to as
non-metastatic castration-resistant prostate cancer (nmCRPC).
Purpose: The article reports the results of a meeting of the
Expert Council arranged by the Kazakh Research Institute of
Oncology and Radiology on December 25, 2020, on non-metastatic castration-resistant prostate cancer diagnostics and
treatment.
Results: Large clinical studies highlight the critical importance of controlling the PSA doubling time as the main prognostic factor for an unfavorable outcome to increase patient
survival and prevent the development of distant metastases.
Based on the results of large randomized studies, experts
recommended using new-generation androgen receptor antagonists in combination with ongoing ADT to improve the
clinical outcomes in nmCRPC patients at high risk of metastatic
progression. The Expert Council was presented with the data of
a registration clinical study on darolutamide efficacy and safety. The advantages of introducing this drug into clinical practice to expand the choice of therapeutic options were identified.
Personalized adjustment of a treatment regimen will increase
the treatment efficacy and ensure higher survival in this category of patients.
Conclusion: Increasing survival as the main objective
in treating nmCRPC patients requires improved diagnostics
through regular controlling of testosterone and PSA levels, calculation of PSA doubling time, and the use of radiological diagnostic methods to rule out distant metastases. The choice of
therapy in patients at high risk of metastasis shall consider the
patient’s status and the treatment efficacy and safety balance.
Efficacy and safety of docetaxel and prednisolone chemotherapy in very elderly men with metastatic castration-resistant prostate cancer (mCRPC) in real world: a single institute experience
