Therapy Management of Metastatic Prostate Carcinoma in General Practice

2019 ◽  
pp. 12-15
Author(s):  
Alexander Meisel
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Treatment Strategies ◽  
Castration Resistant Prostate Cancer ◽  
Continuous Therapy ◽  
Castration Resistant ◽  
Literature Overview ◽  
Metastatic Prostate Carcinoma ◽  
Insight Into ◽  
Systemic Therapies

ABSTRACT In general, advanced prostate cancer is initially treated with androgen deprivation therapy (ADT). Despite high response rates to this treatment, the response is not durable and most of the patients eventually develop metastatic castration-resistant prostate cancer (mCRPC). The treatment strategies for mCRPC usually include a combination of different approaches, such as hormone therapy, chemotherapy, or radiation. Here, we discuss the case of a 78-year old patient with advanced prostate cancer who developed mCRPC after 4 years of continuous therapy with ADT. The patient was subsequently treated with analgesic radiotherapy, followed by chemotherapy, including docetaxel and cabazitaxel. The patient responded well to the treatment, with acceptable treatment-related toxicity. Three years later, however, the disease progressed, and the patient received anti-hormonal therapy with enzalutamide. In conclusion, this case report discusses the different therapy selections and outcomes. Finally, a literature overview offers a comprehensive insight into the current systemic therapies for mCRPC.

scholarly journals Enzalutamide therapy for advanced prostate cancer: efficacy, resistance and beyond

2019 ◽  
Vol 26 (1) ◽  
pp. R31-R52 ◽  
Author(s):  
Simon Linder ◽  
Henk G van der Poel ◽  
Andries M Bergman ◽  
Wilbert Zwart ◽  
Stefan Prekovic
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Advanced Prostate Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Treatment Resistance ◽  
Castration Resistant Prostate Cancer ◽  
Optimal Sequence ◽  
Castration Resistant ◽  
Novel Drugs

The androgen receptor drives the growth of metastatic castration-resistant prostate cancer. This has led to the development of multiple novel drugs targeting this hormone-regulated transcription factor, such as enzalutamide – a potent androgen receptor antagonist. Despite the plethora of possible treatment options, the absolute survival benefit of each treatment separately is limited to a few months. Therefore, current research efforts are directed to determine the optimal sequence of therapies, discover novel drugs effective in metastatic castration-resistant prostate cancer and define patient subpopulations that ultimately benefit from these treatments. Molecular studies provide evidence on which pathways mediate treatment resistance and may lead to improved treatment for metastatic castration-resistant prostate cancer. This review provides, firstly a concise overview of the clinical development, use and effectiveness of enzalutamide in the treatment of advanced prostate cancer, secondly it describes translational research addressing enzalutamide response vs resistance and lastly highlights novel potential treatment strategies in the enzalutamide-resistant setting.

scholarly journals Novel Strategies for Treating Castration-Resistant Prostate Cancer

Biomedicines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 339
Author(s):  
David Ka-Wai Leung ◽  
Peter Ka-Fung Chiu ◽  
Chi-Fai Ng ◽  
Jeremy Yuen-Chun Teoh
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
Advanced Prostate Cancer ◽  
Imaging Techniques ◽  
Treatment Strategies ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistance ◽  
Management Options ◽  
Castration Resistant

The development of castration resistance is an inevitable pathway for the vast majority of patients with advanced prostate cancer. Recently, there have been significant breakthroughs in the understanding and management options of castration-resistant prostate cancer. Three novel hormonal agents showed survival benefits in non-metastatic patients. As for metastatic disease, there was an even wider range of management options being investigated. This review summarized advances in the management of castration-resistant prostate cancer (CRPC) including emerging data on novel imaging techniques and treatment strategies.

scholarly journals A A Canadian consensus forum on the management of patients with advanced prostate cancer

2019 ◽  
Vol 14 (4) ◽  
Author(s):  
Fred Saad ◽  
Christina Canil ◽  
Antonio Finelli ◽  
Sebastien J. Hotte ◽  
Shawn Malone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Castration Resistant Prostate Cancer ◽  
Research Education ◽  
Modified Delphi ◽  
Castration Resistant ◽  
Medical Oncologists ◽  
Oligometastatic Prostate Cancer ◽  
Scientific Group ◽  
High Level

Introduction: The management of advanced prostate cancer (PCa) continues to evolve with the emergence of new diagnostic and therapeutic strategies. As a result, there are multiple areas in this landscape with a lack of high-level evidence to guide practice. Consensus initiatives are an approach to establishing practice guidance in areas where evidence is unclear. We conducted a Canadian-based consensus forum to address key controversial areas in the management of advanced PCa. Methods: As part of a modified Delphi process, a core scientific group of PCa physicians (n=8) identified controversial areas for discussion and developed an initial set of questions, which were then reviewed and finalized with a larger group of 29 multidisciplinary PCa specialists. The main areas of focus were non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), metastatic castration-resistant prostate cancer (mCRPC), oligometastatic prostate cancer, genetic testing in prostate cancer, and imaging in advanced prostate cancer. The predetermined threshold for consensus was set at 74% (agreement from 20 of 27 participating physicians). Results: Consensus participants included uro-oncologists (n=13), medical oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, consensus was reached in 30 questions (n=5 unanimously). Consensus was more common for questions related to biochemical recurrence, sequencing of therapies, and mCRPC. Conclusions: A Canadian consensus forum in PCa identified areas of agreement in nearly 50% of questions discussed. Areas of variability may represent opportunities for further research, education, and sharing of best practices. These findings reinforce the value of multidisciplinary consensus initiatives to optimize patient care.

scholarly journals Clinicopathologic Diagnostic Approach to Aggressive Variant Prostate Cancer

2019 ◽  
Vol 144 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Varsha Manucha ◽  
John Henegan
Keyword(s):  
Prostate Cancer ◽  
English Language ◽  
Treatment Strategies ◽  
Castration Resistant Prostate Cancer ◽  
Ongoing Research ◽  
Castration Resistant ◽  
Current Review ◽  
Pathologic Features ◽  
Neuroendocrine Carcinomas ◽  
Aggressive Variant

Context.— Aggressive variant prostate cancer (AVPCa) develops in a subset of patients with metastatic castration-resistant prostate cancer. The clinical and histologic overlap of AVPCa with other neuroendocrine carcinomas of the prostate has resulted in a lack of consensus on its terminology and treatment. Objective.— To review AVPCa to familiarize pathologists with this entity so they can actively participate in the detection, ongoing research, and evolving management of AVPCa. Data Sources.— The English language literature was reviewed. Conclusions.— The current review summarizes the pathologic features of AVPCa, describes how it has been defined clinically, and discusses how biomarkers may inform treatment strategies in the future.

Radium 223: How Can We Optimize This New Tool for Metastatic Castration-Resistant Prostate Cancer?

2015 ◽  
pp. e270-e273 ◽  
Author(s):  
Tanya Barauskas Dorff ◽  
Mitchell E. Gross
Keyword(s):  
Prostate Cancer ◽  
Patient Selection ◽  
Castration Resistant Prostate Cancer ◽  
Limited Data ◽  
Castration Resistant ◽  
Radium 223 ◽  
Subgroup Analyses ◽  
Therapeutic Sequence ◽  
Theoretical Considerations ◽  
Insight Into

Radium 223 is an alpha-emitting intravenous radiotherapy approved for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC). The approved indication covers men with pain from bony metastatic disease and no visceral involvement; however, questions remain as to optimal patient selection and timing of this treatment relative to other life-extending therapies for mCRPC. Limited data exist to guide clinicians on how to position radium 223 in the therapeutic sequence, however, some theoretical considerations and data derived from the ALSYMPCA trial populations pre- and postdocetaxel will be outlined. Subgroup analyses may provide some insight into patient selection.

scholarly journals The Current Landscape of Treatment in Non-Metastatic Castration-Resistant Prostate Cancer

2019 ◽  
Vol 13 ◽  
pp. 117955491983392 ◽  
Author(s):  
Joelle El-Amm ◽  
Jeanny B Aragon-Ching
Keyword(s):  
Prostate Cancer ◽  
Drug Administration ◽  
Advanced Prostate Cancer ◽  
Unmet Need ◽  
Early Data ◽  
Castration Resistant Prostate Cancer ◽  
Free Survival ◽  
Castration Resistant ◽  
Fda Approval ◽  
Variable Potential

Non-metastatic castration-resistant prostate cancer (nmCRPC) is a heterogeneous disease with variable potential in developing into overt metastases. It is an area of increased unmet need in advanced prostate cancer and for which there had been no great treatments until recent US Food and Drug Administration (FDA) approval of 2 novel anti-androgens apalutamide and enzalutamide, which were both approved given benefit in metastasis-free survival. Early data on the use of darolutamide, another novel anti-androgen, are also explored. This review discusses the pivotal trials that led to the approval of apalutamide and enzalutamide in the nmCRPC setting and discusses the key promises and challenges with the use of these agents.

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