Trends in Prostate Cancer Care

Bobby Liaw, MD: Data for prostate cancer continues to come out very rapidly. I think perhaps it’s best to think about some of the trends that are going on in prostate cancer. 1 trend that we’ve been seeing pretty consistently over the last couple of years is that some of our more “advanced drugs” that we used to reserve for castration-resistant prostate cancer are slowly migrating from castration-resistant prostate cancer into non-metastatic castration-resistant prostate cancer; into the hormone-sensitive prostate cancer settings, to the point where I think that combination therapy for hormone-sensitive prostate cancer really should be considered standard care at this point. But even on top of that, we’re starting to see drugs like abiraterone in localized prostate cancer. Recent studies and recently stamped data showed that the addition of abiraterone to ADT [androgen deprivation therapy] for 2 years in patients getting definitive radiation therapy seems to add additional benefits. So, we’re probably going to start to see more of our advanced drugs finding their way into even earlier stages of the disease. I think we need to be prepared for that.

Because of this trend, I think more than ever, it’s going to be very important for there to be a much more multidisciplinary approach to prostate cancer management. Urologists and radiation oncologists may not necessarily have been in a position to have to collaborate with a medical oncologist at certain stages of the disease. We’re going to start to see this standard of care move a little bit more as some of the new data becomes more adopted into guidelines.

I think that triplet therapy is very exciting, and I’m certainly interested in trying it best to adopt it into my own clinical practice. But for the theme of intensifying treatment upfront leading to much better disease control and overall Survival paying much bigger dividends down the road, I think we need to be much more prepared to offer potentially more difficult-to-sell treatments to patients in the sense that they may not necessarily want a ton of treatment upfront, but we need to start to set the expectation that we have all these things that we can do. There are ways for us to optimize our treatments, but our way of optimizing it may be to use a little bit more of an aggressive treatment upfront so that we can enjoy better disease control down the line.

Atish Choudhury, MD, PhD: This is a constantly-updating space in castration-sensitive prostate cancer, and I think it really requires multi-modality assessment of different patients. This includes between the urologist and the medical oncologist to evaluate for chemotherapy, and the radiation oncologist to evaluate for radiation to sites of disease.

Certainly, more elderly patients would benefit from geriatric assessments to assess their ability to tolerate different treatments. We have to Engage with our colleagues from Cardiology and Endocrinology to help with the management of side effects. Often these patients have social challenges or difficulties with lifestyle. Referral to social work, referral to Nutrition, and making sure people are eating a healthy diet, exercising regularly, and having their adverse events appropriately managed is really the key to getting patients to tolerate and benefit from treatment.

So, it does fall upon us as the providers to make sure that patients are linked to the appropriate supportive care, and then a lot does fall on the patients themselves to make good choices in terms of lifestyle, diet, exercise, remaining socially active and cognitively active, to do as well as possible on these treatments. There have been so many advances in hormone-sensitive prostate cancer.

Survival has been prolonged quite a bit. Some patients may actually discontinue treatment and still retain benefit, so it’s a constantly changing space. We need to be Adaptive patient-to-patient, and make sure that our recommendations are really individualized.

Transcript edited for clarity.

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