Articles related to MEN'S HEALTH

On April 25, 2023, the American Urological Association (AUA), in partnership with the Society of Urologic Oncology (SUO), released the 2023 clinical practice guideline amendment for the management of advanced prostate cancer. This guideline contains a total of 40 recommendations, and the revision includes updates to recommendations under these disease states:

Previously untreated patients in this phase III research receiving enzalutamide with or without abiraterone acetate and prednisone (AAP) were being treated for metastatic castration-resistant prostate cancer (mCRPC). Median overall survival (OS), the main outcome, did not differ statistically between the two groups. Enzalutamide plus AAP, however, resulted in a longer radiographic progression-free survival (rPFS) than enzalutamide alone. Abiraterone clearance was two to three times higher when administered with enzalutamide than when given alone, according to pharmacokinetic studies. In the combo arm, there were more high-grade adverse events, such as atrial fibrillation, transaminitis, hypertension, and fatigue. Patients with mCRPC did not have their OS lengthened by the addition of AAP to enzalutamide, and the authors theorize that this may have been due to the combination arm’s higher abiraterone clearance.

A recent guideline update published in the Journal of Clinical Oncology offers updated recommendations for managing noncastrate advanced, recurrent, or metastatic prostate cancer. The authors recommend five separate standards of care, including docetaxel, abiraterone, enzalutamide, apalutamide, or darolutamide, all administered with androgen deprivation therapy (ADT). Triplet therapy is superior to doublet therapy, and there are no recommendations for the use of any of these agents in any other combination or series apart from the triplet therapies of docetaxel plus abiraterone plus ADT and docetaxel plus darolutamide plus ADT. Docetaxel plus ADT should be offered to patients with metastatic noncastrate prostate cancer with high-volume disease who are unwilling or unable to receive triplet therapy. Triplet therapy should be offered to patients with de novo metastatic noncastrate prostate cancer with high-volume disease who are being offered ADT plus docetaxel chemotherapy, with significant overall survival and radiographic progression-free survival benefits. Overall, patients should be informed that doublet therapy (docetaxel plus ADT) has been proven inferior to triplet therapy such as abiraterone and prednisone plus docetaxel plus ADT.

A total of 1,643 men with localized prostate cancer were enrolled in a trial to assess treatment efficacy, with 545 randomly assigned to active monitoring, 553 to prostatectomy, and 545 to radiotherapy. Prostate cancer-specific mortality was low after 15 years of follow-up, regardless of treatment. Thus, deciding on therapy entails weighing the benefits and drawbacks of treatments for localized prostate cancer.

At a median follow-up of 24 months following initial PSMA PET scans, 73 of the 226 patients studied had clinical recurrence (CR). The 3-year CR-free rates in the 109-person metastasis-directed therapy (MDT) group were 51% and 28% in the no MDT group (117), respectively. Men who did not receive MDT had a significantly higher rate of distant metastases at CR than those who did (86% vs. 77%). The proportion of distant metastases was significantly lower in the MDT group (67% vs. 76%).

Along with other physical findings, this patient shows decreased testicular volume. Review the other findings and determine your next best step for evaluating this patient.