Articles related to PROSTATE CANCER

Second-generation androgen receptor pathway inhibitors (ARPIs) have proven to be essential in managing nonmetastatic castration-resistant prostate cancer (nmCRPC). These treatments provide hope in delaying metastasis and improving overall survival, significantly altering the disease’s prognosis.

Explore the role of androgen deprivation therapy in prostate cancer treatment and its impact on patient survival and oncologic benefits. The recent NRG Oncology/Radiation Therapy Oncology Group study offers fresh insights on androgen deprivation therapy in prostate cancer treatment. The researchers focused on patients with intermediate-risk prostate cancer. They used a sample of 1,492 patients, randomly assigned to receive either escalated radiation therapy alone, or combined with short-term androgen deprivation therapy (ADT). Strikingly, the results didn’t point to a significant survival advantage. The five-year survival estimates were almost identical for both groups, at 90% and 91% respectively. Yet, when it comes to oncologic benefits, adding short-term ADT had a substantial impact. Importantly, this therapy reduced the risk for PSA relapse, distant metastasis, and prostate cancer-specific mortality by 48%, 75%, and 90% respectively. Also, patients on ADT exhibited a 38% lower risk of requiring salvage ADT. However, physicians need to be aware of the potential drawbacks. The study observed that the adverse event rates were notably higher with ADT use, at 69% compared to 21% for radiation therapy alone. Indeed, 12% of the ADT group experienced acute grade 3 or higher adverse events, compared to just 2% of the radiation-only group. […]

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:

During its April 28 meeting, the FDA’s Oncologic Drugs Advisory Committee (ODAC) voted 11-1 on whether access to the combination should be limited to patients whose tumors carry BRCA mutations. The majority of members shared the FDA reviewers’ concerns regarding clinical trial results and uncertainty about whether people without the BRCA mutation would benefit from the regimen. The FDA argued that the results of the phase 3 PROpel clinical trial could not be applied to patients who had not had their BRCA or HRR mutation status determined. As a result, the FDA contended that the PROpel intention-to-treat (ITT) group was heterogeneous, complicating the interpretation and application of the trial’s results to unselected patients.

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.