Opinion
Video
Author(s):
A panelist discusses how patients with high-risk localized prostate cancer receiving treatment intensification should complete an 18- to 24-month course of systemic therapy with radiation for optimal cure rates, rather than stopping early due to prostate-specific antigen (PSA) response alone.
Treatment Duration and Monitoring in High-Risk Localized Disease
This segment outlines the recommended treatment approach and monitoring strategy for patients with high-risk localized prostate cancer receiving intensified systemic therapy. The standard treatment protocol involves 18 to 24 months of combined androgen deprivation therapy and abiraterone alongside definitive radiation therapy, with the goal of achieving cure rather than palliation. This intensive approach aims to eradicate both local and potential micrometastatic disease through comprehensive systemic and local treatment modalities.
Most patients achieving optimal response will experience PSA reduction to very low or undetectable levels, with treatment continuation based on predetermined duration rather than PSA thresholds alone. The protocol emphasizes completing the full 18- to 24-month course whenever possible to maximize curative potential, with treatment modifications considered only for significant tolerability issues or adverse effects that cannot be managed through formulation changes or supportive care measures.
For patients experiencing persistent tolerability problems despite alternative abiraterone formulations, treatment de-escalation to androgen deprivation therapy alone combined with radiation remains an acceptable approach. However, the segment emphasizes that optimal outcomes require completion of the full intensive treatment protocol when medically feasible, balancing the curative potential of treatment intensification against individual patient tolerance and quality of life considerations. Long-term monitoring focuses on PSA surveillance to detect any evidence of disease recurrence following treatment completion.
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