Management of Advanced Prostate Cancer in Urology: Update on Androgen Receptor Inhibitors - Episode 13

Future Directions for the Management of Advanced Prostate Cancer

, , ,

Bobby Liaw, MD; Vivek K. Narayan, MD, MS; Ashley E. Ross, MD, PhD; and Neal Shore, MD, FACS, provide closing thoughts and advice for the optimal management of advanced prostate cancer.

Neal Shore, MD, FACS: I’d like for us to take this opportunity to share final thoughts. Let’s start with you, Bobby, and then Vivek and Ash. What are your closing thoughts on this field of mCSPC [metastatic castration-sensitive prostate cancer] and nmCRPC [nonmetastatic castration-resistant prostate cancer] and role for urologists and the multidisciplinary team?

Bobby Liaw, MD: With the limited discussions today, we see that the treatment landscape is evolving very quickly. There are so many more “advanced therapeutic agents” that were previously reserved for metastatic CRPC [metastatic castration-resistant prostate cancer] are making a lot of inroads into earlier disease settings. We talked more about hormone-sensitive prostate cancer and nonmetastatic CRPC, but we’ll start to see inroads in more locally advanced disease like early-stage disease as well. There are going to be continued discussions on how best to optimize treatment timing, selection, sequencing, and even combinations. More than ever, multidisciplinary care is going to be important, and how we come together to help our patients and as well as us advance our field. With that, I just want to thank you so much for the opportunity to take part in this panel.

Neal Shore, MD, FACS: Thank you. Vivek?

Vivek K. Narayan, MD, MS: I’ll offer some thoughts about the mCSPC setting. But as we talked about earlier, it’s a more involved conversation now when we have men with mCSPC presentations and what we highlighted today is that with longer-term follow-up from various clinical trials and more real-world data sets that are emerging, we’re beginning to see that across the spectrum of mCSPC. Whether it’s de novo or previously treated, hybrid, low burden, etc, we’re seeing a clear role for the use of AR [androgen receptor] inhibitors in this population with demonstrated long-term survival benefits. The take-home message is that we need to be incorporating this into the majority of patients with prostate cancer.

Neal Shore, MD, FACS: Thanks. Ash, final thoughts?

Ashley E. Ross, MD, PhD: Thank you very much. I want to echo what Vivek was saying and talk to the urologists out there. We’re the people making the diagnosis for the first time, and we want consistent and evidence-based messaging so patients are prepared for what’s going to happen next. Our messaging with all these data we presented is that we’re going to put you on combinatorial systemic therapy. It’s going to be androgen deprivation therapy [ADT] plus something else. Oftentimes, we’ll elicit a multidisciplinary team to do that. That way, we have the messaging up front that this is the standard. That’s the category 1 evidence. And you have to ask yourself questions if you’re doing ADT alone. We want to prep the patient for that. That’s why we’re doing combinational therapy, so the messaging—whether they stay with us or go to a medical oncologist and a multidisciplinary approach—is consistent and they’re not being surprised. They realize we’re doing this because they’re going to live longer on that therapy.

Neal Shore, MD, FACS: Great points. Extremely well said. Bobby Liaw from Icahn School of Medicine at Mount Sinai, Vivek Narayan from UPenn [University of Pennsylvania], Ashley Ross from Northwestern University Feinberg School of Medicine—what a star panel. Thank you so much for your great insights, interpretation of the data, and advice to our colleagues. I hope everyone finds it informative. I learned a lot. Thank you very much, and good luck moving forward and taking care of your patients.

Transcript Edited for Clarity