Managing Abiraterone Intolerance: Alternative Dosing Strategies in Practice

EP: 1.A 74-Year-Old Man With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

EP: 2.Assessing Tolerability and Clinical Considerations in Abiraterone Formulation Selection

EP: 3.Formulation Matters: Tailoring Abiraterone Dosing for Optimal Absorption and Tolerability

EP: 4.The Impact of Comorbidities, Adherence, and Access on mCRPC Treatment Decisions

EP: 5.A 62-Year-Old Man With High-Risk Localized Prostate Cancer

EP: 6.The Role of Genomic Classifiers in Guiding Therapy for Localized High-Risk Prostate Cancer

EP: 7.Decision-Making and Multidisciplinary Counseling for Nodal Involvement on PSMA PET

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EP: 8.Managing Abiraterone Intolerance: Alternative Dosing Strategies in Practice

EP: 9.Incorporating Micronized Abiraterone and Low-Fat Meal Dosing: Monitoring Efficacy and Tolerability

EP: 10.Approaching Corticosteroid Selection With Abiraterone in Patients With High-Risk Localized or Locally Advanced Prostate Cancer

EP: 11.Considering Therapy De-Intensification: Balancing Adverse Effects and PSA Response

Surgical vs Radiation Therapy Considerations

This segment discusses treatment selection for patients with high-risk localized prostate cancer with questionable lymph node involvement, comparing radical prostatectomy with pelvic lymph node dissection vs radiation therapy with systemic treatment. The clinical perspective presented favors radiation-based approaches for patients with suspected nodal involvement, citing the technical advantages of radiation oncologists’ ability to treat extensive lymph node regions compared with surgical lymph node dissection limitations.

The rationale for preferring systemic therapy plus radiation includes the likelihood of microscopic lymph node involvement beyond surgically accessible regions in patients with radiographically suspicious nodes. Radiation therapy allows for treatment of broader lymph node basins while maintaining curative intent, potentially addressing occult disease that might be missed by even extended surgical dissection. This approach combines the benefits of local control through radiation with systemic disease management through hormonal therapy.

Although radical prostatectomy remains a valid treatment option for appropriately selected patients with high-risk localized disease, the discussion emphasizes the practical advantages of radiation-based treatment in cases with suspected nodal involvement. The decision ultimately requires individualized assessment considering patient factors, surgeon experience, radiation oncology expertise, and patient preferences regarding treatment-related adverse effects and recovery considerations.