Opinion|Videos|November 15, 2024
Managing Biochemical Recurrence in Prostate Cancer: Risk Stratification and Treatment Decisions
Key Takeaways
- Management options for nmCSPC include active surveillance, radiotherapy, surgery, and systemic therapy, guided by NCCN recommendations.
- High-volume symptomatic patients with minimal comorbidities may benefit from triplet therapy, including docetaxel, darolutamide, and androgen deprivation therapy.
Panelists discuss how management options for nonmetastatic castration-sensitive prostate cancer (nmCSPC) include active surveillance, radiotherapy, and systemic therapy, with recommendations influenced by factors such as tumor volume, prostate-specific antigen (PSA) doubling time, and patient life expectancy, particularly for those with high-volume symptomatic disease.
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Episodes in this series
Video content above is prompted by the following:
- What management options are available for nmCSPC? What factors influence whether you recommend active surveillance vs active treatment?
- National Comprehensive Cancer Network (NCCN) recommendations (active surveillance, radiotherapy, surgery, systemic therapy) (
NCCN, Prostate Cancer, v4.2024 ;Moreira et al, Cancer Manag Res, 2021 ) - Patients with high-volume symptomatic disease, without significant comorbidities, and long life expectancy could receive triplet therapy ofdocetaxel, darolutamide, and androgen deprivation therapy (ARASENS trial:
Hussain et al, J Clin Oncol, 2023 ; PEACE-1 trial:Bossi et al. J Clin Oncol, 2023 )
- National Comprehensive Cancer Network (NCCN) recommendations (active surveillance, radiotherapy, surgery, systemic therapy) (
- Role of the multidisciplinary care team in patient management
- Practical considerations: tumor volume, PSA/PSA doubling time
- Biochemical recurrence (BCR): PSA doubling time less than 12 months considered at high risk for rapid disease progression and death (
Markowski et al, Clin Gen Cancer, 2019 ) - Treatment considerations in trying to delay progression, 30% with BCR will develop metastatic disease (
Antonarakis et al, BJU Int, 2012 )- How can progression to metastatic disease be delayed?
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