Precision Medicine and Patient Selection in mHSPC

In this video, Scott Sellinger, MD, FACS, discusses factors beyond the presence of PTEN deficiency that may influence how clinicians approach capivasertib (Truqap) treatment in metastatic hormone-sensitive prostate cancer. He highlights the importance of understanding the degree of PTEN loss, noting that post hoc analyses from CAPItello-281 suggested patients with the highest levels of PTEN loss, particularly those with 99% to 100% loss by immunohistochemistry, appeared to derive a greater radiographic progression-free survival benefit. Sellinger emphasizes the need for accurate reporting of the extent of PTEN loss so clinicians can identify patients who may be most likely to benefit from treatment intensification.

Sellinger also addresses the importance of multidisciplinary care when introducing capivasertib into practice, particularly as many urologists may be less familiar with managing AKT inhibitors. He recommends involving medical oncologists, advanced practice providers, nurse navigators, and other members of the care team to support patient education, toxicity monitoring, and risk mitigation. While some urologists may not directly prescribe or manage all aspects of therapy, he stresses that understanding the expected adverse events and treatment considerations remains important because urologists will continue to be involved in patients’ care.

Looking more broadly, Sellinger frames capivasertib’s approval as another step toward a precision medicine approach in prostate cancer, where biomarkers increasingly guide treatment selection rather than relying on uniform treatment strategies. He explains that inhibition of the AKT pathway alongside androgen receptor pathway targeting represents a complementary approach designed to more effectively suppress tumor growth. Moving forward, he notes that ongoing questions will focus on identifying which patients require treatment intensification and how clinicians can best balance therapeutic benefit with toxicity. His key message for community urologists is the importance of recognizing patients with significant PTEN loss in the metastatic hormone-sensitive setting, as missing these patients could mean overlooking an opportunity for a targeted treatment approach.