Treatment Considerations for Patients With High-Risk, High-Burden Prostate Cancer
An expert on prostate cancer discusses treatment considerations for patients with high-risk prostate cancer who have high disease burden and other comorbidities.
EP: 1.Patient Profile 1: A 66-Year-Old-Man with Prostate Cancer
EP: 2.Imaging and Biomarker Testing Considerations in Prostate Cancer
EP: 3.Treatment Options for Patients With Prostate Cancer
EP: 4.High-Risk Prostate Cancer: Treatments Following Radical Prostatectomy
EP: 5.Patient Profile 2: A 78-Year-Old Man with Metastatic Prostate Cancer
EP: 6.Treatment Considerations for Patients With High-Risk, High-Burden Prostate Cancer
EP: 7.Unmet Needs Surrounding the Treatment of Prostate Cancer
Case #2: A 78-Year-Old Man with Metastatic Prostate Cancer
Initial Presentation
- A 78-year-old cap screening naive man presents with right hip pain and fatigue
Clinical workup
- Abnormal DRE; PSA 140 ng/mL; Hgb 9.9 g/dL
- Biopsy revealed diffuse Grade Group 4 and 5 prostate adenocarcinoma
- Imaging with CT and 99Tc bone scan revealed multiple metastatic bone lesions in the right hip and pelvis in the pelvis, liver lesions c/w mets, and a few scattered LN
Diagnosis
- Patient is diagnosed with de novo metastatic prostate cancer (de novo M1CSPC)
- Germline and somatic genetic testing are negative
This is a synopsis of a Case-Based Peer Perspectives series featuring Paul M. Yonover, MD, FACS, of Uropartners/SolarisHealth Partners.
Dr. Paul Yonover summarized key considerations in a patient with de novo metastatic castrate-sensitive prostate cancer (mCSPC) who has high risk, high tumor burden disease based on the extent of nodal, osseous and visceral metastases. He stated that a multidisciplinary approach with medical oncology is imperative to optimize systemic therapy in this scenario.
He would recommend docetaxel chemotherapy if tolerable, with escalation by adding an oral agent like darolutamide or abiraterone with prednisone based on data from studies like PEACE-1 and STAMPEDE showing improved outcomes with chemo-hormonal therapy triplets. Radiotherapy to the primary prostate tumor has shown benefit in oligometastatic, low volume mCSPC but is omitted in high burden cases like this where it is unlikely to impact outcomes. However, stereotactic body radiotherapy remains an option for selective control of symptomatic metastatic lesions. The key distinctions from low burden mCSPC are the need for intensified systemic therapy and limited role of local therapies in the setting of extensive metastatic disease.
*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.
Enzalutamide granted approval in EU for nmHSPC
April 24th 2024The approval is supported by data from the phase 3 EMBARK trial, which demonstrated that enzalutamide with or without leuprolide prolonged metastasis-free survival compared with leuprolide alone in patients with high-risk biochemically recurrent nmHSPC.
