Implementing newer agents for the management of castrate‐resistant prostate cancer: what is known and what is needed?

Abstract

Men receiving androgen-deprivation therapy will in time develop metastatic castrate-resistant prostate cancer (mCRPC). Whilst effective treatment options for mCRPC have traditionally been limited, new agents are becoming available. Since 2010, the number and class of agents available to treat mCRPC has increased dramatically. As such, there is a need for clear guidance on the optimum treatment and sequence of treatments for mCRPC before and after chemotherapy. This evidence-based statement, reflecting the views of the authors, provides suggestions on the continued relevance of conventional approaches to first-and second-line treatment in mCRPC, the potential role of novel treatments, and factors that may influence the choice of hormonal agents and/or chemotherapy.Keywords castrate-resistant prostate cancer, individualised management, new agents, evidence-based best practice

Patients’ Preferences for the Treatment of Metastatic Castrate-resistant Prostate Cancer: A Discrete Choice Experiment

“…[9][10][11] mCRPC is also associated with other symptoms, including anxiety, diarrhea, sleep disturbances, rash, vomiting, anemia, and urinary symptoms. 10,12 Fatigue is also a predominant symptom of the disease and is the most common adverse event associated with treatments for mCRPC. 13 These symptoms, together with the patients' treatmentrelated side effects, can have a significant impact on health-related quality of life (HRQOL).…”

Accuracy of real‐time magnetic resonance imaging‐transrectal ultrasound fusion image‐guided transperineal target biopsy with needle tracking with a mechanical position‐encoded stepper in detecting significant prostate cancer in biopsy‐naïve men

“…mpMRI is increasingly used to diagnose clinically significant PCa, because of its growing availability, and advances that combine anatomical and functional data . In the 2014 European Association of Urology guideline, mpMRI was considered to be a particularly accurate method of detecting anterior tumors that are usually missed by systematic biopsy and therefore trigger a repeat (targeted) biopsy . As the cost‐effectiveness of mpMRI as a triage test before the initial biopsy has not been assessed, less evidence exists for its use in primary biopsies than repeat biopsies .…”

“…In the 2014 European Association of Urology guideline, mpMRI was considered to be a particularly accurate method of detecting anterior tumors that are usually missed by systematic biopsy and therefore trigger a repeat (targeted) biopsy . As the cost‐effectiveness of mpMRI as a triage test before the initial biopsy has not been assessed, less evidence exists for its use in primary biopsies than repeat biopsies . However, the efficacy of mpMRI for detecting PCa has been widely verified.…”

Frühe vs. spätere Therapie mit Abirateron plus Prednison bei chemotherapie-naiven, asymptomatischen bis mild symptomatischen Patienten mit metastasiertem CRPC nach Androgendeprivation

“…schen Patienten mit gutem Allgemeinzustand und ohne viszerale Metastasierung. Eine Docetaxel-Therapie wird dort nicht eindeutig empfohlen [14].…”

“…Gesicherte Daten zur Wirksamkeit einer Behandlung mit früh einsetzender Therapie, d. h. unmittelbar nach Auftreten des mCRPC, im Gegensatz zu einer später einsetzenden Therapie, d. h. Zweitlinienbehandlung von mCRPC-Patienten nach sekundärer Hormonmanipulation mit einem Erstgenerationsantiandrogen wie Bicalutamid oder Flutamid, sind bisher nicht für alle zugelassenen Therapieoptionen oder nur eingeschränkt verfügbar. Obwohl die neuen Leitlinien [14] die potenzielle Rolle der frühzeitigen Anwendung neuer antihormoneller Substanzen wie AA + P bereits bei Chemotherapie-naiven Patienten betonen, ist nicht bekannt, inwieweit sich dies in den täglichen therapeutischen Routine-Entscheidungen widerspiegelt. Die vorliegende nicht-interventionelle Studie konzentriert sich daher auf Docetaxel-naive, mCRPC-Patienten, die bereits mit AA + P in der täglichen Praxis behandelt wurden, wobei frühe (AA + P ohne vorheriges Erstgenerationsantiandrogen nach Kastrationsresistenz) von späteren Anwendungen (AA + P im Anschluss an eine gescheiterte Therapie mit Antiandrogen nach Kastrationsresistenz) unterschieden werden sollen.…”