Treating the patient and not just the cancer: therapeutic burden in prostate cancer

Abstract

Background Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will eventually develop castration-resistant PC (CRPC). The recent approval of three, second-generation androgen receptor inhibitors (ARIs), apalutamide, enzalutamide, and darolutamide, has transformed the treatment landscape of PC. Treatment with these second-generation ARIs have produced positive trends in metastasis-free survival, progression-free survival, and overall survival. For patients with non-metastatic CRPC, who are mainly asymptomatic from their disease, maintaining quality of life is a major objective when prescribing therapy. Polypharmacy for age-related comorbidities also is common in this population and may increase the potential for drug–drug interactions (DDIs). Method This review summarizes the multiple factors that may contribute to the therapeutic burden of patients with CRPC, including the interplay between age, comorbidities, concomitant medications, the use of ARIs, and financial distress. Conclusions As the treatment landscape in PC continues to rapidly evolve, consideration must be given to the balance between therapeutic benefits and potential treatment-emergent adverse events that may be further complicated by DDIs with concomitant medications. Patient-centered communication is a crucial aspect of alleviating this burden, and healthcare professionals (HCPs) may benefit from training in effective patient communication. HCPs should closely and frequently monitor patient treatment responses, in order to better understand symptom onset and exacerbation. Patients also should be encouraged to participate in exercise programs, and health information and support groups, which may assist them in preventing or mitigating certain determinants of the therapeutic burden associated with PC and its management.

Quality of life in elderly men after a radical prostatectomy. A qualitative study

“…Participants were concerned about the loss of quality of life following a prostatectomy. Maintaining quality of life is a main aim when choosing one therapy or another in elderly men with prostate cancer [32].…”

Natural Products for the Management of Castration-Resistant Prostate Cancer: Special Focus on Nanoparticles Based Studies

“…However, the prolonged androgen excision is related to severe side effects, and the patients will ultimately acquire CRPC. When compared to their younger counterparts, older patients could be more prospective to develop aggressive forms of the disease (Moussa et al, 2020;Spratt et al, 2021).…”

New Oral Antitumor Drugs and Medication Safety in Uro-Oncology: Implications for Clinical Practice Based on a Subgroup Analysis of the AMBORA Trial

“…Therapeutic success can be endangered by, e.g., drug–drug or drug–food interactions, limited patient adherence, complex dosing regimens, and toxicity [ 2 , 6 , 7 , 8 ]. Especially, patients with prostate cancer (PC) or renal cell carcinoma (RCC) are a high-risk population for medication errors (defined as ‘any preventable event that may cause or lead to inappropriate medication use or patient harm’ [ 9 ]) due to advanced age, organ insufficiencies, and polymedication [ 10 ].…”