Treatment Options in Metastatic Castration-Sensitive Prostate Cancer - Episode 12

Recent Updates in Prostate Cancer Care

Dr Choudhury shares recent updates from 2021 meetings including ASCO GU, AUA, and ESMO.

Atish Choudhury, MD, PhD: I think the main change and the main update to the updated data that has been presented over the past year is this addition of triplet therapy to our armamentarium. The use of docetaxel in combination with abiraterone or darolutamide, whenever that becomes approved in this space. That really does help answer a question that many people are asking, which is, if somebody is treated with docetaxel, is there a rationale for further intensification of treatment with an AR pathway inhibitor immediately afterwards, or is it safe to wait until progression?

I would say that the data from those studies would suggest that the second agent should be initiated at some point prior to true radiographic progression, and whether it’s at completion of docetaxel, somewhere in the middle, or even prior to starting docetaxel, I think we really don’t know yet.

The other data that’s critical to understand for us as a society is the fact that over 50% of patients were presenting with metastatic castration-sensitive prostate cancer are being treated with ADT [androgen deprivation therapy] alone. Again, there are very few patients for whom that is the most optimal treatment strategy, in my opinion.

So, patients with high-volume disease who need rapid cytoreduction would benefit from more intensive therapy, but really all patients would benefit from some form of intensification. That is the most important lesson that we’ve learned over the past year, and the quality-of-life data that has been presented recently from all of those studies really justifies that patients’ quality of life is actually better with the addition of these other agents, even though many providers are concerned about their toxicities.

Transcript edited for clarity.