Recent Updates in Treatment of Non-Metastatic Castration Resistant Prostate Cancer - Episode 7

Unmet Needs in nmCRPC

Aaron Berger, MD, shares unmet needs and challenges in managing patients with nmCRPC.

Audrey Sternberg: Switching gears, we’re going to go more into general treatment of patients with nonmetastatic castration-resistant prostate cancer. What would you say are the unmet needs in this setting?

Aaron Berger, MD: As far as unmet needs, one of the things that would really be helpful for us as prescribers and physicians taking care of these patients is to have more data and guidance about various drug-drug interactions. There are a lot of medications patients are on, whether it’s antihypertensives, diabetes medications, cardiovascular medications, and especially anticoagulants, that may have some interactions with these medications. The guidance as far as what we can glean from the studies isn’t always clear about what’s safe and what might not be safe. Those are difficult questions to answer. But it would be very helpful to have additional resources on that so we make sure we’re not causing any adverse events or making other important medications, like anticoagulants and antihypertensives, less effective by giving them any of these medications. That certainly is a bit of an unmet need in my eyes.

The other thing is, from a long-term perspective, will this disease state continue to be a disease state a lot longer in the future? All 3 of these studies use conventional imaging—CT and bone scan—to diagnose patients with metastasis. With the widespread use of fluciclovine PET [positron emission tomography] scans, and now a couple of different types of PSMA [prostate-specific membrane antigen] PET scans, which are much more sensitive than conventional imaging, the question will be, do these patients actually have metastasis and aren’t nonmetastatic? When you have a scan that can pick up an area of metastasis at 0.2 or 0.3 PSA [prostate-specific antigen], it may turn out that most of these patients are actually metastatic.

All of the studies were done with conventional imaging. I will typically start with conventional imaging because I’m treating them based on the trials. But as these tests become more widespread, I’ve had patients coming in who have heard about it. They want the PSMA scan. It’s starting to be done in our area. It certainly will become more widespread over the next couple of years as it gets ramped up. But that would be the big question as far as this entire disease state: Will it still be a disease state 5 years from now?

Audrey Sternberg: What clinical pearls do you have to share with colleagues who might not be seeing patients with prostate cancer every day in the clinic?

Aaron Berger, MD: The clinical pearl I would share is don’t be afraid of these medications. They’re all pretty well tolerated. With the adverse effect profiles, as long as you know the big ones to be aware of—don’t give it to patients with things like seizures, significant neurologic issues, or gait abnormalities—and what the major potential adverse effects are, don’t be afraid of these things.

Especially as urologists, from a personal point of view, we’ve known a lot of these patients for a long time. We do their biopsy, we may have done their surgery, and we may have sent them for radiation. We’ve been following them for a while. Patients like staying with who they know. For those doctors who aren’t comfortable or aren’t doing this: Anything new can be a little daunting, but I wouldn’t be afraid of these medications, because you can easily add them into your clinical practice without a lot of trepidation. And the patients would appreciate staying with the doctor who’s been taking care of them for quite some time in many cases.

Audrey Sternberg: Thank you for that. And thank you all for watching this CancerNetwork® OncView program from MJH Life Sciences™. We hope you found this to be valuable to your clinical practice.

This transcript has been edited for clarity.