In a nutshell
This review summarized clinical guidelines for treating prostate cancer (PC) recommended by the European Society for Medical Oncology (ESMO). The main recommendation was that all therapies should be risk-based and personalized.
Some background
Treatment recommendations for PC can vary across countries and time periods. It is important to update them based on the latest clinical evidence found by ESMO.
Methods & findings
Localized PC (LPC) means tumors confined to the prostate gland. Men with low-risk LPC should be monitored actively or given radical prostatectomy (RP) or radiation therapy (RT). RP means surgical removal of the prostate. RP or RT are also recommended for men with intermediate-risk (IR) LPC.
Locally-advanced PC refers to cancers starting to spread out of the prostate. Such conditions in high-risk (HR) patients should be treated by high-dose RT plus androgen deprivation therapy (ADT). ADT deactivates male sex hormones to inhibit the growth of PC. ADT should be given to men receiving RT for 4-6 months for IR and 18-36 months for HR disease. Docetaxel (Taxotere) chemotherapy may be considered before RT for young, fit men with very HR-LPC.
The prostate-specific antigen (PSA) level must be monitored in patients after RP. PSA is a specialized prostate gland protein whose higher levels indicate cancer progression. PSA failure or biochemical relapse (BCR) refers to rising blood-PSA levels after surgery. In such cases, salvage RT (SRT) is recommended to prevent metastasis or cancer spreading. Otherwise, RT after RP is not favorable. Men facing BCR should avoid receiving early ADT unless they have proven metastasis or their PSA levels rise rapidly. ADT must only be given intermittently for those starting ADT after BCR without evidence of metastasis.
Men with metastatic hormone naïve prostate cancer (mHNPC) are the ones without prior ADT and are responsive to ADT. For such patients, ADT can be given in combination with either abiraterone (Zytiga), prednisone (Deltasone), apalutamide (Erleada), docetaxel or enzalutamide (Xtandi). For men with mHNPC who are unfit for the aforementioned drugs, ADT can be given alone.
Castration-resistant PC (CRPC) defines cancer which is unresponsive to ADT. In men with non-metastatic-CRPC and higher risks of disease progression, apalutamide, darolutamide (Nubeqa), or enzalutamide are recommended.
Docetaxel is recommended for men with metastatic CRPC (mCRPC). For men with mCRPC and mild symptoms who had no prior chemotherapy, abiraterone or enzalutamide are recommended. Skeletal-related events (SREs) mean bone fracture or spinal cord injury due to cancer spreading to the bones. Patients with CRPC and high risks of SREs should receive denosumab (Prolia) or bisphosphonate based treatment. Testing for cancerous genetic defects in patients with mCRPC is also recommended.
The bottom line
This article provided the latest ESMO recommendation for the management of patients with prostate cancer.
Published By :
Annals of oncology: official journal of the European Society for Medical Oncology
Date :
Jun 25, 2020
