Recommendations for second-line therapy in men with hormone-resistant prostate cancer

This review outlined the opinions of the American Society of Clinical Oncology for the treatment of hormone therapy resistant men with prostate cancer.

Advanced prostate cancer is cancer that has spread outside the prostate gland into surrounding organs. In some cases, cancer can become hormone-resistant. This is when the cancer no longer responds to hormone therapies (those that target the male sex hormones active in prostate cancer, such as testosterone). Signs of resistance (progression of the cancer despite treatment) can be asymptomatic (no symptoms) with signs of biochemical recurrence. This is an increase in prostate specific antigen (PSA – protein elevated in the blood in the presence of prostate cancer). They can also manifest in additional tumors with few symptoms.

When patients develop a resistance to hormone therapy, second-line therapies can be considered. This may be a different form of hormone therapy or a combination of other treatments. The American Society of Clinical Oncology (ASCO) gathered a group of experts to provide recommendations for the use of second-line treatments in men with hormone resistant prostate cancer. In particular, they offer recommendations for men who have not been treated with chemotherapy (chemotherapy-naïve).

The aim of this study was to determine the best second-line hormone treatment options for chemotherapy-naïve men with hormone-resistant prostate cancer. The ASCO reviewed the results of six randomized trials in making their recommendations.

Second-line therapies that lowered or slowed a rise in PSA levels were recommended for chemotherapy-naïve patients who were at risk of developing new tumors. Abiraterone acetate (Zytiga) plus prednisone (Prednisone intensol) or enzalutamide (Xtandi) should be offered after first-line hormone treatment failure with evidence of tumor growth. These treatments have been recommended in patients as they have been shown to increase progression-free survival (time from treatment until disease progression) and overall survival (time from treatment until death from any cause) rates.

In chemotherapy-naïve patients with low-risk cancer and a low risk of tumor growth (defined as low PSA levels) second-line therapy was not recommended. PSA levels should be checked every 4 to 6 months in men with no evidence of tumors.

This review outlined the opinions of the American Society of Clinical Oncology for the treatment of hormone therapy resistant men with prostate cancer.