Abstract
Most prostate cancer cases present as localised disease at initial diagnosis but can progress in about a fifth of patients to castration-resistant prostate cancer (CRPC) within 5 years. A major concern for patients and physicians is the development of metastases, affecting quality of life (QoL), and reducing overall survival (OS). Treatment guidelines for the different stages of prostate cancer continue to be modified with the publication of clinical trial results. Currently, androgen receptor inhibitors (ARi) are used in the management of non-metastatic CRPC. Among these, explained Martin Bögemann, Department of Urology, University of Münster, Germany, darolutamide’s unique structure means it causes minimal side effects, likely due to reduced blood-brain barrier penetration, while also reducing the potential for drug-drug interactions, which is especially important for patients treated for comorbidities. Treatment of metastatic hormone-sensitive prostate cancer (mHSPC) depends on a variety of factors, including when metastases developed in the course of disease and their volume. Bertrand Tombal, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Belgium, described the evolution of mHSPC therapy from androgen deprivation therapy (ADT) and surgical castration as the only available options, to the emergence of the chemotherapeutic docetaxel and androgen receptor pathway inhibition (ARPI). He explained the results of Phase III clinical trials of various combination approaches, with a combination treatment of docetaxel, ADT, and darolutamide showing promise for overall survival. Discussions are ongoing about which patients with mHSPC should receive this triple therapy approach. Christian Gratzke, Department of Urology, University Hospital Freiburg, Germany followed by describing how treatment decisions are made, including the role of imaging, with a case study of a patient with non-metastatic castration-resistant prostate cancer (nmCRPC), and another with mHSPC. A further panel discussion considered treatment options for various presentations of prostate cancer, and why one would be chosen over another. The panel concluded with a question and answer sessions that focused on when and why patients with prostate cancer are sent for genetic testing.
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