Resolution of the Expert Council on the New Approach to Drug Therapy for Non-Metastatic Castration-Resistant Prostate Cancer

Abstract

Relevance: Prostate cancer (PC) is one of the most common
 malignant neoplasms in the male population. The widespread
 introduction of modern diagnostic methods and the determination of prostate-specific antigen (PSA) levels have increased
 the number of detected cases of localized and locally advanced
 PC forms. However, in some patients treated with radical
 methods and long-term androgen deprivation therapy (ADT),
 the disease continues to progress in the form of an increase in
 PSA levels with castration testosterone values and with no distant metastases. Such a course of the disease is referred to as
 non-metastatic castration-resistant prostate cancer (nmCRPC).
 Purpose: The article reports the results of a meeting of the
 Expert Council arranged by the Kazakh Research Institute of
 Oncology and Radiology on December 25, 2020, on non-metastatic castration-resistant prostate cancer diagnostics and
 treatment.
 Results: Large clinical studies highlight the critical importance of controlling the PSA doubling time as the main prognostic factor for an unfavorable outcome to increase patient
 survival and prevent the development of distant metastases.
 Based on the results of large randomized studies, experts
 recommended using new-generation androgen receptor antagonists in combination with ongoing ADT to improve the
 clinical outcomes in nmCRPC patients at high risk of metastatic
 progression. The Expert Council was presented with the data of
 a registration clinical study on darolutamide efficacy and safety. The advantages of introducing this drug into clinical practice to expand the choice of therapeutic options were identified.
 Personalized adjustment of a treatment regimen will increase
 the treatment efficacy and ensure higher survival in this category of patients.
 Conclusion: Increasing survival as the main objective
 in treating nmCRPC patients requires improved diagnostics
 through regular controlling of testosterone and PSA levels, calculation of PSA doubling time, and the use of radiological diagnostic methods to rule out distant metastases. The choice of
 therapy in patients at high risk of metastasis shall consider the
 patient’s status and the treatment efficacy and safety balance.