Navigating the M0 Space

Posted by E. David Crawford, MD | Jun 2019

E. David Crawford, MD, presented “Navigating the M0 Space” during the 27th Annual Perspectives in Urology: Point Counterpoint on November 9, 2018 in Scottsdale, Arizona.

How to cite: Crawford, E. David. “Navigating the M0 Space” November 9, 2018. Accessed Nov 2024. https://grandroundsinurology.com/navigating-the-m0-space/

Navigating the M0 Space Summary:

E. David Crawford, MD, reviews the historical developments in androgen deprivation therapy (ADT) for prostate cancer and the emergence of the non-metastatic castration-resistant, or M0, prostate cancer. He then describes future directions for treatment options for these patients with a focus on androgen pathway inhibitors.

Abstract:

The concept of androgen deprivation therapy (ADT) to control prostate cancer goes back to the 1780s. At that time, the surgeon John Hunter established the relationship between castration and the size of the prostate gland. Since then, there have been historical developments in ADT. Major developments include the advent of luteinizing hormone-releasing hormone (LHRH) agonists in the 1970s, antiandrogens in 1995, and finally third-generation antiandrogens in recent years.

However, there are significant quality of life and medical issues, notably cardiovascular adverse events, associated with ADT. In addition to these issues, ADT had played a role in the development of a new challenge facing physicians.

Perhaps due to the use of ADT in cases of biochemical failure, an iatrogenic space called non-metastatic castration-resistant prostate cancer (nmCRPC), or M0 disease, has emerged. The definition of M0 disease is the presence of biochemical progression with no radiographic progression despite castrate levels of testosterone.

Treating these patients, with the goals of prolonging life, preventing pain and complications, as well as preserving quality of life and performance status, can be a challenge for physicians to navigate. The American Urological Association (AUA) has published guidelines for clinical decision-making in CRPC. Also, research shows prostate-specific antigen doubling time (PSDAT) can help physicians risk-stratify patients with nmCRPC, as well as predict bone metastasis and death. However, there are still many unanswered questions in this space.

In the future, androgen pathway inhibitors could address this unmet need. This presentation reviews the mechanisms, major trials evaluating, and reported adverse events of abiraterone acetate, enzalutamide, and apalutamide in patients with M0 disease. Antiandrogen monotherapy without ADT might be an optimal treatment method. However, there is much research still needed on ADT and M0 space.

About Perspectives in Urology: Point Counterpoint

Perspectives in Urology: Point Counterpoint (PCP) is an annual CME-accredited conference devoted to discussing and debating the latest topics in men’s health, general urology, and genitourinary cancers. The conference’s format includes more than didactic lectures. It also includes debates, point-counterpoint discussion panels, and unique case-based presentations. Dr. Crawford presented this lecture during the 27th PCP in 2018. Please visit this page in order to register for future PCP meetings.

ABOUT THE AUTHOR

E. David Crawford, MD

Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.

About The Author

E. David Crawford, MD

Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles. Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians. In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC. Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world. Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf. Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal. He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.

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