Topic: Advanced Disease

How to Best Select Doublet vs. Triplet Therapy in MCSPC

by Scott B. Sellinger, MD | Dec 2024

Scott B. Sellinger, MD, FACS, addresses key considerations in deciding between doublet and triplet therapies for metastatic castration-sensitive prostate cancer.

In this 12-minute presentation, Dr. Sellinger highlights the superiority of androgen deprivation therapy (ADT) combined with androgen pathway inhibitors. He discusses evidence from pivotal trials, including TITAN, ARCHES, PEACE-1, and ARASENS, demonstrating that doublet and triplet therapies offer superior survival benefits compared to ADT alone.

Sellinger emphasizes that selecting between doublet and triplet therapy is both an art and a science, balancing clinical guidelines with patient-specific factors such as age, comorbidities, and access to treatment. While higher volume and symptomatic patients might benefit from more intensive triplet therapy, the importance of patient preference, PSA response, and cost considerations is underscored. He suggests that establishing clearer guidelines on doublet versus triplet therapy could help practitioners make more confident decisions for their patients in this nuanced field.

Novel Ways of Targeting the Androgen Receptor

by Daniel P. Petrylak, MD | Nov 2024

Daniel P. Petrylak, MD, explores novel approaches for targeting the androgen receptor (AR) in prostate cancer, highlighting that around 90% of prostate cancer specimens express the androgen receptor, which persists through castrate resistance.

In this 7-minute talk, Dr. Petrylak focuses on targeting the AR ligand-binding domain with molecules known as proteolysis-targeting chimeras (PROTACs). Laboratory findings reveal that PROTACs can degrade AR variants resistant to traditional therapies like enzalutamide, showing efficacy against androgen gene amplification mutations.

He shares that ARV-110, a PROTAC developed for clinical use, showed promise in phase 1 trials with castration-resistant prostate cancer patients. However, due to significant side effects, the ARV-110 trials were abandoned in favor of a newer compound, ARV-766. While ARV-110 has demonstrated efficacy in castration-resistant prostate cancer, ARV-766 offers a broader range of AR degradation with improved patient tolerance, making it the preferred candidate for continued clinical evaluation.

Cardiometabolic Health for Men with Advanced Prostate Cancer: Lessons Learned and Future Directions

by Andrew W. Hahn, MD | Sep 2024

Andrew W. Hahn, MD, addresses cardiometabolic health in men with advanced prostate cancer, focusing on the impacts of hormone therapy and strategies for managing cardiovascular risks.

In this 10-minute talk, Dr. Hahn highlights the common overlap of prostate cancer and cardiometabolic risk factors and underscores the necessity of evaluating cardiovascular risk in prostate cancer patients. He reviews data indicating that androgen deprivation therapy (ADT) can indirectly increase cardiovascular risks by altering body composition and intensifying metabolic syndrome. Adding androgen receptors nearly doubles cardiovascular event risk. Despite FDA advisories, guidelines, and the availability of cardiovascular risk assessments, many patients undergoing ADT lack appropriate cardiovascular monitoring.

Dr. Hahn highlights future directions in identifying men at heightened risk for cardiovascular events using imaging and genomic biomarkers. Promising approaches include myocardial perfusion PET scans and exploring genomic markers that correlate with cardiovascular toxicity in hormone therapy. Managing cardiometabolic health in advanced prostate cancer requires careful risk assessment and personalized approaches. Biomarkers are needed to effectively predict cardiovascular complications from hormone therapy.

Integrating Care in Advanced Prostate Cancer

by John W. Davis, MD | Sep 2024

John W. Davis, MD, addresses the economic burden and stress experienced by patients due to high treatment costs in advanced prostate cancer (APC) management. He stresses that this aspect of APC care often goes under-discussed.

In this 11-minute presentation, Dr. Davis highlights direct costs such as medications, hospital stays, and physician fees, as well as indirect costs including lost income and travel expenses. He emphasizes that these financial strains can lead to treatment non-adherence, delayed care, and worsened clinical outcomes.

John W. Davis, MD, highlights the different ways integrated care models can be adopted across healthcare systems to enhance the management of advanced prostate cancer. By fostering a collaborative approach and eliminating barriers, Dr. Davis believes that the future of advanced prostate cancer care will be strengthened.

PARPi in mCRPC

by Daniel P. Petrylak, MD | Sep 2024

Daniel P. Petrylak, MD, Yale University Cancer Center, New Haven, Connecticut, summarizes the current and future role of PARP inhibitors in mCRPC, providing valuable insights into their clinical application and potential to improve patient outcomes.

In this 9-minute presentation, Dr. Henderson highlights direct costs such as medications, hospital stays, and physician fees, as well as indirect costs including lost income and travel expenses. He emphasizes that these financial strains can lead to treatment non-adherence, delayed care, and worsened clinical outcomes.

Dr. Henderson discusses various strategies and interventions to address these challenges, underscoring the importance of policy changes at the institutional and governmental levels to improve access to affordable care.

The Importance of Diagnosing and Treating Oligometastatic Prostate Cancer and ADT Usage

by Marc B. Garnick, MD | Jun 2024

Dr. Marc Garnick explores the diagnosis and treatment of oligometastatic prostate cancer with the strategic use of androgen deprivation therapy (ADT). Advanced imaging techniques are essential for identifying oligometastatic disease, such as PET scans and advanced MRI. These technologies enhance the precision of detecting small metastatic lesions, facilitating timely and appropriate treatment decisions. By reducing androgen levels that fuel prostate cancer growth, the strategic use of ADT not only helps in controlling the primary tumor but also in managing metastatic lesions, thereby extending the therapeutic window and improving overall survival rates.
Dr. Garnick also addresses the timing and duration of ADT in the context of oligometastatic prostate cancer. He highlights individualized treatment plans based on patient-specific factors, including the extent of disease, patient health status, and response to initial therapies. This personalized approach ensures that patients receive the most effective treatment while minimizing potential side effects associated with prolonged ADT usage.

International, Multi-Disciplinary Consensus on Treatment of Advanced Prostate Cancer

by Silke Gillessen, MD | Jun 2024

Silke Gillessen, MD analyzes the international, multi-disciplinary consensus on the treatment of advanced prostate cancer, emphasizing the collaborative efforts of experts from various medical fields. She highlights the critical importance of integrating diverse perspectives to develop effective treatment protocols.

The consensus process involves an extensive review of clinical data, expert opinions, and patient outcomes, ensuring that the recommendations are evidence-based and practical. Dr. Gillessen discusses key areas of agreement for treatment, including hormone therapy, chemotherapy, and novel targeted therapies.

Dr. Gillessen highlights the potential of new treatment modalities, such as PARP inhibitors and immunotherapies. Moreover, she advocates for treatment plans tailored to individual patient profiles, taking into account genetic, molecular, and clinical factors. This approach aims to enhance treatment efficacy and minimize adverse effects, aligning with the principles of precision oncology.

Understanding Metastatic Castration-Resistant Prostate Cancer

by Shell Liang, PhD | Jun 2024

Shell Liang, PhD, discusses metastatic castration-resistant prostate cancer (mCRPC), a form of prostate cancer that progresses despite androgen deprivation therapy (ADT). Dr. Liang emphasizes the critical need for advanced therapeutic strategies to manage this aggressive cancer subtype effectively.
The presentation reviews the current therapeutic landscape for mCRPC, focusing on second-generation AR pathway inhibitors such as abiraterone and enzalutamide. Additionally, the discussion includes the role of chemotherapeutic agents like docetaxel and cabazitaxel. Dr. Liang also explores emerging treatment modalities, including PARP inhibitors and immunotherapies.
Dr. Liang advocates using genomic profiling to identify actionable mutations and tailor treatments to individual patient profiles. This approach aims to optimize therapeutic efficacy and minimize adverse effects, aligning with the principles of precision medicine.

Choosing Systemic Therapy for Men with Metastatic Hormone Sensitive Prostate Cancer

by Andrew W. Hahn, MD | Jun 2024

Andrew W. Hahn, MD, analyzes systemic therapy choices for men with metastatic hormone-sensitive prostate cancer. His presentation delves into the critical factors influencing treatment decisions and the latest advancements in therapeutic options.
Dr. Hahn begins by outlining current systemic therapies, including androgen deprivation therapy (ADT) and its combination with other agents. By discussing the mechanisms of action and the efficacy of various therapeutic agents, Dr. Hahn provides a detailed examination of the available treatment options.
Dr. Hahn also addresses the role of personalized medicine in managing metastatic hormone-sensitive prostate cancer. He highlights the importance of genetic profiling and biomarker testing in tailoring treatment plans to individual patients.
Throughout the presentation, Dr. Hahn underscores the dynamic nature of prostate cancer treatment, with ongoing research continually informing and refining clinical practice.

Advanced Prostate Cancer: Sequencing of Treatment

by Arnulf Stenzl, MD | Jun 2024

Arnulf Stenzl, MD, discusses the challenges of appropriately sequencing advanced prostate cancer treatment and presents possible solutions. In his presentation, he addresses:

Recent and Anticipated Changes in Advanced Prostate Cancer Treatment
The Issue of Physician Information Overload
The Lack of Easily Accessible Comparative Data Between Agents
Possible Applications of Artificial Intelligence in Literature Searches

PSMA in Metastatic Prostate Cancer: Imaging as Biomarker

by Louise Emmett, MD | Jun 2024

Louise Emmett, MD, addresses prostate-specific membrane antigen (PSMA) in metastatic prostate cancer, focusing on imaging as a biomarker.

Multi-Disciplinary Approach to Advanced Prostate Cancer Care

by Kelvin A. Moses, MD, PhD, FACS | May 2024

Kelvin A. Moses, MD, PhD, FACS, explores a multidisciplinary approach to advanced prostate cancer care and treatment.

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