Managing Nonmetastatic Castration-resistant Prostate Cancer.
- Mateo J Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
- Fizazi K Institut Gustave Roussy and University of Paris Sud, Villejuif, France.
- Gillessen S Department of Oncology and Hematology, Kantonsspital St. Gallen, Switzerland.
- Heidenreich A University Hospital Aachen, Cologne, Germany.
- Perez-Lopez R Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
- Oyen WJG The Royal Marsden Hospital and The Institute of Cancer Research, London, UK.
- Shore N Carolina Urologic Research Center and Atlantic Urology Clinics, Myrtle Beach, SC, USA.
- Smith M Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Sweeney C Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
- Tombal B Cliniques Universitaires Saint Luc, Brussels, Belgium.
- Tomlins SA Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA.
- de Bono JS The Royal Marsden Hospital and The Institute of Cancer Research, London, UK. Electronic address: johann.de-bono@icr.ac.uk.
- 2018-08-19
Published in:
- European urology. - 2019
Apalutamide
Castration-resistant prostate cancer
Enzalutamide
Imaging biomarkers
Metastasis-free survival
Nonmetastatic castration-resistant prostate cancer
Prostate-specific antigen doubling time
Androgen Antagonists
Antineoplastic Agents
Humans
Kallikreins
Magnetic Resonance Imaging
Male
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Prostate-Specific Antigen
Prostatic Neoplasms, Castration-Resistant
Tomography, X-Ray Computed
Treatment Outcome
Whole Body Imaging
English
CONTEXT
Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have rising prostate-specific antigen (PSA) and castrate testosterone levels, with no radiological findings of metastatic disease on computed tomography and bone scan. Given recent drug approvals for nmCRPC, with many other therapeutics and imaging modalities being developed, management of nmCRPC is a rapidly evolving field that merits detailed investigation.
OBJECTIVE
To review current nmCRPC management practices and identify opportunities for improving care of nmCRPC patients.
EVIDENCE ACQUISITION
A literature search up to July 2018 was conducted, including clinical trials and clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, European Association of Urology, Prostate Cancer Clinical Trials Working Group, Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence). Keywords included prostate cancer, nonmetastatic, castration resistance, rising PSA, and biochemical relapse.
EVIDENCE SYNTHESIS
Recommendations regarding indications for, and frequency of, imaging and PSA testing, as well as for initiating systemic therapy in nmCRPC are based on PSA rise kinetics and symptoms. Both enzalutamide and apalutamide have been shown to significantly increase metastasis-free survival in phase III placebo-controlled randomised trials in nmCRPC patients with PSA doubling time (DT) ≤10 mo. The expected impact of new imaging techniques in the assessment of nmCRPC is also reviewed.
CONCLUSIONS
nmCRPC is a heterogeneous disease; while observation may be an option for some patients, enzalutamide and apalutamide may be appropriate to treat nmCRPC patients with PSA-DT ≤10 mo. The emergence of more accurate imaging modalities as well as circulating tumour biomarker assays will likely redefine the assessment of nmCRPC in the near future.
PATIENT SUMMARY
Herein, we review key literature and clinical practice guidelines to summarise the optimal management of patients with prostate cancer and rising prostate-specific antigen despite castrate testosterone levels, but with no evidence of distant metastasis on traditional imaging. New drugs are being developed for this disease setting; novel imaging and tumour biomarker blood tests are likely to define this disease state more accurately.
Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have rising prostate-specific antigen (PSA) and castrate testosterone levels, with no radiological findings of metastatic disease on computed tomography and bone scan. Given recent drug approvals for nmCRPC, with many other therapeutics and imaging modalities being developed, management of nmCRPC is a rapidly evolving field that merits detailed investigation.
OBJECTIVE
To review current nmCRPC management practices and identify opportunities for improving care of nmCRPC patients.
EVIDENCE ACQUISITION
A literature search up to July 2018 was conducted, including clinical trials and clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, European Association of Urology, Prostate Cancer Clinical Trials Working Group, Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence). Keywords included prostate cancer, nonmetastatic, castration resistance, rising PSA, and biochemical relapse.
EVIDENCE SYNTHESIS
Recommendations regarding indications for, and frequency of, imaging and PSA testing, as well as for initiating systemic therapy in nmCRPC are based on PSA rise kinetics and symptoms. Both enzalutamide and apalutamide have been shown to significantly increase metastasis-free survival in phase III placebo-controlled randomised trials in nmCRPC patients with PSA doubling time (DT) ≤10 mo. The expected impact of new imaging techniques in the assessment of nmCRPC is also reviewed.
CONCLUSIONS
nmCRPC is a heterogeneous disease; while observation may be an option for some patients, enzalutamide and apalutamide may be appropriate to treat nmCRPC patients with PSA-DT ≤10 mo. The emergence of more accurate imaging modalities as well as circulating tumour biomarker assays will likely redefine the assessment of nmCRPC in the near future.
PATIENT SUMMARY
Herein, we review key literature and clinical practice guidelines to summarise the optimal management of patients with prostate cancer and rising prostate-specific antigen despite castrate testosterone levels, but with no evidence of distant metastasis on traditional imaging. New drugs are being developed for this disease setting; novel imaging and tumour biomarker blood tests are likely to define this disease state more accurately.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.eururo.2018.07.035
- PMID 30119985
- Persistent URL
- https://sonar.ch/global/documents/291212
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