Advanced Prostate Cancer

Introduction: Despite the approval of numerous agents in this setting, patients with metastatic castrate-resistant prostate cancer (mCRPC) have a poor prognosis, with an estimated median overall survival (OS) of approximately three years with currently approved first-line agents.^1-3 In the “real world”, survival outcomes are even worse, with an estimated median OS of less than two years, likely due to patients in the “real world” often never receiving second- and third-line treatment regimens.⁴ As such, it is clear that new agents and/or combinations in this setting are sorely needed.

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Artificial intelligence continues to transform the field of medicine, including the management of prostate cancer. In this Center of Excellence article, we discuss the contemporary literature evaluating artificial intelligence for risk stratification after primary therapy, ADT treatment intensification, and evaluation of metastatic disease.

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While external beam radiotherapy is a standard treatment option as first-line therapy for men with localized prostate cancer, it has been more recently recognized as an important component in the care of men with metastatic prostate cancer. This Center of Excellence article will explore recent evidence for the utilization of radiotherapy in the metastatic setting.

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While PSMA PET/CT is currently FDA approved for the initial staging of patients with presumed localized, high-risk prostate cancer and for the diagnostic work up of patients with biochemical failure following primary treatment, the role of PSMA PET/CT in patients with known metastatic prostate cancer is not as well-defined. Read More

While there have been clear survival benefits for patients with metastatic castration resistant prostate cancer (mCRPC) with the use of taxane chemotherapy and novel androgen receptor targeting agents, most patients eventually progress following these treatments. Thus, there remains a need for the development of novel therapeutic approaches. As summarized below, these have included immunotherapy and targeted therapies, which are discussed in this Center of Excellence mCRPC article. Read More

Radiopharmaceuticals are pharmaceutical agents which contain radioisotopes that emit radiation, which may be used for diagnostic or treatment purposes. Historically, beta-particle emitting agents including strontium-89 (Metastron), samarium-153 (Quadramet), phosphorus-32, and rhenium-186 were used as palliative therapies for patients with symptomatic bone disease. In this context, they are quite effective in relieving bony pain but did not significantly improve survival.^1-3 Read More

While the emergence of castration resistant disease comes as a result of the disease progressing in spite of castrate levels of testosterone (at times called hormone refractory disease), prostate cancer (even in the castration resistance prostate cancer (CRPC) setting) remains heavily dependent on the androgen axis. Thus, novel treatment approaches have targeted other aspects of these signaling pathways with considerable clinical benefit. This mCRPC Center of Excellence article will focus on treatment advances related to novel hormonal therapies (NHTs).

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Prostate cancer, while commonly diagnosed as localized disease, remains the second leading cause of cancer mortality in the United States and Europe.¹ For patients who die of prostate cancer, some will be initially diagnosed and treated for metastatic hormone-sensitive disease (mHSPC) while others will progress from an initial diagnosis of localized disease through non-metastatic castration-resistant disease (nmCPRC) following initial local therapy with subsequent androgen deprivation therapy (ADT) for biochemical recurrence.

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Prostate cancer is a clinically heterogeneous disease with many patients having an indolent course requiring no interventions and others who either present with or progress to metastasis. While underlying dominant driving mutations are not widespread, there have been a number of key genomic mutations that have been consistently identified in prostate cancer patients, Read More

The coronavirus has the potential to impact the integrity and patient safety of ongoing trials as well as increase the operational burden on trial programs, therefore potentially limiting access to trials and new therapies for oncology patients. Opportunities for clinical trial enrollment may still be provided to patients during the COVID-19 outbreak, but likely require thorough evaluation on a case-by-case basis. Read More

Despite prostate cancer (PCa) being the second most common cause of cancer mortality among American men,¹ there are 2.9 million men in the United States living with PCa. As such, there are many “PCa survivors” that are either on active surveillance (AS)/watchful waiting (WW) or have undergone treatment for localized (ie. radiation therapy (RT), radical prostatectomy (RP), focal therapy, etc) or advanced disease. 

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Understanding and elucidating the underlying genetic basis of carcinogenesis has been the holy grail for cancer researchers, for both the scientific understanding of disease pathophysiology and potential therapeutic implications. Perhaps the best example of the therapeutic implications of understanding carcinogenesis come from chronic myeloid leukemia where the identification of the “Philadelphia chromosome”;

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Despite the exciting advances in treatment over the last decade for metastatic castration-resistant prostate cancer (mCRPC), the disease remains incurable with a median overall survival of 12-35 months.^1-4 Targeting the immune system to expand treatment options in the advanced disease state has resulted in significant improvements Read More

In 2018 1.3 million prostate cancer (PCa) cases were diagnosed worldwide, with approximately 20% having metastatic disease.¹ Oligometastatic PCa is defined as a state of low-volume metastatic disease that appears to be prognostically different and likely amenable to different treatment options, which could potentially change the disease trajectory when compared with high-volume metastatic disease.² Read More

In 2018 in the United States, there will be an estimated 164,690 new cases of prostate cancer (19% of all male cancer incident cases, 1st) and an estimated 29,430 prostate cancer mortalities (9% of all male cancer deaths, 2nd only to lung/bronchus cancer).¹ Over the last four decades, there was a spike Read More

The discovery of prostate-specific antigen (PSA) in the late 1970s and its widespread application and adoption in the 1980s and 1990s ushered in the prostate cancer screening and disease monitoring era. As the first tumor marker for prostate cancer, it is organ specific but not cancer specific.¹ Read More