Topic: Metastatic Prostate Cancer

Clinical Case Discussion: Metastatic Prostate Cancer and Evidence for More Precision Therapy

A. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine, introduces a metastatic prostate cancer case, and through it explores and reviews treatment options. He discusses homologous recombination and the role that it plays in DNA repair pathways, noting that 25% of patients with advanced prostate cancer have deleterious mutations in DNA damage repair genes which lead to an increased risk of prostate cancer and chance of having nodal and/or distant metastases. Dr. Yen then reviews the TRITON2 study on rucaparib in mCRPC patients with homologous recombination deficiency and the PROfound study on olaparib in mCRPC patients with homologous recombination repair alterations, both of which found a far greater response to treatment in the cohorts with the target mutations. Next, Dr. Yen discusses PARP inhibitors and their side effects, such as fatigue, nausea, pulmonary embolism, anemia, and others. Through his exploration of treatment options, Dr. Yen concludes that next-line chemotherapy is the best option for the patient given the visceral progression of their disease.

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TITAN Study Leads to FDA Approval of Apalutamide for Patients with Metastatic Castration-Sensitive Prostate Cancer

Kim N. Chi, MD, and E. David Crawford, MD, discuss the findings of the TITAN study regarding the use of apalutamide in patients with castration-sensitive prostate cancer (mCSPC) who are also undergoing androgen deprivation therapy (ADT). These findings led to the FDA approval of apalutamide for these patients. The results showed a significant reduction in radiographic progression or death and a reduction in overall risk of death, and therefore support the addition of apalutamide to ADT for a broad range of patients with mCSPC. Apalutamide was initially approved in 2018 for patients with non-metastatic castration-resistant prostate cancer.

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Sequencing of Adjuvant Therapies

Daniel P. Petrylak, MD, provides his perspective on optimal drug sequencing for castration resistant prostate cancer (CRPC) and metastatic CRPC (mCRPC). He reviews the literature regarding available and emerging immunotherapeutic, hormonal, cytotoxic, and DNA damaging treatment options and when to time each drug.

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Incorporating New PET Imaging and Theranostic Approaches into Prostate Cancer Practice | Interesting Cases

Robert R. Flavell, MD, offers an introductory overview of theranostics and advances in nuclear imaging and therapies, especially prostate-specific membrane antigen (PSMA) agents. Subsequently, he leads a panel with Susan F. Slovin, MD, PhD, E. David Crawford, MD, and Phillip J. Koo, MD in reviewing four distinct prostate cancer cases, sharing their thoughts and recommendations with regard to use of recently developed imaging agents and therapies.

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Immunotherapy 101 for the Urologist

Raoul S. Concepcion, MD, summarizes the mechanism of action behind the immune response to cancer. He also provides an update on the current and emerging immunotherapies for cancer treatment, including vaccines, checkpoint inhibitors, CAR T-cell therapies, viral vectors, and adoptive cell therapy.

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