(UroToday.com) As part of a plenary presentation at the Virtual 2020 European Association of Urology (EAU) Annual Meeting assessing “Modern prostate cancer imaging in daily practice,” Guillaume Ploussard, MD, PhD, followed Annika Herlemann MD’s presentation by suggesting we start with systemic therapy for patients with biochemical recurrence following initial local therapy.
Dr. Ploussard highlighted that metastasis directed therapy is limited by the reliance on imaging, toxicity and quality of life effects, and the need for eventually combined therapy. In contrast, androgen deprivation therapy (ADT) is proven effective in the treatment of advanced prostate cancer and intensified systemic therapy has more recently been proven to be effective.
Dr. Ploussard began with a review of the goal of imaging in recurrence, highlighting that the goal should be to exclude distant metastasis in order to proceed with local, curative salvage therapy.
He highlighted the relative paucity of data for metastasis-directed therapy (MDT) with no relevant phase III data and few, small phase II comparative studies. Further, none of these studies have demonstrated survival benefit and PSA responses are generally short-lived. However, each MDT approach is associated with morbidity. Thus, due to inconsistent biological effect, he suggested that this should not be considered standard of care.
Dr. Ploussard then highlighted data from the DART trial demonstrated that the early addition of ADT has been shown to improve survival in patients with recurrent disease.
In terms of patients with recurrent disease, intensified systemic therapy has not proven beneficial to date. However, this is based on subgroup analyses of small groups of patients and, in the larger study populations, this approach has demonstrated significant benefit.
Presented by: Guillaume Ploussard, MD, PhD, Saint-Jean Languedoc Hospital and Institut Universitaire du Cancer – Oncopole, Toulouse, France
Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Twitter: @WallisCJD, at the Virtual 2020 EAU Annual Meeting #EAU20, July 17-19, 2020.