A multidisciplinary approach to address unmet needs in the management of patients with non-metastatic castration-resistant prostate cancer.

With the availability of second-generation androgen receptor inhibitors (SGARIs), the treatment landscape has changed dramatically for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). In clinical trials, the SGARIs (apalutamide, enzalutamide, darolutamide) increased metastasis-free survival (MFS), overall survival (OS), and patient quality of life compared to placebo. These drugs were subsequently integrated into nmCRPC clinical practice guidelines. With advances in radiographic imaging, disease assessment, and patient monitoring, nmCRPC strategies are evolving to address limitations related to tracking disease progression using prostate-specific antigen (PSA) kinetics.

A panel of 10 multidisciplinary experts in prostate cancer conducted reviews and discussions of unmet needs in the management and monitoring of patients with nmCRPC in order to develop consensus recommendations.

Across the SGARI literature, patient MFS and OS are generally comparable for all treatments, but important distinctions exist regarding short- and long-term drug safety profiles and drug-drug interactions. With respect to disease monitoring, a substantial proportion of patients using SGARIs may experience disease progression without rising PSA levels, suggesting a need for enhanced radiographic imaging in addition to PSA monitoring. Recent data also indicate that novel prostate-specific membrane antigen positron emission tomography radiotracers provide enhanced accuracy for disease detection, as compared to conventional imaging.

Clinical decision-making in nmCRPC has become more complex, with new opportunities to apply precision medicine to patient care. Multidisciplinary teams can ensure that patients with nmCRPC receive optimal and individualized disease management.

Prostate cancer and prostatic diseases. 2024 Mar 02 [Epub ahead of print]

Neal Shore, Emmanuel Antonarakis, Ashley Ross, Catherine Marshall, Kelly Stratton, Adanma Ayanambakkam, Michael Cookson, Rana McKay, Alan Bryce, Marina Kaymakcalan

GenesisCare US, Myrtle Beach, SC, USA. ., University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA., Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Johns Hopkins Medical Institutions, Baltimore, MD, USA., University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., University of California, San Diego, La Jolla, CA, USA., Mayo Clinic, Phoenix, AZ, USA., Dana Farber Cancer Institute, Boston, MA, USA.