Dr. Adam Kibel commented on the clinical opportunities for treating metastatic castrate-resistant prostate cancer (mCRPC). “This patient most likely started with the urologist who knows the patient for the longest period of time, and has gone through multiple levels of treatment with us. Through the course of treatment, this patient also has a relationship with a radiation oncologist. It’s with this understanding that we have a great opportunity to advance the patient experience. Patients want to hear the right answer but they also want to hear the same answer.” The radiation therapist has something to add to the treatment paradigm.” In real time, Dr. Kibel feels focal radiation therapy is underutilized for painful metastatic disease. “The data from the Radium-223 trial was exciting news” It is but one ongoing example of how radiation oncology will evolve for the benefit of the mCRPC patient. “Overall, the relationship with your radiation oncology colleague can be very beneficial to the patient.”
Of the novel agents on the horizon, Dr. Kibel says we need to recognize that for intermediate-risk prostate cancer patient, getting higher doses of radiation therapy will be more effective and with adjuvant therapy will increase overall effectiveness. “We don’t fully understand if we need to give both at the same time. More is not more; more may not provide any additional advantage.” For those patients with adverse pathology getting radiation therapy, “It’s important to know that not everyone with higher risk disease is going to fail. While the evidence is slightly better for adjuvant therapy than salvage radiation therapy, most of those studies were done before PSA was widely available.”
“If you are going to observe someone – that’s what I do for the vast majority of my patients -- you need a very low threshold for instituting therapy.” According to Dr. Kibel, there is still the opportunity to cure the patient with active surveillance to monitor prostate disease progression and then using an adjuvant or salvage approach for treatment.
Dr. Adam S. Kibel is Professor and Chairman of the Harvard Program in Urology (Longwood) and Chief of Urology, Brigham and Women’s Hospital/Dana Farber Cancer Institute. Dr. Kibel specializes in surgical treatment of all types of urologic cancers. Current research areas focus on the identification of molecular markers of urologic tumors, adjuvant and neoadjuvant approaches to the treatment of aggressive disease, and the improved imaging of patients with urologic malignancies.
View Full 2012 GU Cancers Symposium Coverage
