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Navigating systemic therapy for metastatic castration-naïve prostate cancer

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Abstract

Introduction

The last decade has seen a remarkable shift in the treatment landscape of advanced prostate cancer, none more so than in the management of metastatic castration-naïve disease.

Methods

This narrative review will examine existing and emerging evidence supporting systemic therapy use for metastatic castration-naïve prostate cancer (mCNPC) and provide guidance on the selection of these agents with respect to optimising patient outcomes.

Results

The addition of either docetaxel (chemohormonal approach) or an AR pathway inhibitor (abiraterone, enzalutamide or apalutamide) is a reasonable standard of care option for men commencing long-term ADT for mCNPC. While the issue of disease volume as a predictive biomarker for docetaxel benefit has previously been debated, recent data support consideration of upfront docetaxel in all patients, regardless of metastatic burden. Decisions regarding systemic treatment for men with mCNPC should be based on comprehensive consideration of disease, patient and logistical factors. Multiple novel therapeutics for mCNPC are currently under active investigation.

Conclusion

The introduction of potent systemic therapy earlier in the mCNPC disease course has resulted in dramatic improvements in clinical outcomes for patients. As the management of mCNPC continues to evolve, the future remains promising, with the expectation of ongoing improvements to patient outcomes and quality of life.

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Funding

Edmond M Kwan is supported by a National Health and Medical Research Council (NHMRC), Grant no [APP113107] Postgraduate Scholarship; Arun A Azad is supported by a NHMRC project grant, Victorian Cancer Agency Clinical Research Fellowship and Astellas Investigator-initiated grant.

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Authors and Affiliations

  1. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia

    E. M. Kwan

  2. Department of Medical Oncology, Monash Health, Melbourne, Australia

    E. M. Kwan

  3. Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia

    I. A. Thangasamy, J. Teh, O. Alghazo, N. J. Sathianathen & N. Lawrentschuk

  4. Faculty of Medicine, University of Queensland, Brisbane, Australia

    I. A. Thangasamy

  5. Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia

    N. Lawrentschuk

  6. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    A. A. Azad

  7. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

    A. A. Azad

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  1. E. M. Kwan
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  2. I. A. Thangasamy
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  3. J. Teh
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  4. O. Alghazo
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  5. N. J. Sathianathen
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  6. N. Lawrentschuk
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  7. A. A. Azad
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Contributions

EMK: Manuscript writing/editing. IAT: Manuscript writing/editing. JT: Manuscript editing. OA: Manuscript editing. NJS: Manuscript editing. NL: Manuscript editing. AAA: Manuscript writing/editing

Corresponding author

Correspondence to A. A. Azad.

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Conflict of interest

Edmond M Kwan has received honorarium from Janssen; research funding from Astellas Pharma and AstraZeneca; travel / accommodation from Astellas Pharma, Pfizer and Ipsen. Arun A Azad is a consultant for Astellas, Janssen and Novartis; is on the speakers bureau for Astellas, Janssen, Novartis and Amgen; has received honorarium from Astellas Pharma, Janssen, Novartis, Tolmar, Amgen, Pfizer and Telix; on the member of the scientific advisory board for Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Pfizer and Telix; research funding from Astellas Pharma and Merck Serono. All authors declare no conflicts of interest.

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Kwan, E.M., Thangasamy, I.A., Teh, J. et al. Navigating systemic therapy for metastatic castration-naïve prostate cancer. World J Urol 39, 339–348 (2021). https://doi.org/10.1007/s00345-019-03060-7

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  • DOI: https://doi.org/10.1007/s00345-019-03060-7

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