Contemporary questions about the initial treatment of advanced forms of prostate cancer


So the discussion about how to use the data from the CHAARTED, STAMPEDE, and LATITUDE trials in the initial treatment of men with node-positive and metastatic hormone-sensitive and castration-resistant prostate cancer continues to be an issue of intense discussion among urologic and medical oncologists.

The application of the data from these trials potentially impact patients with a wide range of prostate cancer types,  including:

  • Newly diagnosed men with N+M0 hormone-sensitive prostate cancer (nmHSPC)
  • Newly diagnosed men with NxM+ hormone-sensitive prostate cancer (mHSPC)
  • Progressive prostate cancer that has become either node-positive or metastatic after earlier treatments (but who are still hormone-sensitive)

For those who are interested in this complex issue, which was brought to the foreafter presentation of two new sets of trial results at the ASCO meeting in June this year, we recommend a recent podcast on the UroToday web site, moderated by Alicia Mogans (Northwestern University), and involving Charles Ryan (University of San Francisco), David Penson (Vanderbilt University), and Neal Shore (the Carolina Urologic Research Center).

It is going to take a while for us to be able to resolve what “the best” type or types of such therapies may be for well-identified patients who meet the above criteria — based not only on the actual trial data themselves, but also on (a) the personal clinical profiles of individual patients; (b) the aggressiveness of the cancers of those individual patients; (c) the individual attitudes of those patients to the risks and benefits of the different types of treatment; and (c) the extent to which different payers are going to be willing to cover the costs of the differing treatments —  not just here in America but in other countries around the world.

In their 35-minute discussion, Dr. Morgans and her colleagues address nearly all of the outstanding questions that affect the routine, practical application of the data from the CHAARTED, STAMPEDE, and LATITUDE trials — and their short-term implications for the next couple of years. They outline key issues for both physicians and their patients and provide a valuable review for patients who are facing some of these choices today or in the relatively near future.

One Response

  1. There is an accompanying podcast with a discussion between Alicia Morgans (Northwestern), Chuck Ryan (UCSF) and Chris Sweeney (Dana Farber) — all GU med oncs — also an earlier podcast from a couple of weeks back between Morgans and Ryan

    For me the conversation between the genitourinary medical oncologists alone carried a lot more weight and I recommend listening to that over the conversation with the urologic oncologists (surgeons!). However well qualified surgeons may be, they are not trained in internal medicine. So when urologists like Dr. Penson and Dr. Shore prescribe second-ine antiandrogens and discuss chemotherapy — that I do not believe they can prescribe — I question how surgeons can provide adequate support when systemic co-morbidities arise.

    I do not subscribe to surgeons being involved in advanced prostate cancer management. My suspicion is that neither do Drs. Morgans or Ryan, however there are political considerations that may prevail.

    Some years ago I was asked to serve on an AUA board established to address advanced prostate cancer treatments by urologists; they were seeking patient advocates. I declined because I frequently speak with patients inappropriately treated by their surgeons when their disease has returned and advanced. Even with additional training, surgeons are not internists.

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