Management of Advanced Prostate Cancer for the Urologist

First, they define three types of prostate cancer. Metastatic castration-sensitive disease refers to patients with metastatic cancer who have low testosterone levels because of androgen deprivation therapy (ADT). Nonmetastatic castration-resistant disease is nonmetastatic cancer with testosterone levels unresponsive to ADT. This category is harder to define as the classification varies based on imaging modality. Finally, metastatic castration-resistant disease is the most lethal type of prostate cancer, as there is an unmet need in developing therapeutics for these patients. Traditionally, the castrate level is defined as a testosterone level <50 ng/dL.

Then, the doctors discuss different types of ADT, which include GnRH agonists, GnRH antagonists, and anti-androgen receptor medications. When explaining ADT to her patients, Dr. McKay always identifies the class of the agent and common side effects (i.e.- bone composition changes, metabolic changes, and mood and libido changes). Dr. McKay notes that she has observed many patients who have had success with ADT and shares lifestyle tips that she recommends to mitigate the side effects of ADT.

Next, the doctors summarize treatment options for different types of prostate cancer patients, including those with de novo metastatic prostate cancer, metastatic hormone sensitive disease, biochemically recurrent disease, and chemotherapy naive patients. In addition, they reflect on past landmark trials and current prospective trials about different combinations of therapies. They end the episode by discussing lutetium-177 as a new therapy for prostate cancer.