Keypoints:
• The treatment paradigm for early-stage prostate cancer, including the role of active surveillance and the use of abiraterone based on the STAMPEDE trial.
• The importance of understanding risk factors and treatment options for low, intermediate, and high-risk patients.
• The implications of PET-PSMA imaging versus conventional CT modalities in staging and treatment decisions.
• The management of biochemical recurrent disease and the significance of PSA doubling time in treatment planning.
• The role of PARP inhibitors in patients with HRR mutations and the nuances of selecting appropriate therapies.
• Strategies for managing metastatic disease, including the use of Lutetium-177 (Pluvicto) and cabazitaxel.
In this episode of the Oncology Brothers podcast, we had the privilege of hosting Dr. Alan Bryce, the Chief Clinical Officer and GU Medical Oncologist from City of Hope, to discuss the current treatment landscape of prostate cancer.
We began by exploring the treatment paradigm for early-stage prostate cancer and emphasized the importance of active surveillance for low and intermediate-risk patients. Dr. Bryce highlighted the strong data supporting active surveillance, noting that the risk of dying from prostate cancer in these patients is very low, provided they adhere to their surveillance schedules. For high-risk patients, we delved into the role of androgen deprivation therapy (ADT) and the significance of the STAMPEDE trial, which supports the use of combination therapy with ADT and abiraterone for improved long-term outcomes.
As we transitioned to the metastatic space, Dr. Bryce discussed the challenges of over-treatment and under-treatment in prostate cancer management. We touched on the importance of using conventional imaging versus PET-PSMA scans, emphasizing that while PET scans can provide additional information, they should not change the expected outcomes based on conventional imaging.
In the context of biochemical recurrent disease, Dr. Bryce shared his approach to treatment, advocating for early salvage radiation therapy and careful monitoring of PSA doubling times to guide systemic therapy decisions. We also discussed the role of PARP inhibitors, particularly in patients with HRR mutations, and the nuances of selecting appropriate therapies based on genetic testing.
Finally, we examined treatment options for advanced disease, including the use of Lutetium-177 (Pluvicto) and cabazitaxel, and the potential role of carboplatin in cases of treatment-emergent small cell or neuroendocrine phenotypes.
Overall, this episode provided a comprehensive overview of prostate cancer management, from early-stage treatment to advanced disease, highlighting the importance of personalized care and the need to balance treatment intensity with patient quality of life. We hope our listeners find this discussion valuable and encourage them to share it with colleagues and leave us feedback.
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