The Latest Research on mCRPC Treatment

The European Association of Urology defines castration-resistant prostate cancer (CRPC) as serum testosterone < 50 ng/dL or < 1.7 nmol/L plus either biochemical progression (three consecutive rises in prostate-specific antigen [PSA] one week apart, resulting in two 50% increases over the nadir, and PSA > 2 ng/mL) or radiologic progression (at least two new bone scan lesions or a soft tissue lesion using Response Evaluation Criteria in Solid Tumors [RECIST]).¹ Symptomatic progression alone is not enough to diagnose CRPC; instead, it should trigger further investigation.

Until 2010, our treatment armamentarium for prostate cancer (PC) was fairly limited. Patients received local therapy for non-metastatic disease, androgen deprivation therapy (ADT) for hormone-naïve metastatic disease, denosumab and zoledronic acid for metastatic castration-resistant prostate cancer (mCRPC), and bisphosphonates or docetaxel for symptomatic mCRPC.

As we counsel our patients about the importance of clinical research, there are two key messages to send. The first is that without clinical trials, we would not have access to the large number of life-prolonging therapies that we have for genitourinary cancers and others. That translates into more family trips, birthday parties, time spent with grandchildren and graduations attended. It translates into more time spent being productive at work, and net increase into societal wealth. These have meaningful impact. The second is that enrolling on a clinical trial is largely about altruism. The typical patient wants to receive a therapy that will help him/her. That is reasonable; however, the greatest reason to enroll in a clinical trial is that new knowledge will be gained regardless of the outcome.

Brief high-level review of the LATITUDE and STAMPEDE Studies: 

LATITUDE was a phase III trial of men with high-volume metastatic prostate cancer (PC) that had not been previously treated with androgen deprivation therapy (ADT).¹ The patients were randomized to receive standard ADT with placebos vs. ADT plus abiraterone and prednisone. The primary endpoint is overall survival (OS).

Everyday Urology-Oncology Insights: Volume 1, Issue 1

Before 2004, there was an unmet need for survival prolonging therapies in men with castration-resistant prostate cancer (CRPC). Palliative therapeutic options were the standard of care. As a result, there was a pervasive nihilism regarding the therapeutic management of men with advanced prostate cancer, especially after they ceased responding to androgen suppressive therapy.