The Latest Research on mHSPC

In the United States and Europe, prostate cancer is the second most common malignancy and the second leading cause of cancer mortality among men¹. While approximately 3% of men in the United States present with metastatic disease², higher rates are experienced globally³. For the past 70 years, androgen deprivation therapy (ADT) has been the mainstay of therapy for locally advanced or metastatic disease, considering that the androgen receptor (AR) pathway is critical for prostate cancer progression⁴. While the majority of patients will benefit from a biochemical and clinical response to ADT, most eventually develop castrate-resistant prostate cancer (CRPC) despite castrate levels of testosterone⁵. In the absence of new treatment options, for nearly twenty years, there had been no appreciable improvement in survival among men diagnosed with metastatic hormone-sensitive prostate cancer⁶. Since 2004, there has been considerable progress in the treatment options and outcomes for men with castrate-resistant prostate cancer, as summarized in the UroToday Center of Excellence article entitled “Evidence-Based Therapeutic Approaches for mCRPC”. However, only since 2016, has there been evidence-based treatment options with proven survival benefit for men with metastatic hormone-sensitive prostate cancer, also known as metastatic castrate sensitive or hormone naïve disease.

 

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Metastatic hormone-sensitive prostate cancer (mHSPC) is the disease space whereby men have metastatic prostate cancer and have never received (ie. are sensitive to) androgen deprivation therapy (ADT). mHSPC previously constituted ~30% of prostate cancer cases,¹ however, from 2004-2012 secondary to PSA testing, the estimate was ~5% of cases.² Many experts in the field suggest that with decreased PSA screening over the last few years, as a result of the United States Preventative Services Task Force (USPSTF) Grade D recommendation for PSA screening (subsequently upgraded to C 3), that these estimates are likely to once again increase.⁴ Typically, these patients have been treated with ADT alone, at which point the clock begins ticking towards a castration-resistant time point and eventual mortality. Since 2015, we have seen several landmark trials published that have added therapies to ADT for these men, favorably impacting overall survival. This article will discuss the effect of docetaxel and abiraterone therapy among men with mHSPC and review the subsequent literature following reporting of these trials. Read More