A 65-year-old man presents with skeletal pain. His PSA is 101 ng per mL, computed tomography (CT) reveals pelvic lymphadenopathy, a 99mTc bone scan shows extensive bone metastases, and prostate biopsy cores are interpreted as Gleason score 9 with intraductal features. The patient starts long-term androgen-deprivation therapy (ADT) and completes five cycles of docetaxel. His pain resolves. His PSA declines but remains persistently elevated at 2.6 ng per mL, so the decision is made to add enzalutamide, a next-generation androgen receptor (AR)-targeted therapy, to ADT.
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Advances in Treatment for Metastatic Hormone Sensitive Prostate Cancer: With So Many Options, Can We Really Go Wrong?
As we all look forward to another prostate cancer awareness month, I find myself reeling with the advances the field has seen in the past year, particularly in the area of hormone sensitive metastatic prostate cancer. We learned that men may live longer if we can radiate the primary tumor if they have low volume metastatic disease. We also learned that enzalutamide and

Alicia Morgans, MD, MPH is an Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. She is a clinician and physician investigator specializing is investigating complications of systemic therapy for prostate cancer survivors. She has expertise in clinical trials and patient reported outcome measures, and as well as incorporating patient preferences and beliefs into clinical decision making.


A 65-year-old man presents with skeletal pain. His PSA is 101 ng per mL, computed tomography (CT) reveals pelvic lymphadenopathy, a 99mTc bone scan shows extensive bone metastases, and prostate biopsy cores are interpreted as Gleason score 9 with intraductal features. The patient starts long-term androgen-deprivation therapy (ADT) and completes five cycles of docetaxel. His pain resolves. His PSA declines but remains persistently elevated at 2.6 ng per mL, so the decision is made to add enzalutamide, a next-generation androgen receptor (AR)-targeted therapy, to ADT.

Published Date: December 2019
Metastatic hormone-sensitive prostate cancer (mHSPC) has become increasingly prevalent in the United States. Between 2009 and 2020, experts have projected a nearly 17% increase in the number of newly diagnosed mHSPC cases and a more than 18% increase in cases of mHSPC occurring after failure of local (curative-intent) treatment.1 This increase is likely multifactorial, reflecting changes in prostate-specific antigen (PSA) screening practices, the increased use of more sensitive imaging modalities, and other factors.2, 3

Imaging in prostate cancer (PC) remains a controversial topic that can be challenging to navigate. In this article, I focus on some of the best tools in our current armamentarium: multiparametric prostate magnetic resonance imaging (mpMRI) for local prostate cancer (PC) and positron emission tomography-computed tomography (PET/CT) for advanced disease. In research settings, these modalities often overlap, but here I take a more practical approach by focusing on the use of PET/CT for the detection of metastatic disease.



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.
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