EAU 2018: Systemic Therapy is the Standard of Care

Systemic Therapy is the Standard of Care 1

Systemic Therapy is the Standard of Care 2a
Presentation:  Dr. Gillessen Sommer provided a medical oncology perspective to this question, and she strongly recommended systemic therapy of some form.

While this patient falls into a unique oligometastatic category, at the end of the day, he had evidence of metastases. Hence, systemic therapy of some form should be administered. 

  • Guidelines for cM1 disease are very clear – ADT + docetaxel or abiraterone
  • When Prostate cancer experts were surveyed on how to manage oligometastatic disease, responses were all over the place
  • Only 25% followed guidelines with systemtic therapy alone
  • However, 92% gave systemic therapy in some form
Oligometastatic disease

  • Definition is unclear, not yet defined – dependent on imaging utilized as well
  • Distinctions of oligometastatic disease:
  • Synchronous vs. metachronous
  • Number and site of lesions
  • Castration-naïve and castration-resistant
Which systemic therapy in these patients?

  • CHAARTED established the benefit of docetaxel with ADT for newly diagnosed metastatic prostate cancer
  • However, original and recent subset analysis based on volume of disease suggests no benefit in low-volume disease (Kyriapoulos JCO 2018)
  • STAMPEDE established the benefit of abiraterone + ADT in high-risk cM0 and newly diagnosed cM1 patients
  • No stratification on volume of metastases – analysis of this is actually being presented later today (Abstract 613)
  • Sydes et al ESMO 2017 (just recently accepted for publication) – indirect comparison of abi/prednisone and docetaxel demonstrated no OS or CSS benefit to either therapy
As such, while systemic therapy should be given, which of the three options (ADT, ADT+Abi, ADT+doce) is not yet clear. All should be discussed with the patients, including data and toxicity risk. 

Presented by: Silke Gillessen Sommer, MD, St. Gallen, Switzerland

Written by: Thenappan Chandrasekar, MD Clinical Fellow, University of Toronto, twitter: @tchandra_uromd at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

Read More Treatment Options for this Case Presented at EAU 2018:

Treatment Option: Local and Metastasis Imaging Targeted Treatments are Needed - Gert De Meerleer, MD, Ghent, Belgium
Treatment Option: Local Control is Needed - Steven Joniau, MD, PhD