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


E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe