Optimizing the treatment of metastatic castration-resistant prostate cancer: a Latin America perspective

Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making.

A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring. There is a lack of level 1 evidence for the best treatment sequence or combinations in mCRPC. In this context, consensus recommendations were provided for the use of taxane-based chemotherapies, androgen receptor axis-targeted agents and targeted alpha therapy, for patients in Latin America. Prostate-specific antigen (PSA) changes alone, during treatment, should be treated with caution; PSA may not be a suitable biomarker for radium-223. Bone scans and computed tomography are the standard imaging modalities in Latin America. Imaging should be prompted during treatment where symptomatic decline and/or significant worsening of laboratory evaluations are reported, or where a course of therapy has been completed and another antineoplastic agent is under consideration. Recommendations and guidance for treatment options in Latin America are provided in the context of country-level variable access to approved agents and technologies for treatment monitoring. Patients should be treated with the purpose of prolonging overall survival and preserving quality of life through increasing the opportunity to administer all available life-prolonging therapies when appropriate.

Medical oncology (Northwood, London, England). 2018 Mar 19*** epublish ***

Juan Pablo Sade, Carlos Alberto Vargas Báez, Martin Greco, Carlos Humberto Martínez, Miguel Ángel Álvarez Avitia, Carlos Palazzo, Narciso Hernández Toriz, Patricia Isabel Bernal Trujillo, Diogo Assed Bastos, Fabio Augusto Schutz, Santiago Bella, Lucas Nogueira, Neal D Shore

Instituto Alexander Fleming, Buenos Aires, Argentina., Universitario Fundacion Santa Fe de Bogota, Bogota, Colombia., Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina., Unidad de Cancerología, Departamento de Cirugía, División de Urología, Hospital Pablo Tobón Uribe Medellín, Antioquia, Colombia., Instituto Nacional de Cancerologia, Mexico City, Mexico., Department of Uro-Oncology, Instituto de Diagnóstico y Tratamiento Sagrada Familia, Tucumán, Argentina., Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico., Department of Nuclear Medicine, Fundación Santa Fe de Bogota, Bogota, Colombia., Hospital Sírio- Libanês and Uro-Oncology Department, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil., Hospital São José, São Paulo, Brazil., Universidad Católica de Córdoba and the Clínica Universitaria Reina Fabiola, Córdoba, Argentina., MD Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Department of Urology, Carolina Urologic Research Center, 823 82nd Parkway, Myrtle Beach, SC, 29572, USA. .

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