Contemporary Management of the Newly Diagnosed Prostate Cancer Patient with Metastatic Disease at Presentation

Androgen deprivation therapy (ADT) has been the standard-of-care (SOC) for metastatic hormone-sensitive prostate cancer (mHSPC) since the middle of the twentieth century. Recently, several practice-changing trials have added new therapy options for these patients. Here we review these studies and discuss guidelines on treatment decision-making.

A trio of studies (GETUG-AFU15, STAMPEDE, CHAARTED) combining docetaxel chemotherapy with ADT all showed clinical benefit of the addition. More recently, the LATITUDE and STAMPEDE-Abiraterone studies established yet another new option for up-front treatment of newly diagnosed metastatic prostate cancer, showing significantly prolonged overall survival (OS) and progression-free survival (PFS) compared to ADT alone in men with high-risk mHSPC. With the recent demonstration that adding either docetaxel or abiraterone plus prednisone to ADT significantly improves survival in mHSPC, physicians are confronted by a growing body of clinical data and treatment regimens. Men with high-volume and/or high-risk metastatic disease should not be treated with ADT alone without strong consideration of docetaxel or abiraterone. The choice of a first-line therapy should be made based on risk stratification, patients' comorbidities, toxicities, quality-of-life (QOL) considerations, and cost.

Current urology reports. 2018 Aug 13*** epublish ***

Lai Xu, Russell K Pachynski

Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St Louis, MO, 63110, USA., Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St Louis, MO, 63110, USA. .

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