Metastatic Castration-Sensitive Prostate Cancer: Abiraterone, Docetaxel, or... - Beyond the Abstract

The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has significantly changed in the last few years, after the androgen signaling blockade has shown to significantly improve the clinical outcomes of these patients. Recent phase III clinical trials with available data (CHAARTED, STAMPEDE, and LATITUDE) support the use abiraterone or docetaxel in the mHSPC space. Given the similar efficacy of these agents with a 24%-38% risk reduction of death reported in these studies, the decision to pursue either abiraterone or docetaxel is not universal and is dependent on factors tailored to a patient’s situation. As such, the authors not only compare the toxicity of these agents, but also address patient-specific considerations such as the volume of disease, performance status, cost, and burden. Furthermore, the review outlines ongoing phase III studies investigating other treatment combinations for mHSPC, including new anti-androgens, nonsteroidal CYP17A1 inhibitors, chemotherapy, and triple therapy regimens.
Novel imaging techniques, such as the FDA approved 18F-fluciclovine PET/CT, also present new opportunities to detect and treat disease earlier. Herein, the authors cover the existing data of other diagnostic methods, particularly those targeting prostate-specific membrane antigen (PSMA). These opportunities will enable us to detect metastatic sites earlier in the disease process and thus identify more patients with a limited number of metastases, also known as oligometastatic disease. The review also covers many questions and challenges remaining in this space, including the detection rates between the diagnostic agents, the optimal target population, and the value and roles of definitive, oligometastatic, and systemic treatments for each disease state.
In summary, the recent advancements in both therapeutics and diagnostics bodes well for patients with mHSPC, yet many questions and challenges remain. With several phase III trials expected to readout within the then 2 years and ongoing investigations into oligometastatic disease, the prostate cancer community can expect to be better informed in the upcoming future.

Written by: Patrick Cotogno, MSPH, Sr. Clinical Research Coordinator, Tulane Medical Center; Oliver A. Sartor MD, Professor of Medicine and Medical Director, Tulane Cancer Center; and Pedro Barata, MD MSc, Assistant Professor of Medicine, Tulane University Medical School.
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