ORLANDO, FL USA (UroToday.com) - Regulatory approvals of agents for advanced prostate cancer have all been for pain reduction, until 2004 when docetaxel and prednisone were approved for improved overall survival (OS). New agents are now focusing on improved survival as well as symptomatic benefit. The case presented was progression of CaP after RT and the patient was on IAS. Five years later, he had CRPC with a PSADT of 4 months and no metastasis. There are no approved drugs for this disease setting. Dr. Michael Morris stated that this scenario represented 12% of patients in his practice and clinical trials are the mainstay. He would not put this patient on chemotherapy, rather would use hormonal manipulation and clinical trials. Drs. David Quinn and Daniel Petrylak agreed with not using chemotherapy in the absence of metastasis. The panel agreed that this is a group on which to test vaccine therapies, since they are not immunosuppressed.
Dr. Mack Roach challenged the medical oncologists with the scenario that if the patient had a solitary hot lymph node on PET imaging, would they consider RT? There is no prospective data to support this, but case reports of surgical excision with long-term cure do exist. A long disease-free interval between the disease and recurrence might prompt such a treatment in an individual patient, Dr. Christopher Logothetis stated. Dr. Petrylak referred to this as the biology of outliers, and collecting data on more of these patients, collectively, would be useful. Dr. Morris felt that PET is often inappropriately applied in some of these settings. The patient progressed to bone metastasis and 63% of the audience (by audience response polling) preferred chemotherapy over clinical trials that include a placebo arm.
Chaired by Mack Roach, MD, FACR, and A. Oliver Sartor, MD at the 2011 Genitourinary Cancers Symposium, General Session II, Prostate Cancer Therapy for Recurrent Disease - February 17-19, 2011 - Orlando World Center Marriott, Orlando, Florida USA