[Metastatic prostate cancer : Update: position paper for the use of chemotherapy]

Taxen-based chemotherapy has been established as an effective treatment option in castration-resistant metastatic prostate cancer (mCRPC). Randomized phase III studies, however, have shown that even in the hormone-naïve metastatic state, the early use of chemotherapy in addition to the classical androgen deprivation therapy (ADT) approach leads to a significant increase in median overall survival.

This position paper aims to provide current data and orientation in the evidence-based treatment of mPC patients in daily clinical practice.

A German group of clinical experts analyzed the current data and developed criteria for the treatment of mPC patients in daily clinical practice.

In the current treatment of hormone-naïve mPC, a beneficial effect of chemotherapy in addition to ADT has become evident. Provided patients are in an appropriate condition, those with a high metastatic load should receive chemotherapy in addition to ADT. Especially in high-risk mCRPC patients (PSA >114 ng/ml, visceral metastasis, ADT response <12 months, tumor-associated complaints), first-line chemotherapy is indicated. After docetaxel failure, continuous treatment with cabazitaxel shows superior overall survival compared to sustained antihormonal therapy.

Chemotherapy is firmly established in treating patients with mCRPC. Long-term, it will be important to identify molecular predictors. The authors suggest the early use of chemotherapy in hormone-naïve mPC, but note that the approval in this indication is currently nonexistent. After disease progression, patients should be treated analogous to mCRPC.

Der Urologe. Ausg. A. 2017 Jul 10 [Epub ahead of print]

C-H Ohlmann, P J Goebell, M-O Grimm, J Klier, F König, S Machtens, M Schostak, A-J Schrader, P Albers

Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland. ., Urologische Universitätsklinik Erlangen, Erlangen, Deutschland., Klinik und Poliklinik für Urologie, Universitätsklinikum Jena, Jena, Deutschland., Urologie Bayenthal, Urologische Gemeinschaftspraxis, Köln, Deutschland., ATURO, Praxis für Urologie, Berlin, Deutschland., Klinik für Urologie und Kinderurologie, Marien-Krankenhaus gGmbH Bergisch Gladbach, Bergisch Gladbach, Deutschland., Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland., Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland., Urologische Klinik und Poliklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.

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