New Standard in Metastatic Prostate Cancer Hits Prime Time

Amy Karon, MPH
Published: Tuesday, Sep 19, 2017
Nicholas J. Vogelzang, MD

Nicholas J. Vogelzang, MD
Although there have improvements in the treatment of men with prostate cancer during the past 15 years, patients with advanced disease continue to pose a clinical challenge. Prostate cancer remains the third leading cause of cancer death among men,1 with more than 26,700 deaths likely to occur in the United States this year.2 Additionally, the incidence of metastatic prostate cancer (mPC), which accounts for 3% of newly diagnosed cases, is rising.3


Table. Practice-Changing Research in Prostate Cancer Trials

Research in Prostate Cancer Trials
Additional survival analyses from STAMPEDE and the results of the LATITUDE trial showed that ADT plus abiraterone acetate (Zytiga), a next-generation adrenal inhibitor, appeared to match or exceed the benefit of ADT plus docetaxel in the metastatic setting. In STAMPEDE, adding abiraterone and prednisolone to ADT lowered the risk of death by about 37% (HR, 0.63; P <.001), cut the chances of treatment failure by about 70% (HR, 0.30; P <.001), and approximately halved the likelihood of serious bone complications compared with ADT monotherapy in men newly diagnosed, locally advanced or mPC.12 In LATITUDE, adding abiraterone and prednisone to ADT lowered the risk of death by 38% (HR, 0.62; P <.001) and significantly improved progression-free survival (HR, 0.5; P <.001) compared with ADT only in men with metastatic castration-sensitive disease.4,13


A New, Earlier Standard of Care

For newly diagnosed, hormone-naïve prostate cancer, the results of these 3 clinical trials truly are practice changing, experts said. Physicians who conventionally treated advanced prostate cancer with leuprolide or bicalutamide “are really beginning to see the light,” said Nicholas Vogelzang, MD, a medical oncologist at Comprehensive Cancer Centers of Nevada in Las Vegas. “They’re well on the path now to saying that these patients need input from medical oncology.”
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