Experts Delve Into 4 Phenotypes of Advanced Prostate Cancer

Christina T. Loguidice
Published: Monday, Aug 20, 2018
Raoul S. Concepcion, MD, FACS

Raoul S. Concepcion, MD, FACS

Changes in prostate cancer(PC) screening protocols have led to an evolution in the type of disease that physicians are encountering when patients first enter the clinic, a panel of experts said during a recent OncLive Peer Exchange®. “We are seeing, especially in the urology office, patients coming in not having been PSA [prostate specific antigen] screened, higher Gleason patterns, and metastatic disease. And, obviously, they’ve not been hormonally treated up until this point,” Raoul S. Concepcion, MD, said. This has led to a more aggressive treatment stance that includes early combination hormonal therapy and chemotherapy, he said.

. “We’ve traditionally thought of PC as a single continuum and it’s not,” Daniel J. George, MD, said. The panel provided practical definitions for 4 phenotypes of advanced PC: biochemical recurrent (BCR) hormone-naïve nonmetastatic PC, metastatic hormone-naïve advancing PC, nonmetastatic castration-resistant PC (CRPC), and metastatic CRPC. They also discussed treatment advances and offered insights into how improved diagnostics, such as next-generation biological imaging, are affecting treatment decision making.

BCR Hormone-Naive Nonmetastatic PC

Patients with BCR hormone-naïve nonmetastatic PC have no history of hormonal therapy or androgen deprivation therapy (ADT) and have an increasing PSA level after radical prostatectomy (RP) or radiation therapy (RT) for localized PC. BCR is common, affecting up to 40% of men post RP and up to 50% of men post RT, with most cases occurring within 10 years of treatment.7,8
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