A brief discussion on the role of quality of life in selecting best therapy for patients with non-metastatic castration-resistant prostate cancer.
Alan Bryce, MD: Dr. Lowentritt, how important is quality of life when we’re considering the therapeutic options, and do you see differences in quality of life with these AR [androgen receptor] inhibitors?
Benjamin Lowentritt, MD, FACS: We’ve been covering this, and after several years, and all the analysis and reporting, we have data on all 3 trials—on ARAMIS [NCT02200614], PROSPER [NCT02003924], and SPARTAN [NCT01946204]—that show the preservation of prostate cancer–related quality of life. Patients who are doing better with their disease, who are on therapy, even when they’re on for longer, are maintaining their quality of life, which is extremely important to support everything else we’re doing. We’re not just prolonging a miserable life, and this goes to the conversation we just had. It’s hard to compare one vs the other in this, but I do think we hopefully now have gotten enough experience with these that there do seem to be differences in our patient experience. In the end, access is going to be most important. You must get them the medication that is available to them—if one is easier than another for them to get availability for—and there are some slight differences that maybe are indicated for certain types of treatments. Whether they can swallow well…there were other comorbid conditions. What we’re seeing and, with time, experiencing, is that we do have some ability to, as Dr Heath just said, pick the right drug for the right patient. Thankfully, we have all these options, and we don’t need to be afraid of them deteriorating our patients’ quality of life over time.
Alan Bryce, MD: I have [treated] several patients over the years who came in with that brain fog, the asthenia, that they can get with some of these agents. I’ve switched them to the darolutamide, and they’ve had dramatically different quality of life and improvement by making that switch because of a lack of the CNS [central nervous system] penetration. I’ve seen it in practice as we see it in the clinical data; it all seems to fit. That’s a minority of patients, but for that subset of patients, the switch seemed to have made a difference.
Benjamin Lowentritt, MD, FACS: One of the things that I always have to say is, especially in this small group of nmCRPC (nonmetastatic castration-resistant prostate cancer), these are patients who have experienced their entire disease almost [only] through PSA [prostate specific antigen testing], and they’ve likely never had any symptoms, so maintaining their quality of life is as important in this group as in any other because you’re just introducing problems. I feel reassured that if we’re going to put patients on for this long, that we’re doing them a service and not just introducing a problem. I also think it’s helpful, the paper that was mentioned ... and other similar [papers], that showed that you can tell the story with PSA further. We want to get rid of PSA as a biomarker in so many ways seemingly because it’s not perfect, but it’s still good in helping us counsel patients, especially in this subset. It’s great that we have all this supporting data from these trials that help us tell the story to the patients.
Alan Bryce, MD: Excellent. Absolutely. I agree completely.
Transcript edited for clarity.