Monitoring Strategies in Nonmetastatic CRPC

EP: 1.Overview of Improvements in Prostate Cancer Management

EP: 2.Optimizing Use of PSMA PET Imaging and PSADT in Prostate Cancer

EP: 3.Evolving Treatment Landscape of Nonmetastatic CRPC

EP: 4.Factors in Selecting Novel AR-Targeted Therapy for Nonmetastatic CRPC

EP: 5.Nonmetastatic Castration-Resistant Prostate Cancer: Quality of Life Measures

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EP: 6.Monitoring Strategies in Nonmetastatic CRPC

EP: 7.Overview of Treatment for Metastatic HSPC

EP: 8.Role of Micronized Abiraterone in Metastatic HSPC

EP: 9.Selecting Optimal Therapy for mHSPC: Design of the ARASENS Trial

EP: 10.Interpreting Data From the ARASENS Trial in Metastatic HSPC

EP: 11.Overview of Therapy for mCRPC: PARP Inhibitors

EP: 12.DNA Alterations and Selection of PARP Inhibitors in mCRPC

EP: 13.Metastatic CRPC: Utility of Imaging as a Biomarker

EP: 14.Selecting Among Novel Imaging Options in Metastatic CRPC

EP: 15.Role of 177Lu-PSMA-617 in mCRPC and Bone Metastases

EP: 16.Addressing Bone and Visceral Metastases in Metastatic CRPC

EP: 17.Results of the VISION Trial and Real-World Use of 177Lu-PSMA-617 in mCRPC

EP: 18.Prostate Cancer Management: Future Directions in Care

Transcript:

Alicia Morgans, MD, MPH: Evan, I'm curious, from your perspective, what do you think about in terms of monitoring patients with nonmetastatic CRPC?

Evan Y. Yu, MD: I think the important thing is to say is these patients are coming in regularly anyhow to get their LHRH [luteinizing hormone-releasing hormone] therapy, so I generally tend to give every 3 months depot shots, and when I see those patients, I check their PSA [prostate-specific antigen]. So that's the number one thing I do for monitoring, and I really keep a close tab on their PSA doubling time. Certainly, if I see an inflection point and the slope of the curve start to change, that might be a significant trigger for me to obtain imaging. And if the PSA is rising, and it's starting to become less linear and more exponential, those are some triggers where I might then get imaging and look to see whether the disease status changed or not.

Alicia Morgans, MD, MPH: Well, that's helpful. Do you have any suggestions for people who are concerned about progression radiographically before you see the PSA rising? Is there any sort of standardization to get imaging every 12 months if I haven't done already or anything like that, that you would recommend for clinicians?

Evan Y. Yu, MD: I think a lot of people do that. They get imaging once every 12 months, looking for either neuroendocrine, amphicrine, double negative, and all the aggressive variant subtypes that can result as part of treatment resistance. I think that's a very reasonable standard that a lot of people do annual imaging even if the PSA hasn't significantly risen.

Matthew R. Smith, MD, PhD: I would add that true radiographic progression without PSA progression is vanishingly rare. It's really uncommon. But I would add that I would take any confirmed PSA elevation seriously because patients on these drugs may progress radiographically at much lower PSAs than if they were on ADT [androgen deprivation therapy] alone.

Transcript edited for clarity.