Nonmetastatic Castration-Resistant Prostate Cancer: Quality of Life Measures


A brief review of the value of quality of life measures while managing patients on therapy for nonmetastatic castration-resistant prostate cancer (nmCRPC).


Alicia Morgans, MD, MPH: Sandy [Sandy Srinivas, MD], I'm just curious from your perspective, we heard a lot about the maintenance of quality of life by patient-reported outcomes during these trials, as we heard from Scott [Scott T. Tagawa, MD, MS, FACP], which I think is really important and helps us given that this is generally an asymptomatic patient population. But that isn't necessarily always the case when we see patients in clinic. From your perspective, how are these drugs treating patients when you see them on a day-to-day basis?

Sandy Srinivas, MD: I mean, I think just going back to the quality of life, I think it's 1 level to have the first end point, which was metastasis-free survival. And then, as Evan [Evan Y. Yu, MD] said, I think seeing overall survival, and now we have quality of life data from all 3 trials really showing that quality of life maintained, and patients are not having that much deterioration in the well-designed trials with end points that we have known for a long time, including health-related quality of life, the BPI [brief pain inventory] scores for pain, and fatigue. So, I think it speaks to keeping patients in this state where they don't have any metastasis. And that's been incredible to have something like 36 to 40 months of a period of not having any metastasis speaks well for these patients. For a patient in front of me, I think this whole ability to see their PSA [prostate-specific antigen] be undetectable is just so incredible to patients that I think they come in, they see their PSA being low that patients are willing to accept some level of fatigue. For the most part, I would say so long as they know that their PSA remains undetectable and there's no progression, patients are quite happy with the progress that they make.

Alicia Morgans, MD, MPH: I think that all makes sense. And as we think about them and monitoring them over what tends to be hopefully a long period of time, I think it's important that we have strategies, especially because it's possible sometimes for patients to progress radiographically before they have a PSA rise, for example, and hopefully before they have clinical symptoms.

Transcript edited for clarity.

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