Optimal Treatment Sequencing for Advanced Prostate Cancer

Moderator Raoul S. Concepcion, MD, explains that the multitude of newly approved therapeutics for metastatic and advanced prostate cancer are fitting nicely into urology practices. However, the question facing many physicians is how to sequence these new therapies.

Paul R. Sieber, MD, believes that it may take a decade before reliable evidence-based information is available on sequencing. Additionally, he questions the future role of cytotoxic therapies, as newer and less toxic options become available.

Rudimentarily Sieber's practice has pushed the use of sipuleucel-T (Provenge) earlier in the treatment paradigm. Following this treatment, many physicians are using abiraterone acetate (Zytiga) in the prechemotherapy space with the possibility of also administering enzalutamide (Xtandi) in the future. Additionally, throughout the course of these treatments the management of skeletal-related events can easily be accomplished using denosumab (Xgeva) and zoledronic acid (Zometa). However, Sieber believes that the role cytotoxic agents play is still largely unclear.