Overview of Improvements in Prostate Cancer Management

Broad discussion on the evolution of care in prostate cancer from both the therapeutic and imaging standpoints.


Alicia Morgans, MD, MPH: Hello and welcome to this OncLive® Peer Exchange titled "Recent Advances in the Treatment of Prostate Cancer". My name is Alicia Morgans and I'm a GU [genitourinary] medical oncologist at Dana-Farber Cancer Institute in Boston. I'd like to welcome my esteemed fellow panelists and ask them to introduce themselves, starting with Dr Matthew Smith.

Matthew R. Smith, MD, PhD: Hello, I'm Matthew Smith. I'm a medical oncologist at Massachusetts General Hospital Cancer Center in Boston.

Alicia Morgans, MD, MPH: Thank you. Next, Dr Sandy Srinivas.

Sandy Srinivas, MD: Hi, my name is Sandy Srinivas. I'm a GU medical oncologist at Stanford in California.

Alicia Morgans, MD, MPH: Thank you so much. Dr Scott Tagawa?

Scott T. Tagawa, MD, MS, FACP: I'm Scott Tagawa. I'm a medical oncologist at Weill Cornell and NewYork-Presbyterian Medical Center.

Alicia Morgans, MD, MPH: Thank you. Dr. Evan Yu?

Evan Y. Yu, MD: Hi everyone. I'm Evan Yu. I'm a medical oncologist at the University of Washington Fred Hutch Cancer Research Center in Seattle, Washington.

Alicia Morgans, MD, MPH: Well, thank you everyone for being here and joining me. Today we're going to discuss a number of recent updates in the treatment of patients with prostate cancer. These have been presented at recent conferences over the past few months. We will discuss the data in the context of guidelines, the treatment landscape, and its impact on clinical practice. Let's get started with the first topic. Sandy [Sandy Srinivas, MD], this question is for you: We're really thinking about the overall treatment landscape of prostate cancer, and there have been so many advances in the recent past. From your perspective, what is the greatest and most exciting thing in terms of systemic therapy that you're on the lookout for in terms of use in your clinic in the next few years?

Sandy Srinivas, MD: Thanks, Alicia [Alicia Morgans, MD, MPH]. There has been a lot of progress made, and I think about it in several different ways. I think, first of all, do we have new drugs that we can use for our patients? Examples of those have clearly been the introduction of PARP inhibitors for our use in prostate cancer. We are looking forward to the much-awaited lutetium-177 for our patients with advanced disease. I also think a lot of progress has been made with existing drugs that we have had for a long period of time. I think over time, we have just learned how to use them more wisely and have moved them up in the earlier lines of therapy, which has resulted in significant impacts in improving longevity.

Alicia Morgans, MD, MPH: Wonderful. I think we're all excited just as you are. I'd love to hear from you, Evan [Evan Y. Yu, MD], in terms of technology, which has also been rapidly evolving. What are you excited about in terms of technology related to prostate cancer care?

Evan Y. Yu, MD: Well, I'm very excited about the new advances in PET [positron emission tomography] imaging. Some of our colleagues overseas, for instance in Germany and Australia, have been using PSMA [prostate-specific membrane antigen] PET for many years, but in the United States, we have not had accessibility. Just recently, we now have access to both PyL [18F-DCFPyL (piflufolastat F-18)] and gallium 68 PSMA PET, which I think will have a lot of utility, especially in early stages of disease. For instance, for staging initially for patients with high-risk localized disease, it has the ability potentially to change both surgical and radiation fields for planning prior to local definitive therapy. I think that another area where PSMA PET will contribute significantly will be for identifying the target. For instance, with lutetium PSMA 617, it will be useful for identifying patients who will be eligible for such treatment and as new PSMA targeted therapies come down the road. I think that it'll be a good companion biomarker at least for identification of eligible subjects and patients that will be eligible to receive that. Finally, I think it opens up the question, can we help with furthering the field with doing oligometastatic directed-therapy? That's the 1 setting where I think outcomes are at this point in time lacking, but for patients who have had primary local therapy and have some biochemical relapse, the sensitivity of PSMA PET is quite outstanding and might be able to identify early oligometastatic disease that might be amenable to additional metastasis-directed therapy. At this point in time, the long-term outcomes are lacking, but trials should be done in that area. I'm really excited about the potential for that to contribute to better outcomes for our patients.

Alicia Morgans, MD, MPH: I completely agree, and I think as we try to integrate these new PET imaging strategies into our treatment plans, whether it's related to early-stage disease, biochemical recurrence, or potentially, as you mentioned in the mCRPC [metastatic castration-resistant prostate cancer] setting, there are going to be pros and cons because this is certainly a more sensitive imaging strategy. It allows us to see things that were previously invisible.

Transcript edited for clarity.

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