Therapeutic Options for Advanced Prostate Cancer

The addition of new therapeutic options for patients with advanced or metastatic prostate cancer has resulted in an increase in the number of patients being treated at a typical urology practice with advanced cancer.

Neal D. Shore, MD, provides details on the multiple therapies that are approved for patients with advanced prostate cancer. In general, androgen deprivation therapy (ADT) with leuprolide or GNRH antagonists remains a first-line therapy for patients who are still sensitive to androgen. For these patients, the antiresorptive agents denosumab and zoledronic acid can be used to help manage skeletal-related events (SREs).

Once patients show radiologic evidence of disease, the immunotherapy sipuleucel-T can be given in a 30 to 40-day completion with a very acceptable tolerability and safety profile, for asymptomatic castration-resistant prostate cancer (CRPC). Following progression, the cytotoxic agents docetaxel and cabazitaxel can be administered sequentially.

In the post chemotherapy space, two new oral agents have gained approval, abiraterone acetate and enzalutamide. The agent abiraterone acetate is an androgen biosynthesis inhibitor and lowers testosterone and testosterone metabolite levels by impacting the binding domain of the androgen receptor. The other agent, enzalutamide, directly binds to the androgen receptor and further prevents translocation at the level of the nucleus in the DNA. Shore believes that these agents both hold the potential to gain approval in the prechemotherapy setting.

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