Prostate cancer
Management of non-metastatic castration-resistant prostate cancer
Castration-resistant prostate cancer (CRPC) is defined as having a castrate serum testosterone level <50 ng/dl (1.7 nmol/l) plus either:
- Biochemical progression: 3 consecutive rises in PSA at least 1 week apart resulting in two 50% increases over the nadir, and a PSA >2 ng/ml
or
- Radiological progression: the appearance of new lesions: either ≥2 new bone lesions on bone scan or a soft tissue lesion using RECIST (Response Evaluation Criteria In Solid Tumours). Symptomatic progression alone must be questioned and subject to further investigation. It is not sufficient to diagnose CRPC [1].
This topic is limited to patients with nmCRPC, diagnosed by conventional imaging (bone and CT scan) or next-generation imaging (PSMA-PET/CT). These patients benefit from the addition of androgen receptor pathway inhibitors (ARPI) to androgen deprivation therapy (ADT), in terms of delaying time to metastasis and improving survival. This topic evaluates which ARPI should be selected for which patient, and what the impact is of next-generation imaging in this field.
Bone-protective agents fall beyond the scope of this topic. However, bone-protective agents should be offered to patients with metastatic prostate cancer (PCa) and skeletal metastases to prevent osseous complications [1].
Regulatory approval status of drugs for nmCRPC discussed in this topic (indications limited to the nmCRPC setting, status 5 April 2024)
This educational platform includes case challenges with treatment options that may not be indicated for this use in your country. Please check your local prescribing information.
References:
- Cornford P, Tilki D, van den Bergh RCN, et al. EAU – EANM – ESTRO – ESUR – ISUP – SIOG guidelines on prostate cancer. Update 2024. Available at: http://uroweb.org/guideline/prostate-cancer/