Prostate cancer

High-risk non-metastatic prostate cancer

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Obiettivo della formazione: To provide insight into factors determining treatment appropriateness in high-risk non-metastatic prostate cancer (PCa). To clarify the role of systemic therapy in clinical practice for this patient population.
Specializzazione: Urology, Medical oncology, Radiation oncology, Clinical oncology
Pubblico target: Specialists (CME: intermediate, advanced), Residents (senior)
Aggiornamento più recente: May 2024
Premessa:

Most patients with high-risk PCa will need a multimodal treatment approach. However, not all high-risk patients are at the same risk of disease progression or death.

Definitions of (very) high-risk PCa according to international guidelines and inclusion criteria of the STAMPEDE trial

T stage definition based on DRE; N stage definition based on CT scan. DRE: digital rectal examination; ECOG PS: Eastern Cooperative Oncology Group performance status, ISUP GG: International Society of Urological Pathology grade group, PSA: prostate-specific antigen

Abiraterone is approved in the metastatic PCa setting only. The European Medicines Agency (EMA) [4] approved abiraterone in combination with prednisone or prednisolone in patients with:

  • newly diagnosed high-risk metastatic hormone-sensitive PCa (mHSPC) in combination with androgen deprivation therapy (ADT)
  • metastatic castration-resistant PCa (mCRPC) who are asymptomatic or mildly symptomatic after failure of ADT in whom chemotherapy is not yet clinically indicated
  • mCRPC whose disease has progressed on or after a docetaxel-based chemotherapy regimen

The Food and Drug Administration (FDA) approved abiraterone in combination with prednisone for the treatment of patients with mCRPC and patients with high-risk mHSPC [5].

The treatment options were rated in November 2023, before publication of the 2024 updates of the EAU and NCCN guidelines.

 

References:

  1. Cornford P, Tilki D, van den Bergh RCN, et al. European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer. Update April 2024. Available at: https://uroweb.org/guideline/prostate-cancer/
  2. Schaeffer EM, Srinivas S, Adra N, et al. National Comprehensive Cancer Network clinical practice guidelines in oncology: Prostate cancer. Version 3.2024. Available at: https://www.nccn.org/professionals/physician_gls/default.aspx
  3. James ND, Sydes MR, Clarke NW, et al. Lancet 2016;387:1163-77. PubMed
  4. Abiraterone summary of product characteristics (EMA). Last accessed on 15 April 2024: https://www.ema.europa.eu/en/medicines/human/EPAR/zytiga
  5. Abiraterone summary of product characteristics (FDA). Last accessed on 15 April 2024: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=202379