GU Cancers 2018 | Debating the future of prostate cancer management

Francesco Montorsi

From the 2018 Genitourinary Cancers Symposium, held in San Francisco, CA, Francesco Montorsi, MD, from Vita-Salute San Raffaele University, Milan, Italy, debates the benefits of abiraterone compared to standard chemotherapy for treating patients with prostate cancer. Prof. Montorsi also highlights unnecessary biopsies, and how these could potentially be avoided using fusion techniques. Prof. Montorsi mentions that patients should be involved in their own management plans, and that their preference of therapy should be taken into consideration. He urges healthcare professionals to regularly keep up to date on novel therapies and changes in practice to provide the optimal care for patients.

Transcript (edited for clarity):

There were a number of issues that came out during this meeting related to the management of prostate cancer. Starting with the use of MRIs in the identification of possible prostate tumors, it was very evident at this conference that MRIs are here to stay. Patients coming in with a PSA which is increased are MRI screened first to see if there is a lesion, which is suspicious for prostate cancer. If that is the case then biopsies should be done using fusion techniques. This is important because by doing this we have reduced the number of patients undergoing unnecessary biopsies which is clearly important in everyday practice.

This is a meeting which is specifically dealing with the management of advanced disease generally speaking, so going back to that debate the big thing was the comparison between the use of oral agents as compared to intravenous chemotherapy in treating patients presenting with hormonal naive cancer which means at first diagnosis patients present with metastatic disease. Usually they would be treated with hormonal therapy only but now there is initial evidence suggesting that if one is adding chemotherapy and Abiraterone, an oral drug, then results will be better. Clearly, this is important because these patients are actually receiving a better expectation of survival and it takes more time to become castration resistant (unresponsive to the classic therapy of hormonal treatment). What we do not know about these two options available is which one the patients would like to receive first. Indeed this is something new for the patients themselves so it is important and time will tell. There is also a financial issue behind this because clearly chemotherapy is now administered using generic treatment so it does cost less, while this new form of hormonal treatment with the pill is still under patent and the cost is higher. It will become a generic in a couple of years so this issue of the cost of treatment will no longer be important.

I would summarize that urologists, medical oncologists and all those who take care of these patients must remain updated because there are so many things that are published in literature every month and things in general practice are changing so it is important to follow.

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