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GU Cancers 2019 | Exploring the treatment options for nmCRPR

Andrew Armstrong, MD, of the Duke Cancer Institute, Durham, NC, reviews the various treatment options available for non-metastatic castration resistant prostate cancer, at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA.

Transcript (edited for clarity)

I think when you see a man, his PSA’s going up despite ADT. They’ve tried bicalutamide, it’s still progressing, they have a rapid PSA doubling time, that patient generally will develop metastatic disease within about 6 to 12 months. And those men may actually have metastatic disease if you do more sensitive PET imaging...

I think when you see a man, his PSA’s going up despite ADT. They’ve tried bicalutamide, it’s still progressing, they have a rapid PSA doubling time, that patient generally will develop metastatic disease within about 6 to 12 months. And those men may actually have metastatic disease if you do more sensitive PET imaging. So this conundrum, you want to offer men treatment and we clearly now have three established therapies: darolutamide, enzalutamide and apalutamide. These are very expensive therapies, we don’t yet if know survival is better but treatment outcomes are better. So delaying metastasis is a value to patients as long as there’s acceptable safety. And so I think most of the trials now show acceptable quality of life, maintenance of a very high level of asymptomatic disease without a lot of side effects, the darolutamide data is very impressive today. The apa and enzalutamide data’s very impressive. Very low risks of seizures.

While there are concerns about falls, fractures particularly in the elderly, you can reduce those risks simply by encouraging men to exercise and stay active. Darolutamide seems to have a lower incidence of fatigue and falls and fracture, lower incidents of hypertension so I’m encouraged by that data.

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