Advanced Prostate Cancer: Role of Advanced Practitioners in Management
Posted: Wednesday, October 21, 2020
“Prostate cancer treatment is a marathon, not a race,” stated Brenda Martone, MSN, ANP-BC, AOCNP, of Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, in her presentation on the first day of the 2020 JADPRO Live Virtual conference, the annual meeting of the Advanced Practitioner Society for Hematology and Oncology. In discussing the key role of advanced practitioners (APs) in treating men with advanced prostate cancer, Ms. Martone focused on the importance of early genetic testing and considerations in decision-making for both APs and their patients.
According to Ms. Martone, the following patient populations should undergo germline genetic testing: those with high-risk, regional or metastatic prostate cancer; those of Ashkenazi Jewish ancestry; those with a family history of high-risk germline mutations (eg, BRCA1/2, Lynch mutation); and those with a family history of cancer. For these patients, next-generation sequencing is indicated as well. In addition, somatic tumor testing to assess targetable tumor alterations is also suggested.
When considering the host of systemic therapies available for advanced prostate cancer, patient preferences are a key factor in the decision-making process, noted Ms. Martone. She also emphasized the critical role APs play in this mutual decision-making, assisting patients in truly understanding the differences among therapeutic agents, particularly in terms of benefits and potential risks.
For instance, the combination of abiraterone plus prednisone produces common side effects such as hypertension and fatigue, as does enzalutamide. Whereas enzalutamide is also associated with seizure, this consideration should be included in any conversation with patients about treatment selection. So too should the following questions: Is the patient fit for chemotherapy? How symptomatic is the patient? What comorbidities are present? Is there a relevant part of a patient’s medical history that might rule in or out a particular treatment? What side effects might a patient be willing to accept or not? How much does a given medication cost?
Disclosure: Ms. Martone reported no conflicts of interest.
