Posted: Thursday, April 20, 2023
Although androgen-deprivation therapy is well established as the standard of care for patients with metastatic prostate cancer, treatment decisions are still often dictated by tumor location, biology, and health status of the patient. Archana Ajmera, MSN, ANP-BC, AOCNP, was joined by Rana R. McKay, MD, of the University of California San Diego Moores Cancer Center, and Kelly L. Stratton, MD, of the University of Oklahoma Health Stephenson Cancer Center, Oklahoma City, at the NCCN 2023 Annual Conference and presented several case studies to illustrate how to develop an evidence-based approach to treatment of patients with metastatic prostate cancer.
The first case focused on a patient with a poorly differentiated adenocarcinoma of Gleason score 10, innumerable pulmonary metastases, hypermetabolic mediastinal and bilateral hilar adenopathy, and multiple pelvic lymph nodes. The patient received androgen-deprivation therapy with relugolix, followed by abiraterone and prednisone, which resulted in a decline in his prostate-specific antigen (PSA) level. Follow-up treatment with docetaxel resulted in an undetectable PSA level, and a follow-up prostate-specific membrane antigen (PSMA) PET scan revealed a partial treatment response.
“We can say that men with a higher burden of metastatic prostate cancer could potentially live longer if they receive three agents,” Ms. Ajmera commented. “This was really practice-changing.”
The second case focused on a patient with a Gleason score of 8. Despite treatment, this patient experienced PSA and bony disease progression. The patient was then treated with the radioligand therapy 177-Lu–PSMA-617, a category 1 recommendation for use in certain circumstances, plus enzalutamide. After four cycles of therapy, the patient’s PSA level declined, and PMSA PET imaging further highlighted the clinical benefits of this combination.
The final case focused on a 50-year-old patient who presented with an elevated PSA level. A multiparametric MRI showed a Prostate Imaging–Reporting and Data System 4 lesion, and the patient was diagnosed with high-risk, Gleason score 8 disease after undergoing a transperineal fusion biopsy. The patient underwent androgen-deprivation therapy in combination with leuprolide and local radiation therapy and achieved an undetectable PSA level.
“We see, from a couple of different perspectives, the consideration for combining [androgen-deprivation therapy] in patients who are getting radiation therapy for low metastatic burden prostate cancer,” Dr. Stratton noted.