Treatment options for hormone-sensitive prostate cancer have expanded substantially in recent time and this E-learning module provides an overview of the latest advances in the treatment landscape for this disease. In addition to androgen deprivation therapy, systemic treatments now include docetaxel, abiraterone, enzalutamide, apalutamide, and darolutamide.
In this E-Learning module, the author elaborates important questions on how to manage men with prostate cancer and rising PSA without evidence of metastases, the initial treatment of men with distant metastases, and treatment options following disease progression while on androgen deprivation therapy.
The author underlines that the number of men with rising PSA and no evident metastases is decreasing with improved imaging such as PSMA-PET CT. Radiotherapy to the primary site should be used if PSA is rising after surgery. Men with slowly rising and low PSA do not require immediate treatment. There are new treatments for those with more rapidly rising PSA.
In the module, the author provides a review of the pivotal trials and puts in context the results that have recently changed the clinical management of men with hormone-sensitive prostate cancer. The author also describes the side effect profile for each treatment option. He warns that patients in the real world have less benefit and more toxicity than those in clinical trials. The author emphasises that it is important to consider treatment selection in the context of clinical value and cost effectiveness.
The author also discusses changing statistics and the misleading perception that prostate cancer affects predominantly men in the developed world. A substantial proportion of prostate cancers in Western civilization are screen-detected and many of them are non-lethal. However, men in developing countries are living longer, so the incidence of prostate cancer is increasing. The author argues that most lethal prostate cancer will be in lower- and middle-income countries and therefore, cost-effective treatments are essential.
