ESMO E-Learning: Treating Advanced Prostate Cancer: Increasing Complexity

In this E-Learning module, the authors elaborate on the rapidly changing treatment landscape in advanced prostate cancer with molecular stratification as standard of care, multiple lines of treatment being available, and additionally many novel anticancer therapeutic strategies becoming evaluated. The authors explain inter- and intra-patient heterogeneity and their implications on management.

The authors start the module by explaining changes in prostate cancer diagnosis and staging. They underline that improved imaging is leading to stage migration, consequently decreasing the prevalence of M0 disease with rising PSA.

The authors explain that advanced prostate cancer comprises clinically important disease subsets and these molecular subsets need to be recognised to optimise care. Molecular characterisation identifies both, inter- and intra-patient heterogeneity, and both can have an impact on disease behaviour, survival outcomes, and treatment sensitivity.

The authors state that, treatments for advanced prostate cancer include LHRH analogues or surgical castration, next-generation androgen receptor signalling inhibitors (abiraterone, enzalutamide, apalutamide, darolutamide), lutetium PSMA, PARP inhibitors, immune checkpoint inhibition, docetaxel, cabazitaxel. Local disease control remains important, even in locally advanced disease, and can improve survival in patients with low-volume metastatic disease. They also elaborate on new therapeutic strategies.

The authors underline that, optimal drug sequencing is not adequately defined, but as with other diseases, it is likely that precise positioning is less important than the patients receiving all the key drug classes at some point in their course of disease. They also underline that men with prostate cancer are living longer and better than ever before.

This E-Learning module provides an excellent overview of recent advances in the management of patients with advanced prostate cancer.