Individualising treatment, the impact of complications and looking into the quality of life in prostate cancer patients with metastasis were the main issues examined in the last-day session of EMUC17 as experts attempt to find optimal treatment combinations.
Chaired by Jeffrey Karnes (US), David Dearnaley (GB) and Maria De Santis (GB), current clinical dilemmas in the management of metastatic PCa were taken up by speakers Nicholas James (GB), Uwe Haberkorn (DE), Derya Tilki (DE), Simon Brewster (GB) and Frédéric Lecouvet (BE).
James discussed the treatment of metastatic castration sensitive PCa and said that the sequence of therapy in CRPC needs to be individualized. “There is not one size fits all,” he said, adding that upfront therapy with abiraterone and docetaxel, improves survival and patterns of care. “There are similar impact on key endpoints like survival and bone complications,” he said referring to both agents.
Lecouvet tackled monitoring metastatic disease discussing issues such as impact on QoL, and harmonization of standards. “Symptoms and PSA are sufficient monitoring tools in most mCNPC,” said Lecouvet referring to the APCC 2017 recommendations in metastatic prostate disease.
“Is modern imaging in PCa game-changing?”asked Lecouvet, saying that in response assessment, imaging tools can lead to insights on disease progression and severity. “Benefits are currently evaluated,” he added.
Tilki took up the issue of treating the primary tumour in metastatic disease and said that there is no Level 1 evidence with respect to managing the primary in mPCa.
“All conclusions to date are gathered from observational data or retrospective institutional studies,” said Tilki. “There are significant biases and unknown confounders that must be taken into consideration in the interpretation of these findings.”