Personalizing approaches to the management of metastatic hormone sensitive prostate cancer: role of advanced imaging, genetics and therapeutics

Personalizing approaches to the management of metastatic hormone sensitive prostate cancer: role of advanced imaging, genetics and therapeutics

Purpose To summarize contemporary and emerging strategies for the diagnosis and management of metastatic hormone sensitive prostate cancer (mHSPC), focusing on diagnostic testing and therapeutics. Methods Literature review using PUBMED-Medline databases as well as clinicaltrials.gov to include repor...

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Bibliographic Details
Published in:World journal of urology Vol. 41; no. 8; pp. 2007 - 2019
Main Authors: Lokeshwar, Soum D., Choksi, Ankur U., Haltstuch, Daniel, Rahman, Syed N., Press, Benjamin H., Syed, Jamil, Hurwitz, Michael E., Kim, Isaac Y., Leapman, Michael S.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2023
Springer Nature B.V
Subjects:
Androgen receptors
Androgens
Chemotherapy
Clinical trials
Computed tomography
Diagnosis
Literature reviews
Medicine
Medicine & Public Health
Metastases
Metastasis
Nephrology
Oncology
Patients
Positron emission tomography
Prostate cancer
Prostatectomy
Tomography
Topic Paper
Urology
Clinical trials
Metastasis
Prostate cancer
Hormone sensitive
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Summary:Purpose To summarize contemporary and emerging strategies for the diagnosis and management of metastatic hormone sensitive prostate cancer (mHSPC), focusing on diagnostic testing and therapeutics. Methods Literature review using PUBMED-Medline databases as well as clinicaltrials.gov to include reported or ongoing clinical trials on treatment for mHSPC. We prioritized the findings from phase III randomized clinical trials, systematic reviews, meta-analyses and clinical practice guidelines. Results There have been significant changes to the diagnosis and staging evaluation of mHSPC with the integration of increasingly accurate positron emission tomography (PET) imaging tracers that exceed the performance of conventional computerized tomography (CT) and bone scan. Germline multigene testing is recommended for the evaluation of patients newly diagnosed with mHSPC given the prevalence of actionable alterations that may create candidacy for specific therapies. Although androgen deprivation therapy (ADT) remains the backbone of treatment for mHSPC, approaches to first-line treatment include the integration of multiple agents including androgen receptor synthesis inhibitors (ARSI; abiraterone) Androgen Receptor antagonists (enzalutamide, darolutamide, apalautamide), and docetaxel chemotherapy. The combination of ADT, ARSI, and docetaxel chemotherapy has recently been evaluated in a randomized trial and was associated with significantly improved overall survival including in patients with a high burden of disease. The role of local treatment to the prostate with radiation has been evaluated in randomized trials with additional studies underway evaluating the role of cytoreductive radical prostatectomy. Conclusion The staging and initial management of patients with mHSPC has undergone significant advances in the last decade with advancements in the diagnosis, treatment and sequencing of therapies.
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ISSN:1433-8726
0724-4983
1433-8726
DOI:10.1007/s00345-023-04409-9