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Title: Navigating systemic therapy for metastatic castration-naïve prostate cancer.
Austin Authors: Kwan, E M;Thangasamy, I A;Teh, J ;Alghazo, O;Sathianathen, N J;Lawrentschuk, Nathan;Azad, A A
Affiliation: Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
Department of Medical Oncology, Monash Health, Melbourne, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
Faculty of Medicine, University of Queensland, Brisbane, Australia
Issue Date: 2-Jan-2020
Date: 2020-01-02
Publication information: World Journal of Urology 2020; online first: 2 January
Abstract: The last decade has seen a remarkable shift in the treatment landscape of advanced prostate cancer, none more so than in the management of metastatic castration-naïve disease. This narrative review will examine existing and emerging evidence supporting systemic therapy use for metastatic castration-naïve prostate cancer (mCNPC) and provide guidance on the selection of these agents with respect to optimising patient outcomes. The addition of either docetaxel (chemohormonal approach) or an AR pathway inhibitor (abiraterone, enzalutamide or apalutamide) is a reasonable standard of care option for men commencing long-term ADT for mCNPC. While the issue of disease volume as a predictive biomarker for docetaxel benefit has previously been debated, recent data support consideration of upfront docetaxel in all patients, regardless of metastatic burden. Decisions regarding systemic treatment for men with mCNPC should be based on comprehensive consideration of disease, patient and logistical factors. Multiple novel therapeutics for mCNPC are currently under active investigation. The introduction of potent systemic therapy earlier in the mCNPC disease course has resulted in dramatic improvements in clinical outcomes for patients. As the management of mCNPC continues to evolve, the future remains promising, with the expectation of ongoing improvements to patient outcomes and quality of life.
DOI: 10.1007/s00345-019-03060-7
ORCID: 0000-0001-8553-5618
Journal: World Journal of Urology
PubMed URL: 31897602
Type: Journal Article
Subjects: Abiraterone
Androgen receptor pathway inhibitors
Metastatic Prostate cancer
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