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Published on: March 6, 2018
Management of advanced prostate cancer in senior adults: the new landscape
1Multidisciplinary Oncology Institute, Genolier, Switzerland. maapro@genolier.net
Abstract:
The landscape of treatment for advanced prostate cancer is continually evolving as new therapies are developed and guidelines are constantly updated. However, the management of older men with advanced disease is not optimal. Many men are denied chemotherapy based on their chronological age, not their health status. Androgen-deprivation therapy (ADT) remains the mainstay of first-line treatment of advanced disease. Once the disease becomes resistant to castration, docetaxel-based chemotherapy is the regulatory-approved standard of care, irrespective of age. The place of weekly docetaxel in patients with poor performance status and signs of frailty has to be further evaluated in clinical studies. New treatments are now available, or on the horizon, for disease that progresses during or after docetaxel therapy. Cabazitaxel and abiraterone have been shown to prolong survival, irrespective of age, and are already in clinical use having received regulatory approval. The optimal sequence for these two agents is still unknown, although there is some indication that in patients predicted to be poor responders to abiraterone (high Gleason score, progression during docetaxel therapy, rapid progression to castrate-resistant prostate cancer with ADT) cabazitaxel should be the preferred choice. Further advances are being investigated, with promising data reported from phase III trials.
Insights
Management of advanced prostate cancer in older men needs improvement. New treatments like cabazitaxel and abiraterone offer survival benefits regardless of age, but optimal sequencing requires further study.
Area of Science:
- Oncology
- Geriatric Medicine
- Urology
Background:
- Advanced prostate cancer treatment is evolving, yet older men often receive suboptimal care.
- Current guidelines may deny chemotherapy based on chronological age rather than health status.
- Androgen-deprivation therapy (ADT) is the standard first-line treatment.
Purpose of the Study:
- To review the current treatment landscape for advanced prostate cancer, focusing on older men.
- To evaluate the role of chemotherapy and newer agents in managing castration-resistant prostate cancer (CRPC).
- To discuss the optimal sequencing of novel therapies for advanced prostate cancer.
Main Methods:
- Review of current treatment guidelines and clinical trial data for advanced prostate cancer.
- Analysis of the efficacy and safety of docetaxel, cabazitaxel, and abiraterone in CRPC.
- Discussion of treatment challenges in older and frail patients.
Main Results:
- Docetaxel chemotherapy is the standard for CRPC, irrespective of age.
- Cabazitaxel and abiraterone prolong survival in CRPC, regardless of age.
- Weekly docetaxel's role in frail patients requires further evaluation.
- Optimal sequencing of cabazitaxel and abiraterone is under investigation, with potential preference for cabazitaxel in poor responders.
Conclusions:
- Treatment for advanced prostate cancer, especially in older men, requires personalized approaches.
- Novel agents like cabazitaxel and abiraterone have significantly improved survival outcomes.
- Further research is needed to optimize treatment sequences and manage frail populations.
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