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Updated: Oct 23, 2025
Sequencing Small Non-coding RNA from Formalin-fixed Tissues and Serum-derived Exosomes from Castration-resistant Prostate Cancer Patients
Published on: November 19, 2019
Rapidly evolving treatment paradigm and considerations for sequencing therapies in metastatic prostate cancer-a
1University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA.
Abstract:
The treatment landscape of metastatic prostate cancer (mPCa) has evolved considerably over the past 15 years with approvals of targeted therapies such as poly-ADP-ribose polymerase inhibitors (PARPi) in castration-resistant [metastatic castration-resistant prostate cancer (mCRPC)] setting and novel antiandrogens and docetaxel in hormone-sensitive [metastatic hormone-sensitive prostate cancer (mHSPC)] setting. A number of promising clinical trials are now evaluating therapeutic combinations rooted in an improving understanding of tumor biology. Despite a plethora of effective treatment options, decisions regarding choice of therapy remain challenging due to the lack of head-to-head trials and a substantial overlap in selection criteria used in these trials. We summarize the data from key trials that led to approval of commonly used mPCa therapies and provides an easy-to-use clinical decision-making framework that incorporates patient-specific and disease-specific factors to aid selection of the optimal therapy. We outline the evolving use-cases for biomarker-guided treatment selection and our approach to incorporating these therapies in clinical practice. Finally, we highlight the rapidly growing pipeline of therapies that are in advanced stages of clinical development, such as combinations of novel antiandrogen and PARPi, vascular endothelial growth factor (VEGF) inhibitor and immunotherapy, as well as prostate specific membrane antigen (PSMA)-targeted therapies, many of which are poised to transform the landscape in the coming decade.
Insights
The treatment of metastatic prostate cancer (mPCa) has advanced with new therapies, but choosing the best option remains complex. This review offers a framework to guide treatment selection based on patient and disease factors.
Area of Science:
- Oncology
- Medical Therapeutics
- Prostate Cancer Research
Background:
- The metastatic prostate cancer (mPCa) treatment landscape has significantly evolved over 15 years.
- Approvals include poly-ADP-ribose polymerase inhibitors (PARPi) for metastatic castration-resistant prostate cancer (mCRPC) and novel antiandrogens/docetaxel for metastatic hormone-sensitive prostate cancer (mHSPC).
- Therapeutic combinations are being explored based on a deeper understanding of tumor biology.
Purpose of the Study:
- To summarize key trial data for commonly used mPCa therapies.
- To provide a clinical decision-making framework for optimal therapy selection.
- To outline biomarker-guided treatment selection and future therapeutic pipelines.
Main Methods:
- Review of pivotal clinical trial data for approved mPCa therapies.
- Development of a framework incorporating patient-specific and disease-specific factors.
- Analysis of current and emerging treatment strategies, including combination therapies and targeted agents.
Main Results:
- Effective treatment options exist for both mHSPC and mCRPC settings.
- Treatment selection is challenging due to limited head-to-head trials and overlapping criteria.
- Biomarker-guided selection and novel combination therapies are emerging.
Conclusions:
- A structured approach is needed to navigate the complex mPCa treatment landscape.
- Biomarker-driven strategies and novel therapeutic combinations show promise.
- The pipeline of advanced therapies, including PARPi combinations, VEGF inhibitors, immunotherapy, and PSMA-targeted agents, is set to transform mPCa care.
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