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Updated: Jun 10, 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
Navigating therapeutic sequencing in the metastatic castration-resistant prostate cancer patient journey
Hannah D McManus1, Tanya Dorff2, Alicia K Morgans3
1Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA.
Background:
Novel therapies for metastatic castration-resistant prostate cancer (mCRPC) have improved patient outcomes. However, there is uncertainty on the optimal selection of therapeutic agents for subsequent lines of therapy.
Methods:
We conducted a comprehensive review of published evidence from pivotal clinical trials and recent guidelines for the treatment of mCRPC. We further identify gaps in knowledge and areas for future research.
Results:
Key considerations to help guide treatment selection for patients with mCRPC include personal treatment history, individual clinical characteristics, symptoms, prognosis, availability of clinical trials, and other patient-specific factors. Genetic testing and prostate-specific membrane antigen-targeted imaging are important tools to evaluate candidacy for newer therapeutic options such as poly (ADP-ribose) polymerase inhibitors, alone or in combination with androgen receptor pathway inhibitors, and [177Lu]Lu-PSMA-617.
Conclusion:
This article provides an overview of the evolving treatment landscape of mCRPC, discussing guideline-recommended treatment options and data from key clinical trials, while highlighting ongoing trials that may impact the future treatment landscape. Recommendations for optimal treatment sequencing based on individual patient factors are provided.
Insights
Selecting optimal treatments for metastatic castration-resistant prostate cancer (mCRPC) requires considering patient history, clinical factors, and utilizing genetic testing. Newer therapies like PARP inhibitors and [177Lu]Lu-PSMA-617 offer improved outcomes.
Area of Science:
- Oncology
- Urology
- Medical Therapeutics
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) presents treatment selection challenges despite novel therapies.
- Optimal sequencing of therapeutic agents for mCRPC remains an area of clinical uncertainty.
Purpose of the Study:
- To provide an overview of the evolving mCRPC treatment landscape.
- To discuss guideline-recommended options and clinical trial data for mCRPC.
- To offer recommendations for optimal treatment sequencing based on individual patient factors.
Main Methods:
- Comprehensive literature review of pivotal clinical trials and treatment guidelines for mCRPC.
- Identification of knowledge gaps and future research directions in mCRPC therapy.
Main Results:
- Treatment selection for mCRPC hinges on patient history, clinical characteristics, symptoms, prognosis, and trial availability.
- Genetic testing and PSMA-targeted imaging are crucial for evaluating eligibility for novel agents.
- Emerging therapies include PARP inhibitors, AR pathway inhibitors, and [177Lu]Lu-PSMA-617.
Conclusions:
- The mCRPC treatment landscape is dynamic, with ongoing trials influencing future strategies.
- Personalized treatment sequencing, guided by patient-specific factors, is essential for optimal mCRPC management.
- Guideline-recommended options and emerging therapies are discussed in the context of clinical trial evidence.
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