©TheCanadian Journal ofUrology™: International Supplement, April 2014
INTRODUCTION
Address correspondence to Dr. Leonard G. Gomella,
Department of Urology, Kimmel Cancer Center, Thomas
Jefferson University, 1025 Walnut Street, Room 1102,
Philadelphia, PA19107USA
Currentmanagement of advancedand
castration resistant prostate cancer
LeonardG.Gomella,MD,
1
Daniel P. Petrylak,MD,
2
BobbyShayegan,MD
3
1
Department ofUrologyKimmelCancerCenter, Thomas JeffersonUniversity, Philadelphia, Pennsylvania,USA
2
Department ofMedicine (MedicalOncology) andUrology, YaleCancerCenter,NewHaven, Connecticut,USA
3
DivisionofUrology,Department of Surgery,McMasterUniversity,Hamilton,Ontario, Canada
GOMELLA LG, PETRYLAK DP, SHAYEGAN B.
Current management of advanced and castration
resistantprostatecancer.
Can JUrol
2014;21(Suppl1):
1-6.
Introduction:
Newer approaches to the management
of advanced prostate cancer have rapidly evolved.
While basic androgen deprivation remains as the first
line in newly diagnosed hormone naïve metastatic
prostate cancer, the agents used and strategies followed
have undergone significant changes. Numerous new
agents such as sipuleucel-T, abiraterone, enzalutamide,
cabazitaxel and radium223have all been approved since
2010 to treat metastatic castration resistant prostate
cancer (CRPC). New imaging techniques to detect
advanceddiseasesuchasF-18PET,11C-cholinePETand
othermodalities are becoming available. The concepts of
“bonehealth’and themanagementof sideeffectsrelated to
androgen deprivation therapy are also gaining attention
asmenare being treatedwith longer courses of androgen
deprivation. Understanding the theorybehind thesenew
agentsandmanagementapproacheswhile focusingon the
practical clinical considerations are essential to improve
outcomes in advanced prostate cancer.
Materialsandmethods:
A review of the current state
of the art in themanagement of advanced and castration
resistant prostate cancer presented in this Canadian
Journal of Urology International supplement was
performed. Key findings are summarized and presented
alongwith critical updates based on recent publications
andmeeting presentations.
Results:
Key concepts identified in the management of
advancedprostate cancer included the newunderstanding
of prostate cancer based on translational discoveries,
applications of various hormonally based strategies in
advanced disease including traditional and recently
approved agents. The use of new imaging modalities to
identifymetastaticdisease, immunotherapyapproachesand
discussions of sequencing andwhichnew agents are likely
to be available in the future in the management of CRPC
were identified. Bone targeted strategies are alsoaddressed
inthesettingofandrogendeprivationandmetastaticdisease.
Conclusions:
The management of men with advanced
prostate cancer has become more multidisciplinary as
treatment options have expanded. As the use of these
agents and new strategies expand, urologists, medical
oncologists and radiation oncologists must all become
familiar with this rapidly changing field in order to
maximize the outcome of patients with advanced and
castration resistant prostate cancer.
KeyWords:
metastatic prostate cancer, castration
resistant prostate cancer, docetaxel, sipuleucel-T,
abiraterone, enzalutamide, cabazitaxel, radium
223, bone targeted agents, LHRH agonists and
antagonists, prostate cancer imaging
cancer (mCRPC). Understanding the theorybehind
thesenewagentsandapproacheswhilefocusingonthe
practical clinicalapplicationsareessential to improve
outcomes. As themanagementof thesepatientswith
advanced disease becomes more multidisciplinary
and the use of these agents expands, urologists,
medical oncologists and radiation oncologistsmust
become more familiar with these new treatment
strategies. This2014CMEsupplementof
TheCanadian
Journal of Urology International
will review advanced
prostatecancerwitha focuson thenewer therapeutic
agents used for advanced and castration resistant
disease.
Introduction
The development of new approaches in the
management of advancedmetastaticprostate cancer
hasaccelerated rapidlyover the last fewyears. Basic
androgendeprivation therapy (ADT)hasbeenrefined
andnumerousnewagentshavebeenapprovedsince
2010 to treat metastatic castration resistant prostate
1
