SEOM clinical guidelines for the treatment of advanced prostate cancer (2020).
A González Del AlbaM J Méndez-VidalS VazquezE CastroM A ClimentE GallardoE Gonzalez-BillalabeitiaD LorenteJ P MarotoJ A ArranzPublished in: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico (2021)
The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.
Keyphrases
- prostate cancer
- end stage renal disease
- ejection fraction
- newly diagnosed
- radical prostatectomy
- dna repair
- squamous cell carcinoma
- prognostic factors
- small cell lung cancer
- early stage
- radiation therapy
- patient reported outcomes
- type diabetes
- high resolution
- mesenchymal stem cells
- depressive symptoms
- dna damage
- copy number
- clinical practice
- insulin resistance
- dna methylation
- men who have sex with men
- single molecule
- physical activity
- bone marrow
- combination therapy
- oxidative stress
- adipose tissue
- human immunodeficiency virus