Dr. Chandler Park of Norton Cancer Institute has outlined key considerations that shape treatment decisions for patients with metastatic hormone-sensitive prostate cancer (mHSPC), emphasizing the importance of patient-specific factors and disease characteristics in therapeutic planning.
Disease Classification and Risk Assessment
The classification of mHSPC follows criteria established through pivotal trials including STAMPEDE, CHAARTED, and LATITUDE. High-volume disease is identified by either the presence of visceral metastases in organs such as lungs or liver, or more than three bone lesions with at least one outside the spine or pelvis. High-risk disease, as defined by the LATITUDE trial, requires at least two of three factors: Gleason scores of 8-10, three or more bone lesions, or visceral metastases.
Treatment Stratification Based on Patient Profiles
"I evaluate patients for high-risk, high-volume disease. If they're young and also have liver-metastatic disease, I consider triplet therapy based on the ARASENS study," states Dr. Park. This triplet approach combines androgen deprivation therapy (ADT), a second-generation androgen receptor inhibitor, and docetaxel.
For the majority of patients, however, doublet therapy remains the standard approach. This typically consists of ADT combined with either apalutamide or enzalutamide. Dr. Park notes that darolutamide plus ADT, supported by the ARANOTE study, presents a valuable alternative for patients receiving anticoagulation therapy due to its reduced risk of drug interactions.
Special Population Considerations
Treatment strategies require careful modification for elderly patients with significant comorbidities. Dr. Park identifies a distinct subset of patients, typically in their 80s or 90s with limited life expectancy, who receive ADT monotherapy to minimize treatment-related complications.
Prognosis and Clinical Implications
The prognosis for patients with newly diagnosed synchronous metastatic prostate cancer remains challenging, with survival typically ranging from 3 to 4 years. This underscores the importance of appropriate treatment selection based on individual patient characteristics and risk factors.
The evolving treatment landscape in mHSPC demonstrates a shift toward more personalized approaches, taking into account factors such as age, comorbidities, disease volume, and specific metastatic patterns to optimize therapeutic outcomes while managing potential complications.
