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Optimal Care in Prostate Cancer
Applying New Evidence to Optimize Care in Advanced Prostate Cancer

Released: October 08, 2020

Expiration: October 07, 2021

Matthew R. Smith
Matthew R. Smith, MD, PhD
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In this module, Matthew Smith, MD, PhD, provides an overview of current evidence on the optimal management of advanced prostate cancer. This educational activity also reviews treatment recommendations from a CCO online interactive treatment decision tool for prostate cancer. This tool allows you to enter your specific patient’s characteristics, then offers treatment recommendations from 5 experts in prostate cancer: Emmanuel S. Antonarakis, MB BCh; Tanya B. Dorff, MD; David I. Quinn, MBBS, PhD, FRACP, FACP; Michael Schweizer, MD; and Matthew R. Smith, MD, PhD. To access this tool, please click here.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity, then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many patients with advanced prostate cancer do you typically provide care for in a month?

A 61-year-old man with a history of poorly controlled diabetes presents with chronic back discomfort and mild urinary symptoms and is found to have prostate-specific antigen (PSA) level of 54 ng/mL with no previous PSA measurements. Digital rectal examination (DRE) reveals globally indurated prostate, and a prostate biopsy shows a Gleason score 4+3 and 4+4 adenocarcinoma in multiple cores. A CT scan shows mild right pelvic lymphadenopathy and small sclerotic lesions in L3 spine and right ischium, confirmed by bone scan. The patient has an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 1 and a life expectancy of ≥ 5 years.

In your current practice, which therapy would you recommend?

A 69-year-old man with pT3bN0 Gleason 4+3 prostate cancer had a prostatectomy 7 years ago followed by salvage radiation therapy a year later. His history is notable for Parkinson’s disease with occasional falls. He has been on ADT with leuprolide depot for 4 years. His pretreatment PSA was 11.3 ng/mL, and his PSA nadir was < 0.10 ng/mL. His current PSA is 7.2 ng/mL, and the PSA doubling time (PSADT) is 5.5 months. No metastases were detected via a bone scan and abdominal-pelvic CT. His ECOG PS is 1, and he has a life expectancy of ≥ 5 years.

In your current practice, which therapy would you recommend?

The patient is a 65-year-old man with metastatic castration-resistant prostate cancer (mCRPC). He was initially managed with ADT alone. He was later found to have metastatic disease and has experienced disease progression during treatment with enzalutamide and subsequent treatment with docetaxel. Restaging demonstrates extensive bone metastases, para-aortic nodes, and liver metastases. The patient is symptomatic. Germline and tumor genetic testing reported no pathologic mutations.

In your current practice, which therapy would you recommend?
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