Skip survey header

PROSCA2019 - Case 01

Thank You!

Your case challenge

View case
You answered: C
You answered: C
A) ADT monotherapy - B) ADT + abiraterone -  C) ADT + docetaxel - D) ADT + enzalutamide
 

What would Karim Fizazi do?

This fit gentleman has a de novo metastatic prostate cancer with bone and lymph node metastases and a doubtful lung metastasis, corresponding to poor-prognosis (high-risk) disease. To better characterize his lung lesion, we may discuss additional imaging (PET-PSMA or PET-Choline).

I would certainly advice for genetic counselling for BRCA-1 and BRCA-2 screening due to the fact that he has de novo metastatic disease, on top of his mother having breast cancer when she was about 50.

Regarding his treatment, ADT alone is no longer an option, because it is clearly associated with inferior outcomes.

ADT+Abiraterone would definitely be my preferred option (over ADT+docetaxel) based on the final analysis of the LATITUDE trial and that of STAMPEDE in M1 patients: not only PFS is dramatically improved (much more than what is achieved with docetaxel over ADT alone) but the risk of death is reduced by about 35-50% with abiraterone, as compared with about 20-25% with docetaxel. Data on quality of life, pain and fatigue also very clearly favour abiraterone. The only parameter favouring docetaxel would be cost.

The early data from the ARCHES trial reported at ASCO GU this year clearly do not support enzalutamide use at this point in this context, given there is no proven benefit in OS. Data from ENZAMET are not available as I’m writing.

Whether abiraterone should be combined to ADT+docetaxel will soon be addressed by PEACE-1, which has completed its planned accrual in 2018.

Want to challenge me? I’m happy to discuss these data in more detail during PROSCA on 23-24 October in Paris!
 


What would Karim Fizazi do?

This fit gentleman has a de novo metastatic prostate cancer with bone and lymph node metastases and a doubtful lung metastasis, corresponding to poor-prognosis (high-risk) disease. To better characterize his lung lesion, we may discuss additional imaging (PET-PSMA or PET-Choline).

I would certainly advice for genetic counselling for BRCA-1 and BRCA-2 screening due to the fact that he has de novo metastatic disease, on top of his mother having breast cancer when she was about 50.

Regarding his treatment, ADT alone is no longer an option, because it is clearly associated with inferior outcomes.

ADT+Abiraterone would definitely be my preferred option (over ADT+docetaxel) based on the final analysis of the LATITUDE trial and that of STAMPEDE in M1 patients: not only PFS is dramatically improved (much more than what is achieved with docetaxel over ADT alone) but the risk of death is reduced by about 35-50% with abiraterone, as compared with about 20-25% with docetaxel. Data on quality of life, pain and fatigue also very clearly favour abiraterone. The only parameter favouring docetaxel would be cost.

The early data from the ARCHES trial reported at ASCO GU this year clearly do not support enzalutamide use at this point in this context, given there is no proven benefit in OS. Data from ENZAMET are not available as I’m writing.

Whether abiraterone should be combined to ADT+docetaxel will soon be addressed by PEACE-1, which has completed its planned accrual in 2018.

Want to challenge me? I’m happy to discuss these data in more detail during PROSCA on 23-24 October in Paris!

Do you have an interesting case of your own?

Up to 3 case reports will be selected by the scientific committee for discussion in the official programme of PROSCA 2019.
 

Submit your case

 

Join us at PROSCA 2019 to get a full update on prostate cancer and discuss with faculty and peers how 2019 highlights will impact your daily practice.


Reserve your seat