Advancements in Treatment for Recurrent Prostate Cancer: Insights from EAU 2020 and ESMO Virtual Congress 2020

Advancements in Treatment for Recurrent Prostate Cancer: Insights from EAU 2020 and ESMO Virtual Congress 2020

Introduction:
At the EAU 2020 and ESMO Virtual Congress 2020, significant advancements in the treatment of recurrent prostate cancer were discussed. Experts presented new guidelines and research findings that shed light on effective therapeutic approaches. In this article, we will explore the key takeaways from both conferences and discuss actionable advice for healthcare professionals and patients alike.

EAU 2020: Recurrence after Radical Prostatectomy:
One of the primary topics discussed at EAU 2020 was the management of recurrence after radical prostatectomy. The EAU guidelines suggest that patients with M1 disease should be offered androgen deprivation therapy (ADT) in combination with abiraterone acetate plus prednisone or apalutamide or enzalutamide, provided they are fit enough for the regimen. Additionally, patients who first present with M1 disease and are fit to receive docetaxel should be offered ADT in combination with chemotherapy (docetaxel). However, it is important to note that patients in the M0 setting should not be offered ADT if the PSA-doubling time is greater than 12 months.

PSMA PET-CT Study:
A study conducted by Ceci et al. examined the efficacy of prostate-specific membrane antigen (PSMA) PET-CT in detecting recurrent prostate cancer. The study included 332 patients, with 97% of them having undergone radical prostatectomy. The results showed that the detection rate for disease using 68Ga-PSMA-11 PET/CT was 53.6%. Furthermore, 62.1% of patients had negative PET findings at a PSA level below 0.5 ng/mL. Among patients with persisting detectable PSA after radical prostatectomy, the detection rate was 64.5%. These findings highlight the potential of PSMA PET-CT as a valuable tool for identifying recurrent prostate cancer.

ESMO Virtual Congress 2020: The PROfound Study and IPATential150:
The ESMO Virtual Congress 2020 featured discussions on the final overall survival (OS) analysis from the PROfound Study and the IPATential150 trial. In the PROfound Study, olaparib was evaluated as a treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC) who had specific genetic mutations. The analysis indicated that olaparib may be beneficial for patients with BRCA1 or BRCA2 mutations who had previously received androgen axis targeting agents and taxes. However, it was suggested to be cautious in using olaparib for patients lacking these mutations, as the lack of benefit was demonstrated in Cohort B.

Importance of Biomarker-Guided Treatment:
The discussions at ESMO Virtual Congress emphasized the significance of biomarker-guided treatment. Dr. Grönberg highlighted that the future lies in individualized treatment based on specific genetic biomarkers. The PROfound trial results, while promising, lacked quality of life data, which is crucial to assess clinical benefit. It was also noted that a more appropriate comparison for olaparib would be cytotoxic chemotherapy. Additionally, the use of next-generation sequencing (NGS) was suggested as a better method for defining PTEN-loss, a biomarker associated with poor prognosis.

Key Takeaways and Actionable Advice:

1. Incorporate ADT with targeted therapies: For patients with M1 disease, offering ADT in combination with abiraterone acetate plus prednisone or apalutamide or enzalutamide can be an effective treatment approach.

2. Consider PSMA PET-CT for recurrent prostate cancer detection: PSMA PET-CT has shown promising results in detecting recurrent prostate cancer. It can be a valuable tool for guiding treatment decisions.

3. Individualize treatment based on genetic biomarkers: The future of prostate cancer treatment lies in biomarker-guided therapy. Identifying specific genetic mutations, such as BRCA1 or BRCA2, can help determine the most effective treatment options for patients.

Conclusion:
The discussions at EAU 2020 and ESMO Virtual Congress 2020 provided valuable insights into the management of recurrent prostate cancer. The incorporation of targeted therapies, the use of PSMA PET-CT for detection, and the importance of biomarker-guided treatment were key highlights. By implementing these actionable pieces of advice, healthcare professionals can improve patient outcomes and provide more personalized care.