Your peers answered:
ADT monotherapy
ADT + ARTA
ADT + ARTA + DOC
ADT + RT to the prostate + ARTA
ADT + RT to the prostate + ARTA + DOC
your answer
Prostate cancer
PROSCA cases on the road to the Annual Global Forum on GU OncologyCase 2023: Manuel (expert opinion by A. Bossi)
Manuel, 59 years old, is an enthusiastic tour guide at the Jardín Botánico-Historico La Concepción de Málaga. He is able to name and differentiate each and every tropical plant in the botanical garden. He was recently diagnosed with metastatic PCa.
Assessment summary:
- Medical history: former smoker (stopped 5 years ago)
- ECOG PS: 0
- Asymptomatic
- PSA: 14 ng/ml
- Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
- Bone scan: 2 spots (T11 & right sacrum)
- CT scan: locally advanced prostatic mass, few enlarged pelvic lymph nodes >2 cm, no visceral metastasis
- Clinical stage: cT3N1M1
Expert opinion by A. Bossi
ADT monotherapy
ADT + ARTA
ADT + ARTA + DOC
ADT + RT to the prostate + ARTA
ADT + RT to the prostate + ARTA + DOC
1-3=inappropriate, 4-6=uncertain, 7-9=appropriate
Clinical perspective: regulatory approval and local restrictions not considered
Evidence
This is a patient with low-volume, synchronous metastatic hormone-sensitive prostate cancer. For this patient population, treatment of the primary by radiotherapy is important. Data from STAMPEDE indicated prostate RT provides an overall survival benefit [1]. Data from the PEACE-I study didn’t show an overall survival benefit, but showed that combining radiotherapy to the prostate with ADT + ARTA leads to important benefits in other endpoints [2].
References
- Parker CC, James ND, Brawley CD, et al. PLoS Med 2022;19:e1003998. PubMed
- Bossi A, Foulon S, Maldonado X, et al. J Clin Oncol 2023;41(suppl 17):abstract LBA5000. Presented at ASCO 2023