Treatment of Primary in Metastatic Prostate Cancer

Abstract

Until recently, men with metastatic prostate cancer were commenced on androgen deprivation therapy at diagnosis, followed by sequential lines of treatment with the development of castration resistance. However, the results of recent clinical trials, which revealed that the addition of radiotherapy to the prostate to a dose of 55 to 60 Gy in 20 fractions over 4 weeks in patients with low-volume metastatic hormone-sensitive prostate cancer, in addition to androgen deprivation therapy and another systemic treatment option, either docetaxel, abiraterone, enzalutamide, or apalutamide, has led to a paradigm change in the management of this disease.

UPDATE: Canadian Urological Association-Canadian Urologic Oncology Group guideline: Metastatic castration-naive and castration-sensitive prostate cancer

“…Intermittent androgen suppression (IAS) that cycles androgen deprivation treatment based on prostate specific antigen (PSA) values has been shown to improve quality of life; however, continuous ADT should be utilized in mCNPC and IAS only used as an exception in select patients with close follow-up (12,13). As well, the benefit of In the context of low volume mCNPC, treatment of the primary disease in the prostate has theoretical benefits, including reducing local side effects that may occur due to local disease progression as well as removing the cancer that could be the source of cytokines and growth factors that may induce disease progression (14).…”