EAU18 - Copenhagen. Hormone-Naive PCa.

[pjoshea13]

[The European Association of Urology [EAU] annual meeting took place in Copenhagen last month.]

The lead paragraph is something of a downer & need not be read - so I moved it to below my signature.

I know that some here are interested in oligometastatic PCa. Interesting quote from the end of the presentation:

"In the setting of oligometastatic disease, the first randomized controlled trial shows that there is benefit in local treatment in oligometastatic disease, manifesting in an 8 month delay of starting ADT."

That's a window of opportunity for preventing further mets IMO.

Here is the rest:

Copenhagen, Denmark (UroToday.com) Dr. Joniau gave an overview of hormone-naïve prostate cancer (HNPC).

"Androgen deprivation therapy (ADT) is the back-bone of HSPC therapy, and the volume of metastatic disease is prognostic. The addition of docetaxel to ADT prolongs overall survival (OS), especially in high volume disease (STAMPEDE and CHAARTED studies). The addition of abiraterone to ADT prolongs OS as well (LATITUDE and STAMPEDE). LATITUDE demonstrated 38% risk reduction of death and 53% risk reduction of progression/death. When comparing ADT + abiraterone to ADT+docetaxel [1] there was strong evidence for favoring abiraterone when looking at failure free survival and progression free survival. No good evidence of a difference was observed in cause specific survival and overall survival. Abiraterone has been demonstrated to be superior to docetaxel in efficacy, acute toxicity, toxic deaths, and convenience. However, the costs of abiraterone are significantly higher than that of docetaxel. There is an ongoing trial attempting to assess if the combination of ADT + abiraterone + docetaxel (PEACE – 1) is even better than each of them alone.

When deciding whether to give docetaxel or abiraterone, we need to understand if the patient is fit to receive docetaxel. Next, we need to know if the patient has a high enough burden of disease to potentially benefit from early docetaxel. Known risk factors in HSPC is high volume disease and de novo metastatic disease. These known risk factors should also be incorporated when choosing between docetaxel and abiraterone. Lastly, cost is a significant factor in choosing between these two treatments, as abiraterone is significantly more expensive than docetaxel. Several factors can help us choose docetaxel over abiraterone, aside from lowered cost. These include the fact that despite more short term adverse events with docetaxel, it is done in 18 weeks. Furthermore, abiraterone requires more clinic visits and long-term monitoring. Additionally, abiraterone can be added on later more easily than docetaxel, which we will not be able to administer to the patient is too frail. Our aim should be to get as many therapies as possible.

The STOMP trial compares between surveillance and metastasis directed therapy for oligometastatic prostate cancer recurrence. Preliminary results demonstrate that 75% of patients on MDT compared to 35% of surveillance patients undergo PSA decline [2] Additionally, this study shows an increased biochemical recurrence free survival, and ADT free therapy in the local treatment arm. This phase 2 study represents the first positive evidence of local therapy for oligometastatic disease.

Dr. Joniau concluded his talk by stating that in de novo metastatic disease:

Addition of docetaxel or abiraterone to ADT are efficient

Treatment selection should consider all patient factors, tumor factors and careful counseling

The ultimate goal should be not to miss the opportunity to receive all treatments"

-Patrick

urotoday.com/conference-hig...

"Approximately 5% of the screened population present with de novo metastatic prostate cancer. This represents 1/3 of the prostate cancer (PC) death in the USA each year. The remaining 2/3 of patients relapse after prior localized therapy. They undergo rapid progression to metastasis, with transformation of HSPC to castrate resistant prostate cancer (CRPC), and then to death. The median time from radical prostatectomy to PSA failure is 24 months (12-44). The median time from PSA failure to metastasis is 32 months (2-129), and finally the median time from metastasis to PC specific mortality is 82 months (7-181). Overall, from PC relapse to PC specific death the median time is 132 months (12-204). "

[snoraste]

Thanks Patrick. I also found interesting the new timelines at the very end of the post.

[jdm3]

Excellent, comprehensive summary. Thanks!

[gusgold]

Wow..that last paragraph is a downer...almost no progress has been made in 50 years

[Raymonda100]

Are the numbers in parentheses the range of months?

[pjoshea13 in reply to Raymonda100]

Hi Raymond,

Yes.

Note that half of the men do better than the median, and the ranges are wide.

Also, the newer drugs haven't been around long enough to be reflected in those numbers.

-Patrick

[Raymonda100]

What is the median (& range) for the 5 percent?

[pjoshea13 in reply to Raymonda100]

Raymond,

Looks like one could use:

"the median time from metastasis to PC specific mortality is 82 months (7-181)".

Such statistics inform one about the group one is in, but say nothing about the individual.

-Patrick

[Raymonda100]

Thank you for responding. From what I've heard and read, the stats for men who have mets at first diagnosis -- and high Gleason scores (i.e. aggressive cancer) -- are different from those for men who have progressed from local to mets after local treatment. Also, the range is huge - 7-181 months - suggesting that age specific rates might be very different.