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Management of Metastatic Castration-Naïve Prostate Cancer

  • Axel HeidenreichEmail author
  • Maximilian Schmautz
  • Konstantin Richter
  • David Pfister
Living reference work entry

Abstract

About 10% of newly diagnosed prostate cancer patients harbor systemic metastases requiring local and systemic therapy. In well-selected patients, cytoreductive radical prostatectomy or local radiation therapy to the primary exerts a beneficial effect on failure-free and overall survival. Systemic therapy might consist of ADT alone, ADT in combination with docetaxel, and ADT in combination with abiraterone and prednisone. CHAARTED and STAMPEDE have demonstrated a significant survival benefit for the combination of ADT plus docetaxel. This survival benefit was only demonstrated for patients with high-risk disease in the CHAARTED trials, whereas no stratification was performed in STAMPEDE. PSA nadir ≤0.2 ng/ml achieved 7 months after ADT is a significant prognostic marker associated with a significant survival benefit as compared to a PSA nadir >0.2 ng/ml. Also, a significant survival benefit was observed for the combination of ADT plus abiraterone acetate and prednisone in the LATITUDE trial for high-risk patients and in the STAMPEDE trial for the total cohort of patients. For daily routine, both combination therapies exert a significant and clinically relevant survival benefit. It is unclear which sequence is to be used, and it appears to be most appropriate to select the treatment option based on the comorbidities of the patient.

Keywords

Prostate cancer Bone metastases Androgen deprivation LHRH analogues LHRH antagonists Docetaxel Abiraterone acetate 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Axel Heidenreich
    • 1
    Email author
  • Maximilian Schmautz
    • 1
  • Konstantin Richter
    • 1
  • David Pfister
    • 1
  1. 1.Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic SurgeryUniversity Hospital CologneKölnGermany

Section editors and affiliations

  • Thomas Steuber
    • 1
  1. 1.Martini-Klinik am UKE GmbHHamburgGermany

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