Advanced Prostate Cancer: Treatment Advances and Future Directions

Three novel androgen axis inhibitors, abiraterone, apalutamide, and enzalutamide, have recently been approved in metastatic castrate-sensitive prostate cancer. Abiraterone, docetaxel, and enzalutamide are the front-line treatments for metastatic castrate-resistant disease, as well as sipuleucel-T and radium-223 that are used in selected patients. Advances in liquid genomics have the potential to guide the management of prostate cancer in the near future. Precision medicine such as treatments directed towards specific mutations, such as PARP inhibitors and prostate-specific membrane antigen (PSMA)-based radionucleotides, will soon open new avenues for treatment of metastatic castrate-resistant prostate cancer. Prostate cancer affects one in every nine men in the USA and is the second leading cause of cancer-related death. The treatment landscape of advanced prostate cancer is changing rapidly. Multiple agents including abiraterone, enzalutamide, apalutamide, darolutamide, docetaxel, cabazitaxel, radium-223, and sipuleucel-T have been approved for advanced prostate cancer. Appropriate drug selection remains crucial in this evolving landscape to derive maximum benefit for the patients. We summarize clinical trials leading to recent drug approvals and discuss optimal treatment selection. We also review recent advances in genomics including its evolving role in prognosis, in elucidating mechanisms of treatment resistance, and in guiding treatment decisions. Prostate cancer affects one in every nine men in the USA and is the second leading cause of cancer-related death. The treatment landscape of advanced prostate cancer is changing rapidly. Multiple agents including abiraterone, enzalutamide, apalutamide, darolutamide, docetaxel, cabazitaxel, radium-223, and sipuleucel-T have been approved for advanced prostate cancer. Appropriate drug selection remains crucial in this evolving landscape to derive maximum benefit for the patients. We summarize clinical trials leading to recent drug approvals and discuss optimal treatment selection. We also review recent advances in genomics including its evolving role in prognosis, in elucidating mechanisms of treatment resistance, and in guiding treatment decisions. treatment to suppress or block the production or action of male hormones. prostate cancer which continues to progress even when testosterone is decreased to very low levels. prostate cancer which can be controlled by decreasing the amount of testosterone in the body. ratio of risk of outcome in one group to risk of outcome in another group occurring at a given interval of time. second-generation androgen axis inhibitors which can suppress prostate cancer growth after it has become castrate-resistant. length of time from either date of diagnosis or start of treatment for which the person with disease (cancer) is still alive. length of time during or after treatment of disease (cancer) in which a person is still alive without the disease progressing locally to a higher stage or spreading to a distant site. time from random assignment to date when the first site of disease is found to progress (using a manifestation-specific definition of progression), or death, whichever occurs first.