SEOM clinical guidelines for the treatment of advanced prostate cancer (2020)

• Published in: Clinical & translational oncology Vol. 23; no. 5; pp. 969 - 979
• Main Authors: González del Alba, A., Méndez-Vidal, M. J., Vazquez, S., Castro, E., Climent, M. A., Gallardo, E., Gonzalez-Billalabeitia, E., Lorente, D., Maroto, J. P., Arranz, J. A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2021
• Subjects: Androgen Antagonists - therapeutic use; Androstenes - therapeutic use; Antineoplastic Agents - therapeutic use; Benzamides - therapeutic use; Clinical Guides in Oncology; Combined Modality Therapy - methods; Docetaxel - therapeutic use; Genes, BRCA1; Genes, BRCA2; Genetic Testing - methods; Humans; Male; Medical Oncology; Medicine; Medicine & Public Health; Nitriles - therapeutic use; Oncology; Orchiectomy; Phenylthiohydantoin - therapeutic use; Phthalazines - therapeutic use; Piperazines - therapeutic use; Prostatic Neoplasms - genetics; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Prostatic Neoplasms, Castration-Resistant - diagnosis; Prostatic Neoplasms, Castration-Resistant - therapy; Radiotherapy - methods; Randomized Controlled Trials as Topic; Spain; Thiohydantoins - therapeutic use; Spain; Biomarkers; Research; Androgen; Castration; Molecular
• ISSN: 1699-048X; 1699-3055; 1699-3055
• DOI: 10.1007/s12094-021-02561-5

The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.