Prostate Cancer Insights: Transformative Advancements in Care

Nasir Chaudry, MD

With new data, the latest research, and ongoing clinical trials, the landscape of prostate cancer treatment continues to evolve. According to Nasir Chaudry, MD, some of the most impactful advancements in the field over the past year have focused on extending the life expectancies of patients with metastatic disease.

“...Additional therapies, even in regard to radiation treatments, can often extend people's [lives], and it is showing meaningful benefits, not always curative, but [it is] definitely extending lives,” said Chaudry, a urologist with Allegheny Health Network, in an interview with Targeted Oncology^TM.

The advent of new agents has caused the treatment paradigm to shift, offering hope for extended survival beyond conventional timelines. Still, Chaudry explained that amidst the many new treatment options available, the key lies in individualizing approaches.

In an interview with Targeted Oncology^TM, Chaudry discussed the evolving landscape of prostate cancer treatment, driven by new research.

Targeted Oncology: In your opinion, what have been some of the most impactful data and research in the prostate cancer space over the past year or so?

Chaudry: In terms of the data, a big part of it is the advancing treatments that are coming in regards to metastatic disease. I can almost say over the last 15 to 17 years, [we have] only seen a new agent come out every few years that is able to extend life expectancies by 6 to 12 months. It used to be that as soon as a cancer became castrate-resistant, it is a fairly poor prognosis, but we're starting to see and are able to extend someone's life beyond that point of time.

3d rendered medically accurate illustration of prostate cancer: © SciePro - stock.adobe.com

Are there any specific research or clinical trials that you could highlight?

A big thing that's coming out with prostate cancer is whenever you're seeing metastatic disease, in the past it used to be automatic hormonal therapy, and that used to be the mainstay of your therapy. What we're seeing now is potentially doing prostatectomy on patients who have basically oligometastatic disease with often less than 5 sites of metastasis is basically showing survival benefits. Basically, additional therapies, even in regards to radiation treatments, can often extend people's [lives], and it is showing meaningful benefits, not always curative, but [it is] definitely extending lives.

With so many options available for patients, what are some factors you look at when determining how to treat a specific patient?

It's always important first, basically [to] be able to establish whether the patient has organ-confined disease or not organ-confined disease. One of the changes that we have seen in the last year, year and a half, is the change in how you do a staging workup. In the past, CT bone scan[s] used to be the standard. Now, we are looking at the recent [National Comprehensive Cancer Network] guideline changes. Everyone should be undergoing [a prostate-specific membrane antigen (PSMA)] scan with basically intermediate-risk disease. I think that's kind of the first step in the process.

All this is assuming someone has intermediate- or high-risk disease. I think it's been well established for low-risk prostate cancer that the standard of care is observation. There are things that can change that, but that's usually the mainstay.

When you're considering treatment for patients, it's best to give them a realistic viewpoint of what each of the therapies will accomplish. Give them a realistic estimate on cure rates and mainly the [adverse] effect profile. When you're looking at radiation vs surgery, they are both very ontologically sound treatments, and they're usually going to give a fairly good cure rate. Obviously, cure rates do depend on whether [the patient is] intermediate-risk, whether they're high-risk disease, but you're never wrong going with each of the therap[ies]. The big distinction between them is what [adverse] effect profile the patient's willing to undergo, and also looking at the realistic life expectancy of the patient. In general, younger patients tend to go more towards surgery, and for older patients, [we’d] generally encourage them more to go toward radiation. Obviously, these are not steadfast rules, but they are the kind of the general trends.

What unmet needs still exist in the space?

With prostate cancer, when looking at where the long-term treatments are going, it is probably going to evolve more into how we are dealing with more advanced stages of prostate cancer. Like most cancers in general, [we will be] looking at what potential immunotherapies in the future would likely yield benefits. The nice thing about immunotherapy is they often have less [adverse] effects than standard regimen[s]. If [we are] looking at where prostate cancer treatment could go in the future, I think that is certainly 1 element.

From a surgical standpoint, I think we are already starting to see more advancements, even over the last 5 to 10 years. What [we are] able to do with the newer robotic systems is we are starting to push and be able to get patients home the same day and often having shorter lengths of needing a catheter. Those things [have been] continuing to improve over the last 5 to 10 years.

For the community oncologist, what are the key takeaways from this conversation?

If someone has a single site of metastatic disease, I think in the past, it was always said that you should never do robotic prostatectomy. I think that is not always the case in all situations. I think in understanding prostate cancer, even from a quality-of-life situation, patients sometimes benefit from getting their prostate taken out, even if [we are] not 100% curing them. I think just making sure that when [we] do have these patients, [we should be] taking a multidisciplinary approach to it. Discuss the case with a radiation oncologist, discuss the case with an oncologist, and come up with a good game plan on how to attack the cancer.