Dr. Andrew Leone is an Assistant Professor of Urology at the University of Central Florida who is fellowship trained in Genitourinary Oncology and widely published in the field of genitourinary cancer. We asked him for his opinion on the most important developments in prostate cancer diagnosis and management in the last year.
1. What do you consider the most important evidence published in the last year?
Combination treatments integrating genetic analysis for metastatic prostate cancer are one of the most important developments in the past year.
Editor’s Note: Results from the TALAPRO-2 trial demonstrated a significant improvement in response rate for patients with castration-resistant metastatic prostate cancer. These study results specifically apply to the approximately 25 percent of people with prostate cancer who have damaged homologous recombination repair (HRR) genes detected in their tumor. In this study, patients were randomized to receive enzalutamide (an androgen receptor inhibitor) plus either a placebo or the study drug talazoparib. Talazoparib is a PARP (poly [adp-ribose] polymerase) inhibitor. PARP inhibition, similar to androgen inhibition, seems to slow the progression of prostate cancer in this subset of men with an HRR deficiency. Other PARP inhibitors for use in patients with metastatic castration-resistant prostate cancer include olaparib and niraparib.
2. Why is this important?
The ability to treat advanced prostate cancer more proactively with combination treatment has been shown to improve survival and delay recurrence.
3. How does this inform how you treat your patients?
Recent increases in the armamentarium available to treat people with advanced prostate cancer offer tremendous hope and a survival benefit for our patients. Implementing earlier combination treatment will continue to prolong survival and improve quality of life as new genetic alterations and targeted medications are developed.
For more information about the TALAPRO-2 trial, and other guidance about the treatment with PARP inhibitors and other modalities for patients with prostate cancer who have progressed despite initial management, see Management of Castration-Resistant Prostate Cancer in DynaMedex.
