We had a nice consensus meeting today on advanced and metastatic prostate cancer and my role was to elude on the role of ADT, so basically the backbone of the treatment of advanced metastatic prostate cancer. We have several treatment options nowadays for advanced prostate cancer in the metastatic setting from chemotherapy to hormonal therapies to modern hormonal therapies, novel substances. My role was to define or to tickle out the differences in the various forms of ADT. I looked at and presented data on the LHRH agonists versus LHRH antagonists and the pros and cons out of this situation.
What are the pros and cons?
We have discussed and concluded that the substance doesn’t matter if it’s agonist or antagonist suppressed testosterone, that’s why they are approved in this indication and they work very well. However, in some clinical situations like in metastatic disease, patients with pre-existing cardiovascular disease or with lower urinary tract symptoms which are the patients we will see a lot as urologists, the antagonist, the blocker, has an advantage in this situation because of the mode of action. Here, due to the mode of action, a reduction of the volume of the prostate size, the FSH reduction and therefore not causing plaque instability in the vas of the patient. So especially for patients with cardiovascular disease the antagonist, the blocker, is a good option.
This leads into the question how this can be applied into the clinic and definitely antagonists if you use antagonists for hormonal treatment in advanced metastatic prostate cancer patients, especially the patients with voiding problems, with large prostates, benefit. Especially the patients with pre-existing cardiovascular disease have a benefit of using the antagonists, the blocker. The patients with heavy metastatic disease where you really want to have a fast PSA reduction or you want to have a fast clinical response without the initial testosterone surge you might expect when using the LHRH agonists.
However, the cardiovascular disease story is still something that has to be proven prospectively so the trials and the pooled analysis is more hypothesis generating. There is one trial, the so-called PRONOUNCE trial, which is prospectively evaluating this question of cardiovascular disease among those various forms of ADT including the antagonists. Here we will have to await the results which are expected to fully recruit in the next year.
Definitely exciting times in advanced prostate cancer. I’m looking forward to having the panel discussion in the afternoon with a lot of worldwide well-known experts to discuss on various clinical situations and what is the best advice in those situations. I’m really looking forward, happy to be here in Cairo. Thanks again for giving me the opportunity to speak.
