HealthCentral: Good Medicine—Treating mCRPC
HealthCentral recently interviewed Adam Weiner, MD, a urologic oncologist at Cedars-Sinai, about treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC), an advanced form of the disease that has spread beyond the prostate and continues to grow after hormone therapy.
Weiner told HealthCentral that for most patients with this advanced disease, the main goals of treatment are to control the cancer, extend life and manage symptoms so they can feel well.
“Generally, mCRPC is not curable, so rather than aiming to eliminate the cancer we focus on slowing its growth, shrinking it where we can, relieving pain and other symptoms, and preventing complications like fractures,” he said, noting fractures can occur when the disease spreads to the bones.
Weiner told HealthCentral that although this kind of prostate cancer no longer responds fully to hormone treatment, therapy remains important. Prostate cancer is fueled by male hormones, especially testosterone, so treatment lowers testosterone or blocks it from reaching the cancer. Over time, however, this disease can find ways to grow despite very low testosterone levels.
“We usually keep patients on hormone treatment and add other treatments that block the androgen pathway more completely or ones that work through other actions,” he said.
Weiner outlined additional treatment options:
- Chemotherapy
- Immunotherapy (treatment that harnesses a patient’s immune system)
- Newer androgen-receptor pathway inhibitors (hormone-blocking therapy)
- Targeted PARP inhibitors (targeted therapy that prevents damaged cancer cells from mending)
- Radiopharmaceuticals (medicines that deliver radiation directly to cancer cells)
Weiner emphasized that genetic and genomic testing can help determine which targeted treatments are most likely to help. Patients with mutations in DNA-repair genes such as BRCA1 or BRCA2 may benefit from PARP inhibitors.
Weiner told HealthCentral that radiopharmaceuticals are “especially valuable in metastatic disease, where the cancer has spread to many sites and we can’t aim a radiation beam at one spot.”
He described the field as “an area of rapid progress.”
Read the complete article from HealthCentral.