Recent research has identified a number of factors which could be used to estimate which patients with prostate cancer are at high risk for a shorter time until prostate-specific antigen (PSA, a protein associated with the presence of prostate cancer in the body) recurrence and failure.
Among patients with nonmetastatic, unfavorable-risk prostate cancer, those who were younger than 70 years old, had a PSA of 10 ng/mL and a Gleason score (which grades prostate cancer based on a pathologist’s review of a biopsy or surgical specimen on a scale of 2 to 10) of 8 or higher had a 43.8% risk of PSA failure at three years, according to findings published in JAMA Network Open.
Study co-author Dr. Mutlay Sayan, an instructor at Harvard Medical School and radiation oncologist at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, spoke with CURE® about the significance of these findings and what they could mean for future research.
Q: Doctor, thank you so much for taking some time to chat.I appreciate you giving me a bit of insight and context for this study.
A: We know that the current standard for someone seeking radiation treatment for unfavorable-risk prostate cancer is radiation treatment plus a hormone therapy. And despite this curative intent treatment, about one-third of patients will have a recurrence. And what we know is that the shorter the time to recurrence following a treatment in this group of patients, they (more they) tend to have not good clinical outcomes.
We wanted to identify people who will have this shorter interval to the recurrence. … What we can do with this information is the important part. We can use this information to design (future) clinical trials for treatment escalation for these patients.
Q: The study mentions, specifically, possible treatment with the chemotherapy docetaxel and androgen deprivation therapy (ADT) for this patient population, if they’re found to be at high risk. Can you tell me a bit about why that treatment escalation is potentially important for this patient group?
A: With this patient group that we know that they are at higher risk of early PSA failure and because of that, we should add something else (to the current standard of care) to improve clinical outcome. We currently have androgen receptor-signaling inhibitors and chemotherapy, like a docetaxel, that we can use for treatment escalation. However, this needs to be evaluated in a well-designed randomized clinical trial.
Q: Say a patient finds themselves in this high-risk group due to different demographic factors and other factors that are detailed in the study. What sorts of conversations should they be having with their doctors and their care teams to make sure they stay on top of their disease?
A:They should ask if there are any clinical trials that they can be eligible to enroll in. And I think, hopefully, in the future, we’ll have a trial addressing this issue. Currently (there is) not. Currently, the standard of care is radiation treatment plus ADT. We have now identified the group of patients who are at high risk for shorter time interval to PSA failure. Next step should be to design a clinical trial for treatment escalation particularly for this group of patients.
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