Urol. praxi. 2019;20(1):25-31 [Onkologie. 2018:12(5):217-223]

Have we found an optimal sequence in the treatment of metastatic castrationally-resistant prostate cancer?

MUDr. Tomáš Svoboda, Ph.D.

Onkologická a radioterapeutická klinika FN Plzeň

Growing incidency of prostate cancer introduce a very important socioeconomic problem. Some patient proportion will develop dinase progression or relace and it´s androgen deprivation treatment successively fail while the tumor pass into castration resistent phase. At present, two main and basic treatment methods can be used in this situation – paliative chemotherapy by docetaxel or cabazitaxel and modern androgen receptor targeted agents treatment (ARTA) in the form of abirateron acetate (AA) or enzalutamide. Targeted alpha therapy, i.e. radium-223, can be sequenced if chemotherapy or ARTA treatment can not be used for some reason. The current indication of radium-223 suggests that it can be Xofigo monotherapy or in combination with luteinising hormone releasing hormone (LHRH) analogue is indicated for the treatment of adult patients with metastatic castration- resistant prostate cancer (mCRPC), symptomatic bone metastases and no known visceral metastases, in progression after at least two prior lines of systemic therapy for mCRPC (other than LHRH analogues), or ineligible for any available systemic mCRPC treatment. Number of treatment lines used is not the really problem when a large group of patients in a good shape is still able to undergo 2-3 of them, but more likely the choice of optimal sequence particular possibilities. The advantage of treatment switch from chemotherapy to ARTA or the other way around was not definitely sold untill now and a large debate about the sequence of each single strategy is ongoing.

Keywords: prostate cancer, castration resistency, androgen deprivation, docetaxel, cabazitaxel, abirateron acetate, enzalutamide,radium-223.

Published: March 18, 2019  Show citation